{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TAMMY M WOODRUFF","gend":1,"add":"10 IVY RIDGE ROAD","city":"CLEVELAND","state":"VA","zip":"24225-9998","dob":"1978-12-27","age":"","mstatus":"","insh":"2156666*01","cliId":"","pno":2762021247,"cno":2762021247,"email":"","ename":"","eno":"","pphy":"RIOS, PAULINA MD","ppno":2767620770,"pcpadd":"1389 DANTE RD,","pcpcity":"SAINT PAUL","pcpstate":"VA","pcpzip":"24283-9998","pcpcounty":"","pcpid":"","pcpname":"Community Medical Care","plan":"OHP","program":"MEDICAID","lob":"M4","region":"SOUTHWEST","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":2765469711,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M25.552","Z96.642","M70.61","M70.62","M16.11","T84.091A","M54.5","M25.551","R93.7","M51.36","G89.29","M47.896","V58.89","D68.51","E66.9","Z68.38","F41.8","R23.2","E66.01","G47.33","R07.89","Z23.","F41.9","R07.9","Z12.31","M25.532","M25.531","M79.672","M79.671","R06.83","R09.82","J32.0","J30.1","Z02.89","F32.9","I87.2","M79.89","M54.16","Z11.52","M50.30","R20.0","I20.8","R06.02","E78.2","R20.2","I87.393","F12.10","Z71.6","Z13.6","Z79.899","NO DATA","M25.50","R70.0","M79.641","M79.642","M47.812","G56.02","M54.2","M65.842","M16.0","K21.9","E66.09","T84.011A","E78.5","R07.2","E78.00","Z79.82","Z88.5","Z88.0","Z88.8","M94.0","R11.0","Z09.","U07.1","N39.0","M54.41","M54.42","Z01.419","M67.959","T84.091D","S99.921A","M51.26","M47.816","F33.1","R19.4","G47.30","I25.10","L53.9","F17.200","D89.89","E11.9","Z88.6","Z80.1","Z88.1","K59.04","M54.31","Z71.3","G89.4","J30.2","K31.89","K59.00","I87.399","D12.2","D12.4","E03.9","Z01.810","I44.4","K63.5","K64.8","K63.89","D66.","M06.9","T84.061A","T84.031A","T84.84XA","F32.1","F17.290","F41.1","G47.00","R69.","B35.1","B35.3","D12.6","M16.12","T84.021A","T84.89XA","M45.4","F17.201"],"date":["2021-12-01","2023-09-01","2022-07-05","2022-07-05","2021-06-22","2021-04-20","2021-06-18","2021-12-01","2021-05-28","2021-12-14","2021-11-11","2021-05-28","2021-06-22","2023-04-17","2021-06-22","2021-06-22","2021-11-22","2021-09-30","2021-09-30","2022-04-22","2021-11-20","2021-09-30","2021-11-20","2021-11-20","2022-03-03","2022-06-20","2022-06-20","2022-06-20","2022-06-20","2021-04-16","2023-05-17","2023-05-17","2023-05-17","2021-07-09","2023-08-24","2023-07-06","2021-12-17","2022-07-08","2022-08-02","2021-12-14","2022-01-27","2021-11-10","2021-11-17","2021-11-17","2021-12-14","2023-07-31","2021-12-27","2021-12-27","2023-07-31","2023-08-30","2023-08-17","2022-08-23","2022-08-23","2022-08-23","2022-08-23","2021-10-06","2022-01-27","2021-12-14","2022-01-27","2022-04-25","2023-08-18","2021-02-16","2021-03-08","2023-06-02","2021-11-20","2023-08-30","2023-08-30","2023-08-30","2023-08-30","2021-11-20","2021-11-22","2021-11-22","2021-11-22","2022-08-03","2022-08-03","2022-08-03","2022-08-03","2021-02-25","2021-12-01","2021-06-22","2021-11-02","2022-02-23","2022-03-31","2022-03-31","2023-08-04","2023-08-04","2023-04-17","2023-04-17","2023-09-07","2023-04-17","2023-08-04","2023-08-30","2023-04-17","2023-08-30","2023-04-27","2023-07-12","2023-06-02","2023-06-02","2023-06-02","2023-04-17","2023-04-17","2023-07-06","2023-08-04","2023-08-04","2023-08-04","2023-07-31","2023-07-31","2023-08-04","2023-08-18","2023-08-18","2023-08-04","2023-08-04","2023-08-30","2023-08-30","2023-08-30","2023-09-07","2023-09-07","2023-09-07","2023-09-07","2023-09-14","2023-08-02","2023-08-02","2023-08-18","2023-09-01","2023-08-30","2023-08-30","2023-08-30","2023-07-31"],"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":[["","59746017310","PREDNISONE","TAB 10MG","37","Select","Select",""],["","68462063945","NITROGLYCERN","SUB 0.4MG","25","Select","Select",""],["","57237001930","DULOXETINE","CAP 60MG","30","Select","Select",""],["","00093770198","LEVOCETIRIZI","TAB 5MG","30","Select","Select",""],["","57664037708","TRAMADOL HCL","TAB 50MG","60","Select","Select",""],["","66689002316","HYDROCO\/APAP","SOL 7.5-325","12","Select","Select",""],["","65162067684","AZELASTINE","SPR 0.001","30","Select","Select",""],["","53885024450","ONETOUCH","TES ULTRA","50","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","00093505898","ATORVASTATIN","TAB 40MG","90","Select","Select",""],["","68645059459","FAMOTIDINE","20 MG","30","Select","Select",""],["","49035041690","EQ ASPIRIN","TAB 325MG","90","Select","Select",""],["","53885001110","ONETOUCH DEL","MIS PLUS 30G","100","Select","Select",""],["","63304069205","CLINDAMYCIN","CAP 150MG","21","Select","Select",""],["","49035032712","GENTLE LAXAT","TAB 5MG EC","30","Select","Select",""],["","68645055654","LISINOP\/HCTZ","TAB 10-12.5","30","Select","Select",""],["","41167035100","XYZAL","TAB 5MG","30","Select","Select",""],["","16729013616","CLONAZEPAM","TAB 0.5MG","60","Select","Select",""],["","10135068260","GUAIFENESIN","TAB 400MG","42","Select","Select",""],["","69097014260","ALBUTEROL","AER HFA","7","Select","Select",""],["","55111017915","TIZANIDINE","TAB 2MG","9","Select","Select",""],["","55111015330","ONDANSETRON","TAB 4MG","12","Select","Select",""],["","50111078710","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","00069034530","PAXLOVID","TAB 300-100","30","Select","Select",""],["","50474071079","CIMZIA","400 MG\/2ML","1","Select","Select",""],["","45802086866","POLYETHYLENE GLYCOL","3350 17 G","28","Select","Select",""],["","00603548321","PROPRANOLOL HCL","20 MG","90","Select","Select",""],["","50111056001","TRAZODONE HCL","50 MG","30","Select","Select",""],["","57237001890","DULOXETINE HCL","30 MG","30","Select","Select",""],["","42571012290","LEVOCETIRIZINE DIHYDROCHLORIDE","5 MG","30","Select","Select",""],["","70700015010","OMEPRAZOLE","20 MG","30","Select","Select",""],["","49035032712","GENTLE LAXATIVE","5 MG","30","Select","Select",""],["","00093505898","ATORVASTATIN CALCIUM","40 MG","30","Select","Select",""],["","72205001390","PREGABALIN","75 MG","60","Select","Select",""],["","29300041401","CYCLOBENZAPRINE HCL","7.5 MG","30","Select","Select",""],["","43386009019","GAVILYTE-G","236-22.74G","4000","Select","Select",""],["","49035072212","ASPIRIN EC","325 MG","90","Select","Select",""],["","31722072610","MONTELUKAST SODIUM","10 MG","30","Select","Select",""],["","00228282011","HYDROCHLOROTHIAZIDE","12.5 MG","90","Select","Select",""],["","49035015712","ASPIRIN","325 MG","30","Select","Select",""],["","59746017310","PREDNISONE TAB","10MG","37","Select","Select",""],["","42571012290","LEVOCETIRIZI TAB","5MG","30","Select","Select",""],["","68462063945","NITROGLYCERN SUB","0.4MG","25","Select","Select",""],["","57664037708","TRAMADOL HCL TAB","50MG","60","Select","Select",""],["","27241009903","DULOXETINE CAP","60MG","30","Select","Select",""],["","31722094201","HYDROCO\/APAP TAB","7.5-325","12","Select","Select",""],["","00093505898","ATORVASTATIN TAB","40MG","90","Select","Select",""],["","63304069205","CLINDAMYCIN CAP","150MG","21","Select","Select",""],["","49035015712","EQ ASPIRIN TAB","325MG","34","Select","Select",""],["","65162067684","AZELASTINE SPR","0.1%","30","Select","Select",""],["","00054327099","FLUTICASONE SPR","50MCG","16","Select","Select",""],["","49035032712","GENTLE LAXAT TAB","5MG EC","30","Select","Select",""],["","66689002316","HYDROCO\/APAP SOL","7.5-325","12","Select","Select",""],["","53885024450","ONETOUCH TES ULTRA","","50","Select","Select",""],["","68645059459","FAMOTIDINE TAB","20MG","90","Select","Select",""],["","53885001110","ONETOUCH DEL MIS PLUS","30G","100","Select","Select",""],["","68645055654","LISINOP\/HCTZ TAB","10-12.5","30","Select","Select",""],["","41167035100","XYZAL TAB","5MG","30","Select","Select",""],["","10135068260","GUAIFENESIN TAB","400MG","42","Select","Select",""],["","00093083201","CLONAZEPAM TAB","0.5MG","60","Select","Select",""],["","50111078710","AZITHROMYCIN TAB","250MG","6","Select","Select",""],["","00069034530","PAXLOVID TAB","300-100","30","Select","Select",""],["","55111015330","ONDANSETRON TAB","4MG","12","Select","Select",""],["","55111017915","TIZANIDINE TAB","2MG","9","Select","Select",""],["","69097014260","ALBUTEROL AER HFA","","7","Select","Select",""],["","51672127501","CLOTRIMAZOLE","1 %","45","Select","Select",""],["","00904674860","BISACODYL","5 MG","30","Select","Select",""],["","50458058030","XARELTO","10 MG","30","Select","Select",""],["","00406052201","OXYCODONE-ACETAMINOPHEN","7.5-325 MG","28","Select","Select",""],["","00406012501","HYDROCODONE-ACETAMINOPHEN","10MG-325MG","50","Select","Select",""],["","63304061650","DOXYCYCLINE MONOHYDRATE","100 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":""}]}]}