{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BRITTANY MCCLUNG","gend":1,"add":"12785 BRADWELL ROAD","city":"HERNDON","state":"VA","zip":"20171-9998","dob":"1992-08-25","age":"","mstatus":"","insh":"2111297*01","cliId":"","pno":5713283411,"cno":5713283411,"email":"","ename":"","eno":"","pphy":"ULRICH, MEAGAN NP","ppno":7034432000,"pcpadd":"163 FORT EVANS ROAD NE,","pcpcity":"LEESBURG","pcpstate":"VA","pcpzip":"20176-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"NORTHERN & WINCHESTER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7034432033,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["L03.111","I10.","F17.200","Z48.00","K92.0","M51.36","R11.2","F31.9","F32.9","F41.1","F90.9","R10.9","G89.29","R07.9","H53.149","Z04.9","U07.1","R50.9","F43.10","E78.2","R42.","R55.","F51.4","K22.710","NO DATA","K44.9","F17.210","Z79.899","R13.10","F31.70","R19.7","Z90.49","R11.10","N83.201","R10.32","I45.19","L02.411","F41.9","R20.2","T43.595A","M54.41","M54.6","R11.0","R07.89","R07.81","R06.02","T78.40XA","M54.9","F41.8","Z53.21","Z98.890","S39.012A","W18.40XA","Z20.822","J98.01","K52.9","R07.0","R10.84","Z72.0","E66.9","K22.70","R03.0","R51.9","S60.222A","F90.1","H53.9","R07.1","R30.0","N76.0","F90.0","R22.2","Z82.49","Z83.3","S33.5XXA","R89.9","Z30.09","K92.2","Z01.419","Z30.9","R10.10","F11.20","M41.9","Z87.11","Z87.19","Z91.041","Z98.84","Z68.29","E86.0","R82.0","R10.13","D50.9","Z68.32","K21.9","D64.9","S09.90XA","Z13.21","Z71.3","Z09.","K25.9","D51.9","N93.9","R10.2","K29.71","K29.91"],"date":["2021-01-30","2023-04-26","2023-01-12","2021-01-30","2021-12-18","2022-11-09","2023-04-13","2023-07-10","2023-02-09","2023-07-10","2023-01-18","2021-07-05","2022-07-19","2023-04-26","2021-09-22","2022-05-02","2021-12-27","2021-12-27","2023-07-10","2023-04-26","2022-09-16","2021-04-11","2023-07-10","2023-04-03","2023-05-11","2022-11-17","2023-04-03","2023-04-03","2023-04-03","2022-07-20","2022-09-19","2022-09-16","2023-07-19","2022-11-09","2022-11-09","2023-01-12","2021-01-23","2023-04-03","2021-01-31","2021-10-25","2021-11-22","2023-04-26","2021-11-22","2023-01-12","2022-03-09","2023-04-13","2022-09-09","2023-04-26","2022-07-19","2022-07-19","2022-07-22","2022-01-08","2022-01-08","2023-01-12","2022-02-03","2022-03-11","2022-03-11","2022-09-19","2023-02-09","2023-05-23","2023-02-09","2023-01-12","2023-01-12","2021-11-09","2021-12-14","2022-03-08","2022-09-19","2022-12-04","2022-12-13","2023-07-10","2021-01-22","2021-01-22","2021-01-22","2022-01-11","2023-02-09","2023-02-09","2021-06-29","2021-12-09","2021-12-09","2021-06-29","2021-06-29","2021-06-29","2021-06-29","2023-07-19","2021-06-29","2023-05-23","2021-06-29","2021-06-29","2021-11-15","2023-07-19","2023-06-02","2023-04-03","2023-05-23","2023-04-26","2023-04-26","2023-05-23","2023-05-23","2023-04-03","2023-04-03","2023-05-19","2023-04-13","2023-04-13","2023-07-19","2023-07-19"],"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":[["","51991074890","DULOXETINE","CAP 60MG","30","Select","Select",""],["","00378728590","LEVONOR\/ETHI","TAB ESTRADIO","91","Select","Select",""],["","29300016915","TIZANIDINE","TAB 4MG","90","Select","Select",""],["","68180098103","LISINOPRIL","20 MG","90","Select","Select",""],["","59651000305","OMEPRAZOLE","40 