{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DAVID MAUER","gend":0,"add":"370 TRENTON AVE","city":"SHENANDOAH","state":"VA","zip":"22849-9998","dob":"1965-02-28","age":"","mstatus":"","insh":"2323041*01","cliId":"","pno":5402140416,"cno":5402140416,"email":"","ename":"","eno":"","pphy":"TIMMONS, JOHN W MD","ppno":5406529100,"pcpadd":"505 WILLIAMS AVENUE,","pcpcity":"SHENANDOAH","pcpstate":"VA","pcpzip":"22849-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"NORTHERN & WINCHESTER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":5406529119,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R07.9","R06.02","Z23.","E11.9","E11.621","Z79.4","L97.514","Z89.421","E11.21","NO DATA","E87.5","I10.","J02.9","J02.0","G47.33","M54.12","M54.6","G89.29","W57.XXXA","L97.521","I25.10","L97.522","M79.672","L97.429","M62.472","E11.610","R06.2","J06.9","I51.7","M86.9","L97.512","N18.4","L97.529","I12.9","E11.22","S91.302A","I87.312","E11.40","G47.31","Z87.39","E66.3","Z79.84","Z68.33","I87.2","M75.52","M19.112","R07.89","G62.9","G47.10","R06.83","E11.69","M86.672","Z12.11","G47.30","R60.9","R60.0","E11.59","E10.621","E10.40","E10.22","E10.69","L97.422","I12.0","N18.6","I08.1","H43.11","M86.472","R00.2","S42.031A","S22.41XA","K64.4","M77.11","R41.3","E11.42","S91.332S","E10.3393","L97.222","I87.392","E13.69","G47.9","Z65.3","Z65.8","F41.9","R93.89","R52.","Z99.89","R06.81","J34.89","E78.5","R94.31","I34.0","Z20.822","L97.519","K63.5","Z68.36","M43.6","Z74.09","M62.81","L97.829","M47.814","L97.821","M86.172","M86.60","I13.2","I50.9","Z83.3","Z20.828","M50.90","E11.3513","E11.3393","F41.8","M50.30","F43.9","Z68.38","V58.89","D50.9","M79.2","F45.42","M62.830","I25.118","E13.40","Z79.899","Z79.891","E11.3512","M62.579","L98.492","E11.52","I96."],"date":["2022-11-15","2022-10-27","2021-06-30","2022-06-06","2023-07-18","2023-05-30","2021-10-08","2021-10-08","2023-06-09","2023-06-12","2021-10-25","2023-06-12","2022-01-12","2022-01-12","2023-05-10","2023-04-19","2023-07-06","2023-07-06","2022-04-05","2022-04-18","2022-11-15","2023-07-18","2021-03-18","2021-12-01","2021-03-18","2021-03-18","2021-03-30","2021-03-30","2022-11-15","2022-04-06","2021-11-16","2023-07-06","2022-04-18","2023-04-11","2023-05-10","2022-04-18","2023-04-11","2023-05-08","2023-06-01","2023-06-01","2023-06-01","2023-04-11","2022-09-07","2023-06-01","2021-02-09","2022-04-04","2021-02-09","2021-11-05","2021-06-04","2021-06-04","2021-12-07","2022-07-07","2021-12-07","2023-06-08","2022-10-27","2023-05-02","2022-07-07","2022-04-06","2022-04-06","2022-04-06","2022-04-06","2023-05-08","2022-04-06","2022-04-06","2022-11-15","2022-12-21","2021-03-09","2021-03-10","2021-06-03","2021-06-03","2021-12-07","2023-07-06","2023-05-10","2023-06-01","2022-11-09","2023-02-01","2023-05-02","2023-06-01","2023-01-11","2023-01-11","2023-01-11","2023-01-11","2023-01-11","2023-01-11","2023-01-11","2023-01-11","2021-01-25","2021-01-25","2022-08-19","2021-02-25","2021-03-12","2021-03-29","2021-07-21","2021-12-07","2022-03-02","2022-05-04","2022-05-04","2022-05-04","2022-03-24","2022-04-04","2022-08-31","2021-03-17","2021-12-01","2021-10-22","2021-10-22","2022-08-19","2021-03-29","2023-04-05","2023-05-30","2023-05-10","2023-05-10","2023-04-19","2022-08-09","2023-06-01","2022-07-07","2022-07-07","2023-07-06","2023-07-06","2023-07-06","2023-07-06","2023-07-06","2023-07-06","2023-07-06","2023-02-09","2023-07-06","2023-06-01","2023-06-01","2023-06-01"],"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":[["","00169413212","OZEMPIC","INJ 2\/1.5ML","2","Select","Select",""],["","00310653004","BYDUREON PEN","INJ 2MG","12","Select","Select",""],["","60505014201","GLIPIZIDE","10 MG","60","Select","Select",""],["","00406048401","APAP\/CODEINE","TAB 300-30MG","4","Select","Select",""],["","00006027731","JANUVIA","100 MG","30","Select","Select",""],["","00172208380","HYDROCHLOROT","TAB 25MG","30","Select","Select",""],["","51672131200","MUPIROCIN","OIN 0.02","22","Select","Select",""],["","60505267108","ATORVASTATIN","TAB 80MG","13","Select","Select",""],["","65162010350","GABAPENTIN","400 