{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ALLEN MONTOYA","gend":0,"add":"107 BALKAN CT","city":"STEPHENSON","state":"VA","zip":"22601-9998","dob":"1991-03-05","age":"","mstatus":"","insh":"2362669*01","cliId":"","pno":5405148127,"cno":5405148127,"email":"","ename":"","eno":"","pphy":"LIPSEY, JUSTIN PA","ppno":5405365500,"pcpadd":"611 E JUBAL EARLY DR,","pcpcity":"WINCHESTER","pcpstate":"VA","pcpzip":"22601-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"NORTHERN & WINCHESTER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":5405365507,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F11.20","L02.612","L02.611","L03.115","L03.116","L97.512","L97.522","E11.69","M86.172","L02.02","L02.11","R69.","NO DATA","F19.10","T40.1X1A","E87.2","F41.9","N17.9","F12.20","M77.52","E11.621","M86.9","E87.70","I10.","D64.9","E10.65","E10.10","E03.9","F17.210","F32.9","F90.9","Z88.5","Z79.4","Z79.890","Z91.19","F19.20","Z71.3","S43.51XA","J30.2","Z91.128","E86.0","Z83.3","Z88.6","R73.9","M86.171","R60.0","E10.69","N17.0","L97.529","E10.40","Z20.822","R34.","I95.9","D63.8","E10.621","E10.649","T36.8X5A","T36.0X5A","T39.8X5A","E11.9","F39.","Z49.01","T81.49XA","B95.61","Z89.419","H60.11","F11.10","L03.211","F90.2","V58.89","M25.511","Z45.2","E11.43","T40.1X4A","E11.65","E11.00","S49.91XA","T40.411A","R79.89","Z09.","Z13.31","F33.0","S46.911A","S39.012A","V49.40XA","E78.2","S98.112A","R80.9","E03.8","E06.3","F31.32","F33.1","J02.9"],"date":["2023-09-20","2022-04-15","2022-04-15","2022-04-15","2022-04-15","2022-05-10","2022-05-10","2022-04-16","2022-05-10","2021-02-26","2021-02-22","2021-03-22","2022-08-02","2021-03-23","2021-03-26","2021-03-25","2023-09-06","2022-04-28","2023-09-06","2022-04-13","2022-06-28","2022-04-23","2022-04-28","2022-04-28","2022-04-28","2023-05-22","2021-03-26","2022-04-23","2022-02-11","2021-05-11","2023-09-06","2022-02-11","2022-06-07","2022-02-11","2021-03-22","2023-06-28","2021-05-11","2021-10-13","2022-02-11","2022-02-11","2022-02-11","2022-02-11","2022-02-11","2022-02-11","2022-05-10","2022-04-21","2022-04-15","2022-04-15","2022-10-12","2022-04-15","2022-04-15","2022-04-15","2022-04-15","2022-04-15","2022-04-15","2022-04-15","2022-04-15","2022-04-15","2022-04-15","2022-08-02","2022-04-23","2022-04-22","2022-04-29","2022-04-29","2022-04-29","2021-03-02","2021-03-02","2021-03-02","2023-09-06","2021-10-27","2021-10-27","2022-04-28","2022-10-12","2021-03-22","2022-06-07","2022-02-11","2021-10-06","2021-03-22","2021-04-01","2021-04-01","2021-04-01","2023-09-06","2021-10-06","2021-10-06","2021-10-06","2022-06-07","2022-06-07","2022-06-07","2022-06-07","2022-06-07","2023-09-06","2023-06-05","2023-09-11"],"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":[["","65162027250","SMZ\/TMP DS","TAB 800-160","20","Select","Select",""],["","73070010315","INSULIN ASPA","INJ FLEXPEN","15","Select","Select",""],["","69238184001","LEVOTHYROXIN","TAB 200MCG","98","Select","Select",""],["","00093101042","MUPIROCIN","OIN 0.02","22","Select","Select",""],["","00169633910","NOVOLOG","INJ FLEXPEN","45","Select","Select",""],["","65862069730","VENLAFAXINE","CAP 150MG ER","30","Select","Select",""],["","29300013601","CLONIDINE","TAB 0.2MG","30","Select","Select",""],["","67877021905","CEPHALEXIN","CAP 500MG","28","Select","Select",""],["","53885024510","ONETOUCH","TES ULTRA","400","Select","Select",""],["","43598065530","BUPROPN HCL","TAB 150MG XL","30","Select","Select",""],["","68180029706","DULOXETINE","CAP 40MG","30","Select","Select",""],["","68382005105","MELOXICAM","TAB 15MG","30","Select","Select",""],["","00088221905","LANTUS SOLOS","INJ 100\/ML","6","Select","Select",""],["","81131038681","RELION PEN","MIS 31GX8MM","300","Select","Select",""],["","49035074162","ARTHRTS