{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MICHELLE D TANNER","gend":1,"add":"130 RAIDANT CT LOT 8","city":"RICHLANDS","state":"VA","zip":"24641-9998","dob":"1998-11-06","age":"","mstatus":"","insh":"2192880*01","cliId":"","pno":2769709502,"cno":2769709502,"email":"","ename":"","eno":"","pphy":"SHORTT, JENNIFER NP","ppno":2765966375,"pcpadd":"111 FASHION RD,","pcpcity":"POUNDING MILL","pcpstate":"VA","pcpzip":"24637-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"SOUTHWEST","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":8776390057,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["O03.9","O20.0","Z3A.11","E03.9","O24.111","E78.2","Z39.1","E11.65","Z96.41","Z79.899","Z79.4","O26.91","R10.9","O24.911","O16.1","O99.331","F17.210","O26.891","K21.9","O99.281","Z3A.12","Z90.49","R11.0","O26.892","O26.90","O42.913","Z34.82","Z34.83","E11.9","Z3A.10","O99.891","O9A.212","S93.401A","W19.XXXA","Z3A.15","S99.911A","T24.211A","T25.122A","NO DATA","K29.30","O24.112","O99.282","Z3A.22","O60.03","Z3A.29","O24.913","O16.3","F43.21","F60.89","K29.50","K31.89","B08.4","E11.69","U07.1","J40.","R05.9","O26.893","T24.111A","Z23.","O99.343","O99.283","E28.2","O24.113","Z3A.28","Z79.82","T25.022A","O42.113","O24.313","O34.211","O24.12","O45.93","Z37.0","O99.284","O36.5930","O9A.22","O76.","V58.89","O34.219","Z71.81","Z86.16","O24.32","O75.89","Z3A.30","Z30.09","R07.9","S49.92XA","G56.92","O24.011","E10.9","E87.6","Z3A.01","Z3A.27","Z3A.00","S90.02XA","S50.01XA","J02.9","Z79.890","S59.901A","B34.9","R43.2","O24.311","O43.891","Z36.89","V23.87","Z34.81","Z3A.09","V23.9","O46.8X1","O99.213","E66.8","I36.8","I34.8","E11.319","R07.0","J02.0"],"date":["2021-07-31","2021-07-29","2022-04-06","2023-04-21","2023-04-21","2023-04-21","2023-01-24","2023-01-24","2022-08-13","2023-04-21","2023-04-21","2022-02-23","2022-07-24","2022-02-23","2022-02-23","2022-02-23","2022-02-23","2022-02-23","2022-02-23","2022-04-06","2022-02-23","2022-02-23","2022-02-23","2022-07-24","2022-08-13","2022-08-13","2022-10-06","2022-10-06","2022-08-11","2021-07-27","2022-02-23","2022-04-22","2022-04-22","2022-04-22","2022-04-22","2022-04-22","2022-08-11","2022-08-11","2023-04-21","2021-01-29","2022-06-24","2022-06-24","2022-06-24","2022-08-13","2022-08-16","2022-08-13","2022-08-13","2022-10-21","2022-10-21","2021-01-29","2021-01-29","2021-12-13","2023-04-21","2022-02-07","2022-02-07","2022-02-07","2022-08-16","2022-08-11","2022-08-11","2022-08-11","2022-08-11","2022-08-11","2022-08-11","2022-08-11","2022-08-11","2022-08-11","2022-08-16","2022-08-16","2022-08-17","2022-08-13","2022-08-13","2022-08-17","2022-08-13","2022-08-13","2022-08-13","2022-08-13","2022-08-13","2022-08-14","2022-08-13","2022-08-13","2022-08-17","2022-08-17","2022-08-17","2022-10-05","2021-01-28","2021-04-22","2021-04-22","2022-02-24","2022-02-24","2022-03-03","2022-03-03","2022-07-24","2021-07-03","2021-12-11","2021-12-11","2021-12-11","2023-04-21","2021-12-11","2022-02-02","2022-02-02","2022-03-03","2022-03-03","2022-03-03","2022-03-03","2022-03-21","2022-03-21","2022-03-21","2022-03-21","2022-08-15","2022-08-15","2022-06-24","2022-06-24","2023-04-21","2023-09-25","2023-09-25"],"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":[["","68180096603","LEVOTHYROXIN TAB","50MCG","30","Select","Select",""],["","00002751001","HUMALOG