{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"RACHEL  A TRENT","gend":1,"add":"1329 SUNSET HILL ROAD","city":"BIG ISLAND","state":"VA","zip":"24526-9998","dob":"1977-06-16","age":"","mstatus":"","insh":"2239397*01","cliId":"","pno":5408744762,"cno":5408744762,"email":"","ename":"","eno":"","pphy":"KSIONSKI, SEBASTIAN MD","ppno":4343155340,"pcpadd":"935 S MAIN ST","pcpcity":"FARMVILLE","pcpstate":"VA","pcpzip":"23901-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"ROANOKE ALLEGHANY","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":4342001679,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M54.5","M54.16","M62.830","F40.240","M75.21","R42.","R51.9","R07.89","E78.5","K21.9","J44.9","Z91.030","Z91.018","Z87.891","Z79.899","J31.2","J02.0","NO DATA","R50.9","Z79.82","Z91.038","N92.1","I49.9","J03.01","R59.1","R53.83","R35.0","R10.30","R30.0","R11.0","M54.6","M62.81","R27.8","R10.2","N32.81","R39.15","R26.2","N95.0","G37.9","B34.9","J02.9","J44.1","M19.90","Z20.822","U07.1","D84.9","F41.9","Z85.79","Z86.19","R13.10","R12.","K22.2","K29.70","F43.10","I20.8","R06.00","Q21.1","Z20.828","J03.91","M54.9","R07.0","M25.511","M75.81","M75.41","Q24.5","R06.83","S93.401A","N81.9","K59.00","W01.0XXA","E88.2","G89.29","M51.36","I12.9","M94.0","J35.01","R53.82","C84.00","C86.6","C84.09","K58.9","R10.11","R10.32","R10.12","R14.0","Z87.09","M79.2","G43.919","M47.22","F43.12","R05.9","J35.1","Z32.02","B99.9","R59.9","G47.19","N76.0","C85.80","M71.22","C85.90","E66.01","M79.605","M54.42","R06.02","M79.602","R22.41","R22.42","M25.50","K52.9","R10.13","G47.10","R39.89","R39.12","N94.10","N39.8","L21.9","L28.0","L82.1","B35.1","R21.","C84.03","N81.10","J20.9","R00.2","B37.0","Z20.818","R59.0","R13.19","L30.8","G89.4","M25.561","Z71.82","M79.641","M25.562","M79.642"],"date":["2021-02-03","2021-01-19","2021-09-29","2021-01-19","2023-04-25","2021-08-07","2023-01-23","2021-12-23","2023-03-11","2023-03-14","2023-02-09","2021-09-09","2021-09-30","2022-04-06","2023-03-16","2021-08-13","2021-09-09","2023-02-09","2021-09-09","2021-09-30","2021-09-09","2021-11-11","2021-12-23","2022-04-19","2022-04-19","2022-04-19","2022-02-23","2022-02-28","2022-02-23","2023-02-09","2022-03-25","2022-06-21","2022-06-21","2023-03-10","2023-03-10","2022-06-21","2022-06-21","2022-06-22","2022-08-31","2022-08-12","2023-01-31","2023-03-11","2022-08-12","2022-08-12","2023-01-23","2023-01-23","2023-04-20","2023-01-23","2023-01-23","2023-03-14","2023-02-09","2023-02-09","2023-02-09","2023-04-24","2021-08-11","2021-09-22","2021-08-11","2021-08-31","2021-09-13","2022-03-25","2023-01-13","2022-01-31","2022-01-31","2022-01-31","2022-03-08","2022-03-24","2022-10-01","2022-10-01","2022-11-08","2022-10-01","2023-03-16","2023-04-27","2021-02-03","2021-07-12","2021-09-22","2022-03-22","2022-03-22","2023-01-05","2023-03-16","2023-03-16","2023-01-03","2021-09-30","2021-09-30","2021-09-30","2021-12-29","2022-04-07","2022-04-07","2022-04-07","2022-12-18","2023-03-11","2022-12-30","2021-08-24","2021-11-11","2022-01-11","2022-01-11","2022-01-11","2022-02-28","2023-01-13","2023-03-11","2023-03-14","2023-03-11","2023-03-11","2021-03-30","2021-08-04","2021-08-04","2021-08-04","2021-08-04","2022-08-05","2023-03-23","2021-09-23","2022-03-07","2022-06-09","2022-04-06","2022-04-06","2022-04-06","2022-08-05","2022-08-05","2022-08-05","2022-08-05","2022-08-05","2022-08-05","2022-10-12","2023-01-04","2023-01-19","2023-01-19","2023-01-23","2023-03-14","2023-03-14","2023-03-16","2023-04-27","2023-04-27","2023-04-27","2023-04-27","2023-04-27","2023-04-27"],"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":[["","00172392760","DIAZEPAM","10 MG","30","Select","Select",""],["","00173071920","FLOVENT HFA","AER 110MCG","12","Select","Select",""],["","71093014105","METHOCARBAM","TAB 750MG","90","Select","Select",""],["","00093310905","AMOXICILLIN","CAP 