{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ROBERT  W JOHNSON","gend":0,"add":"407 TV DR APT C","city":"FREDERICKSBURG","state":"VA","zip":"22408-9998","dob":"1979-07-16","age":"","mstatus":"","insh":"2411457*01","cliId":"","pno":5402886599,"cno":5402886599,"email":"","ename":"","eno":"","pphy":"LAPPLE, ALEXANDRA NP","ppno":5403693917,"pcpadd":"411 B PARK HILL DR","pcpcity":"FREDERICKSBURG","pcpstate":"VA","pcpzip":"22401-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":5403729473,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I63.9","I50.20","L89.154","I21.3","E11.69","I25.10","Z95.1","I42.9","I82.C11","I49.8","G40.909","E03.9","E11.9","I10.","K21.9","B95.61","E11.622","M46.28","M62.81","R26.2","R26.89","M86.9","I69.398","R53.1","Z79.4","L89.150","E55.9","G40.89","R53.82","E78.5","S30.91XA","I69.351","D64.9","I25.5","F17.210","E66.9","Z79.2","Z68.32","Z79.01","Z79.82","M25.519","Z79.891","Z51.81","G60.3","I70.293","M25.572","M25.571","B35.1","M25.611","B35.3","I89.0","I87.2","E11.59","J90.","F41.9","M25.511","NO DATA","Z51.89","I11.0","E11.65","Z48.01","N40.1","R33.8","R45.1","G89.29","G72.81","I12.9","N18.9","I25.2","R63.0","E87.2","E78.2","M86.18","I82.403","I82.409","M79.89","M75.01","J96.01","N12.","T83.511A","R57.0","I50.23","N17.0","M72.6","I63.412","R65.21","G93.41","A41.59","A40.1","J91.8","E87.1","L03.90","R06.02","A49.9","M53.3","Z74.09","Z45.2","U07.1","R11.2","R77.8","Z86.718","L20.84","I50.22","N40.0","R53.81","T81.89XA","Z20.828","E11.42","I50.32","I13.0","Z95.811","I69.322","L89.159","R07.9","M75.81","I25.810","I69.851","R47.01","G81.01","R33.9","V58.89","Z78.9","L03.317","N17.9","Z68.34","Z20.822","S31.809A","L89.153","I50.9","E11.40","Z86.73","Z87.891","E78.00","M20.11"],"date":["2022-06-09","2021-10-15","2022-02-08","2021-10-14","2023-01-16","2023-04-17","2022-02-04","2022-10-04","2021-11-22","2021-10-16","2022-02-04","2023-01-16","2022-10-10","2023-04-17","2023-01-16","2021-11-11","2021-11-22","2022-01-08","2022-11-30","2021-11-05","2022-11-30","2022-03-01","2021-11-22","2021-11-22","2022-02-04","2022-01-08","2023-01-16","2023-01-16","2021-12-18","2022-10-04","2023-01-16","2022-02-04","2022-02-04","2023-04-17","2022-02-04","2022-02-04","2022-01-06","2022-02-04","2022-02-04","2022-02-04","2022-09-22","2023-04-13","2023-03-15","2022-04-29","2022-04-29","2022-04-29","2022-04-29","2023-03-31","2022-11-30","2023-03-31","2023-01-13","2023-01-13","2023-03-31","2021-10-15","2021-10-15","2023-04-27","2023-03-15","2021-11-11","2021-11-30","2021-10-30","2021-11-11","2021-10-15","2021-10-15","2021-11-11","2021-10-15","2021-11-11","2021-11-11","2021-11-11","2021-11-30","2021-11-11","2021-11-11","2023-04-17","2022-01-11","2022-09-09","2022-09-09","2022-09-09","2023-04-12","2021-09-01","2021-09-10","2021-09-01","2021-09-01","2021-09-24","2021-09-01","2021-09-01","2021-09-01","2021-09-01","2021-09-01","2021-09-01","2021-09-01","2021-09-01","2021-09-01","2021-09-10","2023-04-17","2021-09-10","2021-11-24","2023-04-12","2021-11-08","2022-02-04","2022-01-26","2022-01-25","2022-02-04","2023-01-13","2023-04-17","2021-10-30","2021-10-30","2022-01-17","2022-03-03","2022-04-29","2022-10-04","2021-09-24","2021-09-24","2021-09-24","2021-11-08","2023-04-17","2022-01-14","2022-06-16","2021-12-07","2021-09-01","2021-09-01","2021-09-01","2021-09-01","2021-09-01","2021-10-30","2021-10-30","2021-10-30","2021-10-30","2021-11-02","2021-11-30","2021-11-30","2021-11-30","2021-11-30","2021-11-30","2022-08-08","2023-03-31"],"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":[["","51672127501","CLOTRIMAZOLE","CRE 