MG","30","Select","Select",""],["","63304045001","MORPHINE SUL","TAB 15MG ER","30","Select","Select",""],["","00093221001","SUCRALFATE","TAB 1GM","240","Select","Select",""],["","10702005601","OXYCODONE","TAB 10MG","90","Select","Select",""],["","65862039010","ONDANSETRON","TAB 4MG ODT","8","Select","Select",""],["","68180072003","AMLODIPINE","TAB 5MG","90","Select","Select",""],["","42858010201","OXYCOD\/APAP","TAB 5-325MG","9","Select","Select",""],["","65862048901","QUETIAPINE","TAB 25MG","30","Select","Select",""],["","61874016030","VRAYLAR","6 MG","30","Select","Select",""],["","70954006020","PREDNISONE","TAB 20MG","10","Select","Select",""],["","00378230201","PRAZOSIN HCL","2 MG","30","Select","Select",""],["","43547034006","RISPERIDONE","TAB 0.5MG","30","Select","Select",""],["","42806016005","HYDROXYZ HCL","TAB 25MG","120","Select","Select",""],["","13668042990","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","71093014105","METHOCARBAM","TAB 750MG","60","Select","Select",""],["","60505265901","TRAZODONE","TAB 300MG","30","Select","Select",""],["","69238207807","PROPRANOLOL","TAB 20MG","60","Select","Select",""],["","00603188016","LIDOCAINE","PAD 0.05","6","Select","Select",""],["","51991070505","ALPRAZOLAM","TAB 0.5MG","10","Select","Select",""],["","00115169449","EPINEPHRINE","INJ 0.3MG","2","Select","Select",""],["","00093321205","CLONAZEPAM","1 MG","15","Select","Select",""],["","51672413001","LAMOTRIGINE","TAB 25MG","60","Select","Select",""],["","00228212750","CLONIDINE","TAB 0.1MG","60","Select","Select",""],["","65862019105","CYCLOBENZAPR","TAB 10MG","30","Select","Select",""],["","69097014260","ALBUTEROL","AER HFA","7","Select","Select",""],["","13107005999","APAP\/CODEINE","TAB 300-30MG","10","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","00093310905","AMOXICILLIN","CAP 500MG","21","Select","Select",""],["","68382003516","VENLAFAXINE","CAP 75MG ER","30","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","14","Select","Select",""],["","65862085901","FAMOTIDINE","20 MG","60","Select","Select",""],["","70436001304","DESVENLAFAX","TAB 100MG ER","30","Select","Select",""],["","64980037603","ATOMOXETINE","CAP 40MG","60","Select","Select",""],["","00456112030","VIIBRYD","TAB 20MG","30","Select","Select",""],["","16729035310","VILAZODONE","TAB 20MG","30","Select","Select",""],["","23155019401","NIFEDIPINE","CAP 10MG","270","Select","Select",""],["","00054452725","LITHIUM CARB","TAB 300MG","60","Select","Select",""],["","68462018147","CLOTRIMAZOLE","CRE 0.01","45","Select","Select",""],["","70710114003","FLUCONAZOLE","200 MG","4","Select","Select",""],["","00054452725","LITHIUM CARBONATE","300 MG","90","Select","Select",""],["","60505265901","TRAZODONE HCL","300 MG","30","Select","Select",""],["","51991074890","DULOXETINE HCL","60 MG","60","Select","Select",""],["","69238207807","PROPRANOLOL HCL","20 MG","60","Select","Select",""],["","00378728590","LEVONORG-ETH ESTRAD ETH ESTRAD","150-30(84)","91","Select","Select",""],["","53746074501","PROMETHAZINE HCL","12.5 MG","12","Select","Select",""],["","00378728153","LEVONORGESTREL-ETH ESTRADIOL","0.15-0.03","91","Select","Select",""],["","00228212750","CLONIDINE