{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CYNTHIA   A SEYMOUR","gend":1,"add":"224 SOUTH BEAVERDAM RD TRLR 3","city":"WAVERLY","state":"VA","zip":"23890-9998","dob":"1961-08-04","age":"","mstatus":"","insh":"20079291*01","cliId":"","pno":8048348278,"cno":8048348278,"email":"","ename":"","eno":"","pphy":"HOLLOMAN, HEATHER NP","ppno":8048348871,"pcpadd":"344 W MAIN ST","pcpcity":"WAVERLY","pcpstate":"VA","pcpzip":"23890-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":8048348875,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J44.1","J18.9","C34.31","I21.4","Z86.711","J10.1","R00.0","I25.5","I25.10","J44.9","R07.9","R06.09","I47.1","I11.9","Z51.12","G44.52","L40.9","F17.210","Z79.899","J96.01","J96.11","C34.90","I49.5","I50.9","E78.5","R31.29","R07.89","Z51.11","R00.2","Z79.01","Z79.51","Z79.52","E86.0","I95.9","L89.151","E78.2","R06.02","F17.200","F41.8","I73.9","I26.99","J96.21","Z95.5","R00.1","I87.2","U07.1","I49.8","R09.02","Z85.118"],"date":["2023-02-01","2022-10-06","2023-02-20","2022-05-23","2022-08-02","2023-02-01","2023-02-16","2023-02-16","2023-03-29","2023-02-16","2023-03-29","2023-03-29","2023-03-29","2023-03-29","2022-01-11","2022-03-08","2022-05-11","2022-05-11","2022-08-02","2022-05-22","2022-05-22","2022-07-07","2022-05-23","2022-05-23","2022-06-16","2022-08-23","2022-08-23","2022-02-18","2022-08-02","2022-08-02","2022-08-02","2022-08-02","2022-08-02","2022-08-02","2023-03-02","2022-07-19","2022-07-06","2022-10-20","2022-11-03","2022-11-03","2022-05-20","2022-07-07","2022-06-15","2022-06-15","2022-08-25","2022-07-07","2022-06-09","2022-07-06","2022-07-06"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}}]},{"t":"Covid Screening","q":[{"a":[]}]},{"t":"Self-Assessment and Social History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Activities of Daily Living","q":[{"a":[]}]},{"t":"Medical History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Family History","q":[{"a":[]}]},{"t":"Preventive Care","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","69452014420","BENZONATATE","200 MG","90","Select","Select",""],["","00093005805","TRAMADOL HCL","50 MG","60","Select","Select",""],["","70954006010","PREDNISONE","20 MG","8","Select","Select",""],["","00003089421","ELIQUIS","5 MG","60","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","00310737020","BUDES\/FORMOT","AER 160-4.5","10","Select","Select",""],["","67877025115","TRIAMCINOLON","CRE 0.001","30","Select","Select",""],["","00378395377","ATORVASTATIN","TAB 80MG","30","Select","Select",""],["","69315011701","FUROSEMIDE","40 MG","30","Select","Select",""],["","69097084064","IPRATROPIUM\/","SOL ALBUTER","360","Select","Select",""],["","65862019301","FLUOXETINE","CAP 20MG","90","Select","Select",""],["","68180096301","ALBUTEROL","AER HFA","8","Select","Select",""],["","69238145902","POT CHLORIDE","SOL 0.1","105","Select","Select",""],["","45802043321","DEXTROMETHOR","SUS 30MG\/5ML","600","Select","Select",""],["","00904404073","ASPIRIN","CHW 81MG","30","Select","Select",""],["","50111056001","TRAZODONE","TAB 50MG","90","Select","Select",""],["","62037099901","POT CL MICRO","TAB 20MEQ ER","30","Select","Select",""],["","00003376474","ELIQUIS ST P","TAB 5MG","74","Select","Select",""],["","00597010061","SPIRIVA","SPR 2.5MCG","4","Select","Select",""],["","00186037020","SYMBICORT","160-4.5MCG","10.2","Select","Select",""],["","51862024160","AMIODARONE","TAB 200MG","30","Select","Select",""],["","68462010530","ONDANSETRON","TAB 4MG","40","Select","Select",""],["","11877001140","BINAXNOW COV","KIT HOME TES","8","Select","Select",""],["","45802005911","NYSTATIN","100000\/G","30","Select","Select",""],["","47781091401","DEXAMETHASON","TAB 4MG","20","Select","Select",""],["","49884015676","VARENICLINE","TAB 1MG","56","Select","Select",""],["","00597015290","JARDIANCE","10 MG","90","Select","Select",""],["","00173088710","TRELEGY","AER 100MCG","60","Select","Select",""],["","00093227534","AMOX\/K CLAV","TAB 875-125","20","Select","Select",""],["","00116200116","CHLORHEX GLU","SOL 0.0012","473","Select","Select",""],["","55111012601","CIPROFLOXACN","TAB 250MG","14","Select","Select",""],["","00536123441","ASPIRIN LOW","TAB 81MG EC","30","Select","Select",""],["","68382041201","OMEPRAZOLE","20 MG","30","Select","Select",""],["","51672418803","BETAMETHASONE VALERATE","0.12 %","50","Select","Select",""],["","43598044874","NICOTINE PATCH","21 MG\/24HR","28","Select","Select",""],["","00310737020","BUDESONIDE-FORMOTEROL FUMARATE","160-4.5MCG","10.2","Select","Select",""],["","00378395377","ATORVASTATIN CALCIUM","80 MG","30","Select","Select",""],["","65862019401","FLUOXETINE HCL","40 MG","30","Select","Select",""],["","45802025742","MOMETASONE FUROATE","0.1 %","60","Select","Select",""],["","00597016061","SPIRIVA RESPIMAT","1.25 MCG","4","Select","Select",""],["","59746000103","METHYLPREDNISOLONE","4 MG","21","Select","Select",""],["","45802043321","DEXTROMETHORPHAN POLISTIREX","30 MG\/5 ML","600","Select","Select",""],["","50111056001","TRAZODONE HCL","50 MG","90","Select","Select",""],["","49884015676","VARENICLINE TARTRATE","1 MG","56","Select","Select",""],["","00173088710","TRELEGY ELLIPTA","100-62.5","1","Select","Select",""],["","63824017763","CHILDREN'S DELSYM COUGH","30 MG\/5 ML","600","Select","Select",""],["","00093227434","AMOXICILLIN-CLAVULANATE POTASS","500-125 MG","20","Select","Select",""]]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Review of Systems and Diagnoses","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":[]}]},{"t":"Mini-Cog","q":[{"a":[]},{"a":[]}]},{"t":"Home Safety & Personal Goals","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Active Problem Conditions","q":[{"a":[]}]},{"t":"Patient Summary","q":[{"a1":"","a2":"","a3":"","a4":"","a5":"","a6":"","a7":[],"a8":"","a9":"","a10":[],"a11":"","a12":"","a13":""}]}]}