{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TERENCE   B WASHBURN","gend":0,"add":"4208 KEMPWOOD PL","city":"CHESTERFIELD","state":"VA","zip":"23832-9998","dob":"1966-06-18","age":"","mstatus":"","insh":"2158644*01","cliId":"","pno":7742181255,"cno":7742181255,"email":"","ename":"","eno":"","pphy":"MANTZOURIS, TAMMY J MD","ppno":8048285883,"pcpadd":"401 N 11TH STREET","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":"23219-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":8048285399,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K42.9","R25.1","J44.9","Z87.891","R53.1","R47.9","G25.3","E11.9","G20.","K59.00","G47.30","Z23.","G47.33","J43.2","Z99.81","Z79.82","Z86.73","S09.90XA","R55.","I95.9","W01.0XXA","D64.9","R39.9","R06.02","Z85.01","Z90.49","J34.89","Z11.59","N40.0","R00.2","H59.031","H04.123","H40.003","H25.12","I72.0","G83.20","R29.818","R00.1","R27.0","R93.0","F32.9","R41.3","R51.9","K21.9","R91.1","H27.111","M51.16","G57.22","M16.12","M70.62","R40.4","NO DATA","F41.9","Z63.0","M25.551","M54.12","M54.16","G57.12","M25.552","G89.29","C15.9","M62.838","M47.812","K44.9","Z85.828","R30.9","T17.908S","R09.81","M95.0","Z01.818","H26.9","H26.101","N40.1","R33.8","R33.9","R39.16","R39.198","R39.14","G56.01","G56.02","Z96.1","R47.1","R20.8","M54.32","E83.42","E11.40","I49.9","M16.11","M54.5","M47.816","R20.0","M79.605","Z91.81","R06.00","H93.8X9","H90.3","Z79.899","M47.817","S70.01XA","S30.0XXA","W01.198A","L85.3","Q66.71","Q66.72","G23.2","G62.89","M72.2","I51.7","I34.8","J34.2","J34.3","H81.8X9","Z48.810","H04.129","G56.03","R47.01","R42.","E78.5","F50.89","H90.0","M62.81","H57.11","Z99.89","K76.89","K86.89","N28.89","D35.02","N20.0","I70.90","K66.0","M85.80","G25.2","Q68.1","E11.69","E53.8","E66.9","M79.671","M79.672","I49.1","I49.3","Z95.0","M47.26","D72.829","M25.511","M25.512","M25.521","M25.522","M25.561","M25.562","R68.2","M54.42","M70.61","M25.851","I08.1","Z09.","M48.02","R13.10","R63.4","G62.9","R53.83","I95.89","E87.6","E83.39","R26.9","R29.898","E11.42","E11.36","R29.810","Z20.822","K22.70","R70.0","J43.9","M19.90","G45.9","I10.","R00.0","M79.644","M79.601","M79.641","S63.681S","Z73.6","Z04.9","I63.9","E27.40","H53.40","G40.009","B35.3","Z74.09","H26.131","J45.909","Z01.810","M77.41","M77.42","G93.9","R90.89","Z68.25","M51.26","R13.12","R91.8","R39.15","R39.11","R25.2","Z85.818","R10.33","Z47.89","R49.0","R09.89","M79.604","M62.50","R10.9","R27.9","R52."],"date":["2022-07-26","2023-02-17","2023-03-06","2023-03-06","2023-03-06","2022-08-26","2023-03-20","2023-02-15","2023-03-06","2022-09-19","2022-09-19","2023-01-30","2023-02-28","2023-01-24","2023-01-24","2023-01-24","2023-01-24","2023-01-09","2023-01-18","2023-03-06","2023-01-18","2023-01-18","2023-01-26","2023-03-06","2023-02-17","2022-01-26","2021-06-07","2021-02-12","2021-06-30","2021-09-23","2021-06-21","2021-06-21","2021-06-21","2021-06-21","2021-06-28","2021-06-28","2021-08-18","2021-09-23","2022-04-06","2021-08-18","2021-08-18","2021-10-14","2021-08-18","2022-11-29","2022-11-29","2021-11-15","2021-10-05","2021-12-14","2021-12-14","2021-12-14","2021-10-14","2022-05-10","2022-04-06","2021-11-17","2022-12-27","2022-12-27","2023-03-14","2022-02-10","2022-12-27","2022-12-27","2022-05-24","2022-02-23","2022-02-23","2022-04-06","2022-04-06","2022-04-06","2022-11-29","2021-02-15","2021-05-12","2021-02-15","2021-02-15","2021-03-01","2021-09-14","2021-03-29","2023-01-26","2021-03-29","2021-03-29","2021-09-14","2021-11-03","2022-04-06","2021-11-16","2021-08-02","2021-07-01","2021-06-29","2021-06-29","2021-07-01","2021-09-23","2021-08-09","2021-08-09","2022-01-26","2023-03-14","2023-03-06","2021-08-09","2021-10-14","2021-10-27","2021-10-27","2021-10-27","2023-02-08","2022-12-26","2022-12-26","2022-12-26","2023-02-15","2023-03-23","2023-03-23","2023-03-08","2023-03-08","2023-03-23","2021-08-02","2021-02-15","2021-05-12","2021-05-12","2021-05-12","2021-05-20","2021-05-28","2021-07-15","2021-08-05","2021-08-18","2023-01-30","2021-08-05","2021-10-27","2021-11-23","2021-11-23","2022-08-08","2022-01-26","2022-01-26","2022-01-26","2022-01-26","2022-01-26","2022-01-26","2022-01-26","2022-01-26","2022-03-03","2022-03-22","2022-03-03","2022-03-03","2022-03-03","2021-02-09","2021-02-09","2021-03-14","2021-03-14","2021-03-14","2021-06-30","2021-07-01","2021-07-01","2021-07-01","2021-07-01","2021-07-01","2021-07-01","2021-07-01","2021-07-16","2021-07-28","2021