TAB","0.1MG","60","Select","Select",""],["","00093321205","CLONAZEPAM TAB","1MG","15","Select","Select",""],["","60505265901","TRAZODONE TAB","300MG","30","Select","Select",""],["","00603188016","LIDOCAINE PAD","5%","6","Select","Select",""],["","65862019105","CYCLOBENZAPR TAB","10MG","30","Select","Select",""],["","51991074890","DULOXETINE CAP","60MG","30","Select","Select",""],["","00378230201","PRAZOSIN HCL CAP","2MG","90","Select","Select",""],["","61874016030","VRAYLAR CAP","6MG","30","Select","Select",""],["","10702005601","OXYCODONE TAB","10MG","90","Select","Select",""],["","71093014105","METHOCARBAM TAB","750MG","60","Select","Select",""],["","63304045001","MORPHINE SUL TAB","15MG ER","30","Select","Select",""],["","42806016005","HYDROXYZ HCL TAB","25MG","120","Select","Select",""],["","70954006020","PREDNISONE TAB","20MG","10","Select","Select",""],["","13107005999","APAP\/CODEINE TAB","300-30MG","10","Select","Select",""],["","59310057922","PROAIR HFA AER","","8","Select","Select",""],["","68180012202","CEPHALEXIN CAP","500MG","14","Select","Select",""],["","66993001968","ALBUTEROL AER HFA","","18","Select","Select",""],["","00378728590","LEVONOR\/ETHI TAB ESTRADIO","","91","Select","Select",""],["","00093310905","AMOXICILLIN CAP","500MG","21","Select","Select",""],["","64980037603","ATOMOXETINE CAP","40MG","60","Select","Select",""],["","68180098103","LISINOPRIL TAB","20MG","90","Select","Select",""],["","68382003516","VENLAFAXINE CAP","75MG ER","30","Select","Select",""],["","59651000305","OMEPRAZOLE CAP","40MG","180","Select","Select",""],["","68180072003","AMLODIPINE TAB","5MG","90","Select","Select",""],["","65862039010","ONDANSETRON TAB","4MG ODT","8","Select","Select",""],["","65862085901","FAMOTIDINE TAB","20MG","20","Select","Select",""],["","70436001204","DESVENLAFAX TAB","50MG ER","5","Select","Select",""],["","00093221001","SUCRALFATE TAB","1GM","240","Select","Select",""],["","70000052102","OMEPRAZOLE TAB","20MG DR","180","Select","Select",""],["","00456112030","VIIBRYD TAB","20MG","30","Select","Select",""],["","16729035310","VILAZODONE TAB","20MG","30","Select","Select",""],["","70710114003","FLUCONAZOLE TAB","200MG","4","Select","Select",""],["","68462018147","CLOTRIMAZOLE CRE","1%","45","Select","Select",""],["","23155019401","NIFEDIPINE CAP","10MG","270","Select","Select",""],["","69238207807","PROPRANOLOL TAB","20MG","30","Select","Select",""],["","00054452725","LITHIUM CARB TAB","300MG","60","Select","Select",""],["","00093372755","DICLOFENAC EPOLAMINE","1.3 %","60","Select","Select",""],["","65862039010","ONDANSETRON ODT","4 MG","30","Select","Select",""],["","00378729253","NORETHINDRONE","0.35 MG","84","Select","Select",""],["","00406324301","HYDROMORPHONE HCL","2 MG","10","Select","Select",""],["","00406851001","OXYCODONE HCL","10 MG","120","Select","Select",""],["","70010077001","METHOCARBAMOL","750 MG","60","Select","Select",""],["","65862050320","AMOXICILLIN-CLAVULANATE POTASS","875-125 MG","14","Select","Select",""],["","10135070550","LACTOBACILLUS","1MM CELL","60","Select","Select",""],["","42799060501","LOPERAMIDE","2 MG","30","Select","Select",""],["","00093005805","TRAMADOL HCL","50 MG","12","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":""}]}]}