PAIN","TAB 650MG","120","Select","Select",""],["","20555001900","FERROUS GLUC","TAB 324MG","90","Select","Select",""],["","72305020030","EUTHYROX","TAB 200MCG","30","Select","Select",""],["","00143122701","DICYCLOMINE","TAB 20MG","30","Select","Select",""],["","70010075401","METHOCARBAM","TAB 500MG","20","Select","Select",""],["","55111015330","ONDANSETRON","TAB 4MG","30","Select","Select",""],["","20555003400","FERROUS SULF","TAB 325MG EC","60","Select","Select",""],["","00228202950","ALPRAZOLAM","TAB 0.5MG","10","Select","Select",""],["","00093216568","NALOXONE HCL","SPR ","2","Select","Select",""],["","42858000101","OXYCODONE","TAB 5MG","12","Select","Select",""],["","68645051654","AMLODIPINE","TAB 10MG","30","Select","Select",""],["","40093010390","IRON","TAB 65MG","30","Select","Select",""],["","31722072250","LEVOFLOXACIN","TAB 500MG","14","Select","Select",""],["","58602070176","LOPERAMIDE","TAB 2MG","40","Select","Select",""],["","42571016142","AMOX\/K CLAV","TAB 500-125","24","Select","Select",""],["","49100040009","CULTURELLE","CAP ","30","Select","Select",""],["","00904759080","FEROSUL","TAB 325MG","30","Select","Select",""],["","50484081015","REGRANEX","GEL 0.0001","15","Select","Select",""],["","27808023302","DOXYCYCL HYC","CAP 100MG","20","Select","Select",""],["","69238184001","LEVOTHYROXINE SODIUM","200 MCG","120","Select","Select",""],["","70700015010","OMEPRAZOLE","20 MG","14","Select","Select",""],["","00169633910","NOVOLOG FLEXPEN","100\/ML (3)","18","Select","Select",""],["","53885024510","ONETOUCH ULTRA TEST STRIP","","200","Select","Select",""],["","00088221905","LANTUS SOLOSTAR","100\/ML (3)","6","Select","Select",""],["","59651039001","BUSPIRONE HCL","7.5 MG","90","Select","Select",""],["","65862018730","ONDANSETRON HCL","4 MG","30","Select","Select",""],["","12496120803","SUBOXONE","8 MG-2 MG","7","Select","Select",""],["","68180032002","BUPROPION XL","300 MG","7","Select","Select",""],["","67877043003","ARIPIPRAZOLE","2 MG","7","Select","Select",""],["","43598058230","BUPRENORPHINE-NALOXONE","8 MG-2 MG","2","Select","Select",""],["","81131044784",""," ","60","Select","Select",""],["","00169633910","NOVOLOG INJ FLEXPEN","","6","Select","Select",""],["","00088221905","LANTUS SOLOS INJ","100\/ML","6","Select","Select",""],["","69238184001","LEVOTHYROXIN TAB","200MCG","98","Select","Select",""],["","68180032002","BUPROPN HCL TAB","300MG XL","30","Select","Select",""],["","67877021905","CEPHALEXIN CAP","500MG","28","Select","Select",""],["","00093101042","MUPIROCIN OIN","2%","22","Select","Select",""],["","58602070176","LOPERAMIDE TAB","2MG","40","Select","Select",""],["","00228202950","ALPRAZOLAM TAB","0.5MG","10","Select","Select",""],["","49100040009","CULTURELLE CAP","","30","Select","Select",""],["","00904759161","FERROUS SULF TAB","325MG","60","Select","Select",""],["","81131074933","IRON TAB","325MG","60","Select","Select",""],["","31722072250","LEVOFLOXACIN TAB","500MG","14","Select","Select",""],["","42858000101","OXYCODONE TAB","5MG","12","Select","Select",""],["","42571016142","AMOX\/K CLAV TAB","500-125","24","Select","Select",""],["","00093216568","NALOXONE HCL SPR","","2","Select","Select",""],["","53885024510","ONETOUCH TES ULTRA","","400","Select","Select",""],["","68645051654","AMLODIPINE TAB","10MG","30","Select","Select",""],["","27808023302","DOXYCYCL HYC CAP","100MG","20","Select","Select",""],["","00904759080","FEROSUL TAB","325MG","30","Select","Select",""],["","50484081015","REGRANEX GEL","0.01%","15","Select","Select",""],["","65862022701","LAMOTRIGINE","25 MG","14","Select","Select",""],["","65862001705","AMOXICILLIN","500 MG","20","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":""}]}]}