{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SUSAN HARTER","gend":1,"add":"313 BOWEN DR","city":"FREDERICKSBURG","state":"VA","zip":"22407-9998","dob":"1963-11-20","age":"","mstatus":"","insh":"2175765*01","cliId":"","pno":5402703677,"cno":5402703677,"email":"","ename":"","eno":"","pphy":"DEVINCENTIS, CHRISTINA M MD","ppno":5408256263,"pcpadd":"16268 BENNETT RD,","pcpcity":"CULPEPER","pcpstate":"VA","pcpzip":"22701-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":5408254911,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G47.33","E11.65","I10.","E11.42","Z79.4","J44.9","F17.200","R09.02","R01.1","J30.0","Z23.","G56.03","G56.23","Z47.89","Z12.4","Z79.82","Z79.899","Z01.419","Z12.11","R09.81","R51.9","J30.2","F32.9","F41.9","G47.00","I25.10","E11.9","E78.5","E66.9","G47.30","Z68.33","R06.00","F43.12","M22.2X1","F33.9","M23.91","Z92.241","Z79.84","Z88.6","Z88.8","Z72.0","H25.13","H25.12","Z12.2","F17.210","R94.2","J30.89","J32.8","F33.1","F43.10","Z20.822","Z01.810","R07.9","M79.609","E11.3293","H25.813","M23.321","M87.861","M25.461","Z71.2","G56.02","G56.01","Z98.890","M65.312","F41.8","Z48.810","R00.0","E11.51","N39.41","R32.","R05.9","Z88.5","Z99.81","Z79.51","Z03.89","S83.91XA","M25.561","R03.0","X58.XXXA","Y92.89","Y93.89","R20.0","R20.2","V58.89","NO DATA","R59.0","R06.02","I25.83","I78.1","Z87.891","M79.604","G60.2","G56.22","G56.21","I50.32","G47.09","Z96.1","E11.3299"],"date":["2023-09-21","2023-07-11","2023-08-14","2022-08-19","2023-08-18","2023-09-21","2023-09-21","2023-09-21","2022-09-06","2023-09-21","2022-10-04","2022-02-21","2022-02-21","2022-05-18","2022-05-04","2022-06-22","2022-06-22","2022-05-04","2022-06-22","2022-06-22","2022-06-22","2022-06-22","2022-06-22","2022-06-22","2022-06-22","2022-12-29","2023-08-31","2022-12-29","2022-06-22","2022-12-29","2022-06-22","2022-12-29","2023-08-23","2021-08-10","2022-02-18","2022-01-20","2022-01-20","2022-05-27","2022-01-20","2022-05-27","2022-12-29","2023-08-31","2022-05-23","2023-09-21","2022-07-21","2023-09-21","2023-09-21","2022-09-12","2023-09-14","2023-03-08","2022-05-27","2021-11-01","2022-12-29","2022-12-29","2021-12-21","2021-12-21","2022-02-08","2022-02-08","2022-02-08","2022-02-08","2022-03-08","2022-04-12","2022-03-21","2022-05-18","2022-05-19","2022-08-02","2023-01-04","2022-12-29","2022-12-30","2022-12-30","2022-05-27","2022-05-27","2022-05-27","2022-05-27","2022-01-20","2021-08-05","2021-08-05","2021-08-05","2021-08-05","2021-08-05","2021-08-05","2022-01-26","2022-01-26","2022-02-08","2023-05-10","2022-04-07","2022-11-07","2021-04-16","2021-04-16","2022-04-12","2022-01-18","2022-02-21","2022-02-21","2022-02-21","2023-09-21","2023-03-23","2023-08-31","2023-08-31"],"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":[["","00781261305","AMOXICILLIN","CAP 500MG","60","Select","Select",""],["","68180078001","ZOLPIDEM ER","TAB 12.5MG","30","Select","Select",""],["","70010002703","TROSPIUM CHL","CAP 60MG ER","30","Select","Select",""],["","00002318280","TRULICITY","4.5 MG\/0.5","6","Select","Select",""],["","00093916301","VENLAFAXINE","TAB 100MG","90","Select","Select",""],["","33342032915","TRIAMCINOLON","CRE 0.001","45","Select","Select",""],["","70010049110","METFORMIN","TAB 500MG ER","360","Select","Select",""],["","49035091530","OMEPRAZOLE","TAB 20MG","60","Select","Select",""],["","68382080701","TRAZODONE","TAB 150MG","30","Select","Select",""],["","00116200116","CHLORHEX GLU","SOL 0.0012","473","Select","Select",""],["","00378668910","PANTOPRAZOLE","TAB 40MG","90","Select","Select",""],["","70010010810","GABAPENTIN","CAP 100MG","30","Select","Select",""],["","00186037020","SYMBICORT","160-4.5MCG","10.2","Select","Select",""],["","68180096301","ALBUTEROL","AER HFA","8","Select","Select",""],["","59148003813","REXULTI","2 MG","30","Select","Select",""],["","11527070442","SOD FLUORIDE","GEL 1.1-5%","100","Select","Select",""],["","00093505798","ATORVASTATIN","TAB 80MG","90","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","60505082701","IPRATROPIUM","SPR 0.0006","15","Select","Select",""],["","43547040610","CLONAZEPAM","0.5 MG","60","Select","Select",""],["","62332002891","LOSARTAN POT","TAB 50MG","90","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","15","Select","Select",""],["","23155000810","HYDROCHLOROT","TAB 25MG","90","Select","Select",""],["","57599080000","FREESTY LIBR","KIT 2 SENSOR","6","Select","Select",""],["","00093005805","TRAMADOL HCL","TAB 50MG","26","Select","Select",""],["","10702001801","OXYCODONE","TAB 5MG","22","Select","Select",""],["","60758011915","PREDNISOLONE","SUS 