INJ","100\/ML","20","Select","Select",""],["","00074455290","SYNTHROID TAB","50MCG","30","Select","Select",""],["","00088221905","LANTUS SOLOS INJ","100\/ML","15","Select","Select",""],["","08470354001","UNFINE PNTP MIS","32GX4MM","200","Select","Select",""],["","53885027150","ONETOUCH TES VERIO","","100","Select","Select",""],["","00002879959","HUMALOG KWIK INJ","100\/ML","15","Select","Select",""],["","69452015120","VITAMIN D CAP","50000UNT","8","Select","Select",""],["","31722099605","HYDROCO\/APAP TAB","5-325MG","12","Select","Select",""],["","57896010110","NON-ASPIRIN TAB","325MG","30","Select","Select",""],["","00172572880","FAMOTIDINE TAB","20MG","60","Select","Select",""],["","00002773701","INSULIN LISP INJ","100\/ML","10","Select","Select",""],["","67877032001","IBUPROFEN TAB","600MG","30","Select","Select",""],["","65162004710","OXYCODONE TAB","5MG","12","Select","Select",""],["","00548560200","ENOXAPARIN INJ","40\/0.4ML","12","Select","Select",""],["","13668013501","ESCITALOPRAM TAB","5MG","30","Select","Select",""],["","57896010410","ACETAMINOPHE TAB","325MG","30","Select","Select",""],["","65162046935","ELURYNG MIS","","1","Select","Select",""],["","00093767902","ETONOGESTREL-ETHINYL ESTRADIOL .","12-.015MG","1","Select","Select",""],["","00088221905","LANTUS SOLOSTAR","100\/ML (3)","15","Select","Select",""],["","00074455290","SYNTHROID","50 MCG","30","Select","Select",""],["","00002879959","HUMALOG KWIKPEN U-","100 100\/ML","15","Select","Select",""],["","08290320550","NANO","2ND GEN PEN NEEDLE 32GX 5\/32\"","200","Select","Select",""],["","08470354001","UNIFINE PENTIPS","32GX 5\/32\"","200","Select","Select",""],["","49502039475","INSULIN GLARGINE-YFGN","100\/ML (3)","15","Select","Select",""],["","89152168005","AUTOSOFT XC","","45","Select","Select",""],["","65162046935","ELURYNG .","12-.015MG","1","Select","Select",""],["","53885027210","ONETOUCH VERIO TEST STRIP","","100","Select","Select",""],["","68180096603","LEVOTHYROXIN","TAB 50MCG","30","Select","Select",""],["","00088221905","LANTUS SOLOS","INJ 100\/ML","15","Select","Select",""],["","08470354001","UNFINE PNTP","MIS 32GX4MM","200","Select","Select",""],["","53885027150","ONETOUCH","TES VERIO","100","Select","Select",""],["","00002751001","HUMALOG","INJ 100\/ML","20","Select","Select",""],["","00002879959","HUMALOG KWIK","INJ 100\/ML","15","Select","Select",""],["","69452015120","VITAMIN D","CAP 50000UNT","8","Select","Select",""],["","57896010110","NON-ASPIRIN","TAB 325MG","30","Select","Select",""],["","00548560200","ENOXAPARIN","INJ 40\/0.4ML","12","Select","Select",""],["","67877032001","IBUPROFEN","TAB 600MG","30","Select","Select",""],["","65162004710","OXYCODONE","TAB 5MG","12","Select","Select",""],["","13668013501","ESCITALOPRAM","TAB 5MG","30","Select","Select",""],["","00172572880","FAMOTIDINE","TAB 20MG","60","Select","Select",""],["","31722099605","HYDROCO\/APAP","TAB 5-325MG","12","Select","Select",""],["","00002773701","INSULIN LISP","INJ 100\/ML","10","Select","Select",""],["","57896010410","ACETAMINOPHE","TAB 325MG","30","Select","Select",""],["","65162046935","ELURYNG","MIS ","1","Select","Select",""],["","59746017509","PREDNISONE","20 MG","10","Select","Select",""],["","65862064169","AZITHROMYCIN","250 MG","6","Select","Select",""],["","00781261305","AMOXICILLIN","500 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":""}]}]}