-12-14","2021-07-28","2021-08-02","2022-05-19","2022-09-19","2022-10-13","2023-03-06","2023-03-06","2023-03-14","2023-03-06","2023-03-14","2023-03-14","2023-03-06","2021-06-28","2021-06-28","2021-06-28","2021-06-28","2021-11-01","2021-06-28","2021-06-28","2021-06-28","2021-06-28","2021-07-16","2021-07-16","2022-04-06","2022-03-22","2022-03-22","2022-03-30","2022-03-30","2022-11-30","2023-01-09","2023-01-11","2023-03-14","2023-03-14","2021-11-11","2023-02-15","2023-02-08","2021-03-29","2021-06-14","2021-02-15","2021-05-25","2021-05-25","2021-07-02","2021-08-02","2021-08-02","2021-12-14","2022-11-30","2021-04-13","2021-09-14","2021-09-14","2022-03-22","2022-03-22","2022-06-10","2021-11-16","2022-11-30","2023-01-11","2023-03-06","2023-03-06","2022-04-06","2022-11-30","2022-12-26"],"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":[["","65862014930","FINASTERIDE","5 MG","30","Select","Select",""],["","65862086001","FAMOTIDINE","TAB 40MG","90","Select","Select",""],["","69097068205","PREGABALIN","150 MG","90","Select","Select",""],["","68382013201","TAMSULOSIN","CAP 0.4MG","30","Select","Select",""],["","72888001101","BACLOFEN","20 MG","90","Select","Select",""],["","00186091612","PULMICORT","INH 180MCG","1","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","00310460012","BEVESPI","AER 9-4.8MCG","11","Select","Select",""],["","64980051505","OFLOXACIN","DRO 0.3% OP","5","Select","Select",""],["","61314063710","PREDNISOLONE","SUS 1% OP","10","Select","Select",""],["","00378668977","PANTOPRAZOLE","TAB 40MG","180","Select","Select",""],["","52817036000","METOPROL TAR","TAB 25MG","90","Select","Select",""],["","00536106229","STOOL SOFTNR","CAP 100MG","60","Select","Select",""],["","16103036308","SENNA-TABS","TAB 8.6MG","12","Select","Select",""],["","10702001801","OXYCODONE","TAB 5MG","30","Select","Select",""],["","00832003800","OXYBUTYNIN","TAB 5MG","30","Select","Select",""],["","43598083205","ATORVASTATIN","TAB 40MG","90","Select","Select",""],["","00093314701","CEPHALEXIN","CAP 500MG","14","Select","Select",""],["","45802086866","POLYETH GLYC","POW 3350 NF","72","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","57237001106","MIRTAZAPINE","15 MG","30","Select","Select",""],["","00904678370","ASPIRIN LOW","TAB 81MG EC","30","Select","Select",""],["","00143992801","CIPROFLOXACN","TAB 500MG","28","Select","Select",""],["","51645085101","SENNA","TAB 8.6MG","12","Select","Select",""],["","00904386575","DEEP SEA","SPR 0.0065","132","Select","Select",""],["","00228280111","PILOCARPINE","TAB 5MG","120","Select","Select",""],["","00536100836","ASPIRIN","CHW 81MG","30","Select","Select",""],["","80681004000","MELATONIN","TAB 5MG","100","Select","Select",""],["","51991070605","ALPRAZOLAM","TAB 1MG","5","Select","Select",""],["","00406012301","HYDROCO\/APAP","TAB 5-325MG","5","Select","Select",""],["","00093083205","CLONAZEPAM","0.5 MG","45","Select","Select",""],["","00527512570","LACTULOSE","SOL 10GM\/15","473","Select","Select",""],["","13107008401","LORAZEPAM","TAB 1MG","2","Select","Select",""],["","51862085601","CARB\/LEVO","TAB 25-100MG","90","Select","Select",""],["","31722053705","LEVETIRACETA","TAB 500MG","60","Select","Select",""],["","00363058714","ASPIRIN 81","TAB 81MG EC","90","Select","Select",""],["","60687043198","HEALTHYLAX","POW ","72","Select","Select",""],["","00093970210","CARBIDOPA-LEVODOPA","25MG-100MG","180","Select","Select",""],["","60505132501","MIDODRINE HCL","10 MG","30","Select","Select",""],["","00310460012","BEVESPI AEROSPHERE","9-4.8 MCG","10.7","Select","Select",""],["","31722053705","LEVETIRACETAM","500 MG","60","Select","Select",""],["","68382013201","TAMSULOSIN HCL","0.4 MG","90","Select","Select",""],["","00904678370","ASPIRIN EC","81 MG","90","Select","Select",""],["","00472037915","CLOTRIMAZOLE-BETAMETHASONE","1 %-0.05 %","30","Select","Select",""],["","00045049660","TYLENOL","325 MG","30","Select","Select",""],["","45802086866","POLYETHYLENE GLYCOL","3350 17 G","30","Select","Select",""],["","00378668977","PANTOPRAZOLE SODIUM","40 MG","180","Select","Select",""],["","00597010061","SPIRIVA RESPIMAT","2.5 MCG","4","Select","Select",""],["","00555099702","FLUDROCORTISONE ACETATE","0.1 MG","60","Select","Select",""],["","00591544210","PREDNISONE","10 MG","86","Select","Select",""],["","51672130100","AMMONIUM LACTATE","12 %","385","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":""}]}]}