MG","90","Select","Select",""],["","68001015200","CARVEDILOL","25 MG","60","Select","Select",""],["","00781261305","AMOXICILLIN","CAP 500MG","30","Select","Select",""],["","68180072103","AMLODIPINE","TAB 10MG","90","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","00904679489","ASPIRIN","81 MG","30","Select","Select",""],["","43547036109","LOSARTAN POT","TAB 50MG","30","Select","Select",""],["","69315011805","FUROSEMIDE","80 MG","60","Select","Select",""],["","24385027868","GNP ASPIRIN","CHW 81MG","30","Select","Select",""],["","65862070020","CEFUROXIME","500 MG","30","Select","Select",""],["","33342005510","PIOGLITAZONE","TAB 30MG","30","Select","Select",""],["","50742062101","NIFEDIPINE","TAB 60MG ER","30","Select","Select",""],["","00088221905","LANTUS SOLOS","INJ 100\/ML","15","Select","Select",""],["","58160082311","SHINGRIX","INJ 50\/0.5ML","1","Select","Select",""],["","00169185189","NOVOFINE","32 32 GX 1\/4\"","90","Select","Select",""],["","55111012705","CIPROFLOXACN","TAB 500MG","20","Select","Select",""],["","72578000105","DOXYCYCL HYC","TAB 100MG","20","Select","Select",""],["","68001039900","FLUOXETINE","CAP 10MG","30","Select","Select",""],["","00904679489","ASPIRIN LOW","CHW 81MG","30","Select","Select",""],["","33332042210","AFLURIA QUAD","INJ 2022-23","0","Select","Select",""],["","59651005205","EZETIMIBE","10 MG","30","Select","Select",""],["","00005200010","PREVNAR 20","INJ ","0","Select","Select",""],["","58160084211","BOOSTRIX","INJ ","0","Select","Select",""],["","59267030402","PFIZER BIVAL","INJ BA4\/BA5","0","Select","Select",""],["","50742062101","NIFEDIPINE ER","60 MG","30","Select","Select",""],["","60505267108","ATORVASTATIN CALCIUM","80 MG","30","Select","Select",""],["","00088221905","LANTUS SOLOSTAR","100\/ML (3)","15","Select","Select",""],["","00955172805","INSULIN GLARGINE SOLOSTAR","100\/ML (3)","15","Select","Select",""],["","68001040100","FLUOXETINE HCL","40 MG","30","Select","Select",""],["","00310621030","FARXIGA","10 MG","22","Select","Select",""],["","00406012401","HYDROCODONE-ACETAMINOPHEN","7.5-325 MG","120","Select","Select",""],["","00115101101","BACLOFEN","5 MG","69","Select","Select",""],["","45802081184","NALOXONE HCL","4 MG","2","Select","Select",""],["","65162010350","GABAPENTIN CAP","400MG","90","Select","Select",""],["","00006027731","JANUVIA TAB","100MG","30","Select","Select",""],["","00088221905","LANTUS SOLOS INJ","100\/ML","15","Select","Select",""],["","00781261305","AMOXICILLIN CAP","500MG","30","Select","Select",""],["","00904404073","ASPIRIN CHW","81MG","30","Select","Select",""],["","33342005510","PIOGLITAZONE TAB","30MG","30","Select","Select",""],["","60505267108","ATORVASTATIN TAB","80MG","30","Select","Select",""],["","00169185189","NOVOFINE MIS","32GX6MM","30","Select","Select",""],["","69315011805","FUROSEMIDE TAB","80MG","120","Select","Select",""],["","50742062101","NIFEDIPINE TAB","60MG ER","30","Select","Select",""],["","43547036109","LOSARTAN POT TAB","50MG","30","Select","Select",""],["","68001015200","CARVEDILOL TAB","25MG","60","Select","Select",""],["","60505014201","GLIPIZIDE TAB","10MG","60","Select","Select",""],["","58160082311","SHINGRIX INJ","50\/0.5ML","1","Select","Select",""],["","72578000105","DOXYCYCL HYC TAB","100MG","20","Select","Select",""],["","67877021660","CEFUROXIME TAB","500MG","20","Select","Select",""],["","55111012705","CIPROFLOXACN TAB","500MG","20","Select","Select",""],["","50228011410","FLUOXETINE CAP","20MG","30","Select","Select",""],["","00904679489","ASPIRIN LOW CHW","81MG","30","Select","Select",""],["","59267030402","PFIZER BIVAL INJ BA","4\/BA5","0","Select","Select",""],["","59651005290","EZETIMIBE TAB","10MG","30","Select","Select",""],["","00005200010","PREVNAR","20 INJ","0","Select","Select",""],["","33332042210","AFLURIA QUAD INJ","2022-23","0","Select","Select",""],["","58160084211","BOOSTRIX INJ","","0","Select","Select",""],["","50742017505","ISOSORBIDE MONONITRATE ER","30 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":""}]}]}