500MG","20","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","12","Select","Select",""],["","00173068220","VENTOLIN HFA","AER ","18","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","11523720001","CLARITIN","CAP 10MG","10","Select","Select",""],["","65862050320","AMOX\/K CLAV","TAB 875-125","20","Select","Select",""],["","00536116361","MUCUS RELIEF","TAB 600MG ER","20","Select","Select",""],["","55111064530","OMEPRAZOLE","40 MG","30","Select","Select",""],["","43547040011","CYCLOBENZAPR","TAB 10MG","15","Select","Select",""],["","65162068090","PROMETHAZINE","SOL DM","120","Select","Select",""],["","60505025103","TIZANIDINE","TAB 2MG","120","Select","Select",""],["","45802065078","LORATADINE","TAB 10MG","10","Select","Select",""],["","66689030516","SUCRALFATE","1 G\/10 ML","300","Select","Select",""],["","62175061846","PANTOPRAZOLE","TAB 20MG","60","Select","Select",""],["","51991074690","DULOXETINE","CAP 20MG","60","Select","Select",""],["","00143122701","DICYCLOMINE","TAB 20MG","28","Select","Select",""],["","50383077504","LIDOCAINE","SOL 2% VISC","100","Select","Select",""],["","00054418425","DEXAMETHASON","TAB 4MG","2","Select","Select",""],["","57664050658","METOPROL TAR","TAB 25MG","2","Select","Select",""],["","50228017910","GABAPENTIN","100 MG","90","Select","Select",""],["","00093216568","NALOXONE HCL","SPR 4MG","2","Select","Select",""],["","16714069301","FLUCONAZOLE","200 MG","15","Select","Select",""],["","75826011510","PHENAZOPYRID","TAB 200MG","10","Select","Select",""],["","00555077902","MEDROXYPR AC","TAB 10MG","40","Select","Select",""],["","13668019030","TOLTERODINE","CAP 4MG ER","30","Select","Select",""],["","68382025501","OXYBUTYNIN","TAB 5MG ER","30","Select","Select",""],["","00597007541","SPIRIVA","CAP HANDIHLR","30","Select","Select",""],["","68462038630","SOLIFENACIN","TAB 5MG","30","Select","Select",""],["","42806015905","HYDROXYZ HCL","TAB 10MG","60","Select","Select",""],["","57664037708","TRAMADOL HCL","50 MG","60","Select","Select",""],["","00093342501","LORAZEPAM","TAB 0.5MG","2","Select","Select",""],["","43386009662","CLOBETASOL","OIN 0.0005","120","Select","Select",""],["","00093101042","MUPIROCIN","OIN 0.02","22","Select","Select",""],["","00168000616","TRIAMCINOLON","OIN 0.001","454","Select","Select",""],["","00121087316","LACTULOSE","SOL 10GM\/15","150","Select","Select",""],["","00093031401","KETOROLAC","TAB 10MG","20","Select","Select",""],["","00143951910","METHOTREXATE","INJ 50MG\/2ML","2","Select","Select",""],["","69315012710","FOLIC ACID","1 MG","30","Select","Select",""],["","45802004064","SELENIUM SUL","LOT 0.025","118","Select","Select",""],["","66220081022","REDITREX","INJ 10\/.4ML","2","Select","Select",""],["","08290305945","1ML TB SYRNG","MIS 27GX1\/2\"","4","Select","Select",""],["","11877001140","BINAXNOW COV","KIT HOME TES","2","Select","Select",""],["","00006505506","LAGEVRIO","CAP 200MG","40","Select","Select",""],["","60432053716","NYSTATIN","100000\/ML","260","Select","Select",""],["","00093031401","KETOROLAC TROMETHAMINE","10 MG","20","Select","Select",""],["","50383077504","LIDOCAINE HCL VISCOUS","2 %","100","Select","Select",""],["","45802005505","TRIAMCINOLONE ACETONIDE","0.1 %","454","Select","Select",""],["","00597007541","SPIRIVA HANDIHALER","18 MCG","30","Select","Select",""],["","50111078751","AZITHROMYCIN","250 MG","5","Select","Select",""],["","68462015713","ONDANSETRON ODT","4 MG","10","Select","Select",""],["","67877052830","SOLIFENACIN SUCCINATE","10 MG","90","Select","Select",""],["","67877021905","CEPHALEXIN","500 MG","30","Select","Select",""],["","51525590101","CARISOPRODOL","250 MG","60","Select","Select",""],["","59651039001","BUSPIRONE HCL","7.5 MG","60","Select","Select",""],["","45802004064","SELENIUM SULFIDE","2.5 %","120","Select","Select",""],["","08290305945","SAFETYGLIDE TB SYRINGE","27GX1\/2\"","4","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":""}]}]}