0.01","15","Select","Select",""],["","31722052201","HYDRALAZINE","TAB 100MG","270","Select","Select",""],["","00406324301","HYDROMORPHON","TAB 2MG","30","Select","Select",""],["","59011042010","OXYCONTIN","TAB 20MG CR","28","Select","Select",""],["","68180044501","QUETIAPINE","TAB 25MG","30","Select","Select",""],["","39328006412","H-CHLOR 12","SOL 0.00125","473","Select","Select",""],["","31722071390","PANTOPRAZOLE","TAB 40MG","90","Select","Select",""],["","00088222033","LANTUS","INJ 100\/ML","10","Select","Select",""],["","00002822259","INSULIN LISP","INJ 100\/ML","15","Select","Select",""],["","08290320119","BD PEN NEEDL","MIS 31GX5MM","200","Select","Select",""],["","00002879959","HUMALOG KWIK","INJ 100\/ML","9","Select","Select",""],["","00003089321","ELIQUIS","2.5 MG","180","Select","Select",""],["","42858000201","OXYCODONE","TAB 10MG","60","Select","Select",""],["","00832105415","BACLOFEN","10 MG","270","Select","Select",""],["","64980052810","SODIUM BICAR","TAB 650MG","120","Select","Select",""],["","70010010810","GABAPENTIN","CAP 100MG","90","Select","Select",""],["","68382009505","CARVEDILOL","25 MG","270","Select","Select",""],["","00088221905","LANTUS SOLOS","INJ 100\/ML","15","Select","Select",""],["","08290328438","INSULIN SYRG","MIS 0.3\/31G","100","Select","Select",""],["","68645059354","LISINOPRIL","40 MG","90","Select","Select",""],["","72305005030","EUTHYROX","TAB 50MCG","90","Select","Select",""],["","43547040111","FUROSEMIDE","20 MG","90","Select","Select",""],["","65862024608","LEVETIRACETA","TAB 500MG","180","Select","Select",""],["","70710113803","FLUCONAZOLE","TAB 100MG","7","Select","Select",""],["","42806054701","VITAMIN D","2 1250 MCG","12","Select","Select",""],["","00781717612","NALOXONE","SPR ","2","Select","Select",""],["","72205004411","OSELTAMIVIR","CAP 75MG","10","Select","Select",""],["","00143177201","ISOSORB DIN","TAB 20MG","180","Select","Select",""],["","51672129803","KETOCONAZOLE","2 %","60","Select","Select",""],["","11877001140","BINAXNOW COV","KIT HOME TES","8","Select","Select",""],["","16729044815","LEVOTHYROXIN","TAB 50MCG","90","Select","Select",""],["","08290320119","ULTRA-FINE MINI PEN NEEDLE","31 GX3\/16\"","100","Select","Select",""],["","16729044815","LEVOTHYROXINE SODIUM","50 MCG","90","Select","Select",""],["","10702005601","OXYCODONE HCL","10 MG","60","Select","Select",""],["","76385012450","METHOCARBAMOL","750 MG","60","Select","Select",""],["","31722052201","HYDRALAZINE HCL","100 MG","270","Select","Select",""],["","65162083366","DICLOFENAC SODIUM","1 %","100","Select","Select",""],["","65862024608","LEVETIRACETAM","500 MG","180","Select","Select",""],["","00002822259","INSULIN LISPRO KWIKPEN U-","100 100\/ML","6","Select","Select",""],["","49502039475","INSULIN GLARGINE-YFGN","100\/ML (3)","6","Select","Select",""],["","31722071390","PANTOPRAZOLE SODIUM","40 MG","90","Select","Select",""],["","00143177201","ISOSORBIDE DINITRATE","20 MG","540","Select","Select",""],["","60505265605","TRIAMTERENE-HYDROCHLOROTHIAZID","37.5-25 MG","90","Select","Select",""],["","00093505698","ATORVASTATIN CALCIUM","10 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":""}]}]}