1% OP","15","Select","Select",""],["","00378064205","PREDNISONE","TAB 20MG","5","Select","Select",""],["","69315030805","CIPROFLOXACN","SOL 0.3% OP","5","Select","Select",""],["","00088221905","LANTUS SOLOS","INJ 100\/ML","45","Select","Select",""],["","00310737020","BUDES\/FORMOT","AER 160-4.5","10","Select","Select",""],["","49502039475","INSULIN GLAR","INJ 100U\/ML","15","Select","Select",""],["","52268020101","SUTAB","TAB ","24","Select","Select",""],["","00006027731","JANUVIA","TAB 100MG","90","Select","Select",""],["","00228331503","DOXEPIN","TAB 3MG","30","Select","Select",""],["","59651017301","DOXEPIN HCL","10 MG","30","Select","Select",""],["","78206012601","DULERA","AER 200-5MCG","13","Select","Select",""],["","00310737020","BUDESONIDE-FORMOTEROL FUMARATE","160-4.5MCG","10.2","Select","Select",""],["","70010049110","METFORMIN HCL ER","500 MG","360","Select","Select",""],["","70436017404","TROSPIUM CHLORIDE ER","60 MG","30","Select","Select",""],["","00093916301","VENLAFAXINE HCL","100 MG","90","Select","Select",""],["","65862096801","ESZOPICLONE","2 MG","30","Select","Select",""],["","00088221905","LANTUS SOLOSTAR","100\/ML (3)","75","Select","Select",""],["","70377003014","ATORVASTATIN CALCIUM","80 MG","90","Select","Select",""],["","23155000810","HYDROCHLOROTHIAZIDE","25 MG","90","Select","Select",""],["","00093317431","ALBUTEROL SULFATE HFA","90 MCG","8.5","Select","Select",""],["","62332002991","LOSARTAN POTASSIUM","100 MG","90","Select","Select",""],["","00378668910","PANTOPRAZOLE SODIUM","40 MG","90","Select","Select",""],["","00093310905","AMOXICILLIN CAP","500MG","60","Select","Select",""],["","68180078001","ZOLPIDEM ER TAB","12.5MG","30","Select","Select",""],["","70436017404","TROSPIUM CHL CAP","60MG ER","90","Select","Select",""],["","00002223680","TRULICITY INJ","3\/0.5","6","Select","Select",""],["","70010049110","METFORMIN TAB","500MG ER","360","Select","Select",""],["","00378668910","PANTOPRAZOLE TAB","40MG","90","Select","Select",""],["","00093916301","VENLAFAXINE TAB","100MG","90","Select","Select",""],["","33342032915","TRIAMCINOLON CRE","0.1%","45","Select","Select",""],["","60505082701","IPRATROPIUM SPR","0.06%","15","Select","Select",""],["","00093317431","ALBUTEROL AER HFA","","8","Select","Select",""],["","59310057922","PROAIR HFA AER","","8","Select","Select",""],["","11527070442","SOD FLUORIDE GEL","1.1-5%","100","Select","Select",""],["","62332002991","LOSARTAN POT TAB","100MG","90","Select","Select",""],["","70010010810","GABAPENTIN CAP","100MG","30","Select","Select",""],["","59148003813","REXULTI TAB","2MG","30","Select","Select",""],["","00116200116","CHLORHEX GLU SOL","0.12%","473","Select","Select",""],["","00186037020","SYMBICORT AER","160-4.5","10","Select","Select",""],["","50111045001","TRAZODONE TAB","150MG","30","Select","Select",""],["","70700015010","OMEPRAZOLE CAP","20MG","30","Select","Select",""],["","70377003012","ATORVASTATIN TAB","80MG","90","Select","Select",""],["","49035091530","OMEPRAZOLE TAB","20MG","60","Select","Select",""],["","53746010901","HYDROCO\/APAP TAB","5-325MG","15","Select","Select",""],["","00093083205","CLONAZEPAM TAB","0.5MG","30","Select","Select",""],["","57599080300","FREESTY LIBR MIS","2 READER","1","Select","Select",""],["","00093005805","TRAMADOL HCL TAB","50MG","26","Select","Select",""],["","10702001801","OXYCODONE TAB","5MG","22","Select","Select",""],["","00378064205","PREDNISONE TAB","20MG","5","Select","Select",""],["","23155000810","HYDROCHLOROT TAB","25MG","90","Select","Select",""],["","60758011905","PREDNISOLONE SUS","1% OP","15","Select","Select",""],["","00310737020","BUDES\/FORMOT AER","160-4.5","10","Select","Select",""],["","00088221905","LANTUS SOLOS INJ","100\/ML","45","Select","Select",""],["","49502039475","INSULIN GLAR INJ","100U\/ML","15","Select","Select",""],["","69315030805","CIPROFLOXACN SOL","0.3% OP","5","Select","Select",""],["","00228331503","DOXEPIN TAB","3MG","30","Select","Select",""],["","59651017301","DOXEPIN HCL CAP","10MG","30","Select","Select",""],["","00006027731","JANUVIA TAB","100MG","30","Select","Select",""],["","57599080000","FREESTY LIBR KIT","2 SENSOR","6","Select","Select",""],["","78206012601","DULERA AER","200-5MCG","13","Select","Select",""],["","00169633910","NOVOLOG FLEXPEN","100\/ML (3)","45","Select","Select",""],["","00116200116","CHLORHEXIDINE GLUCONATE","0.12 %","473","Select","Select",""],["","00169418113","OZEMPIC .","25 OR 0.5","9","Select","Select",""],["","68180071909","AMLODIPINE BESYLATE","2.5 MG","30","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":""}]}]}