{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"STEVEN V DALBO","gend":0,"add":"8187 OAKGLEN ROAD","city":"MANASSAS","state":"VA","zip":"20110-9998","dob":"1974-07-27","age":"","mstatus":"","insh":"2418103*01","cliId":"","pno":7038539770,"cno":7038539770,"email":"","ename":"","eno":"","pphy":"NOH, ERIC C DO","ppno":7033683161,"pcpadd":"8640 SUDLEY RD STE 203,","pcpcity":"MANASSAS","pcpstate":"VA","pcpzip":"20110-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"NORTHERN & WINCHESTER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7033682498,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["D62.","R04.0","D61.818","R41.82","W19.XXXA","F10.10","S00.83XA","S30.91XA","Z74.3","I62.00","S06.5X9A","G93.5","J96.01","N17.0","J18.9","D68.9","NO DATA","N13.2","K86.0","E87.3","G93.40","R29.6","D73.1","E11.649","E83.39","E83.42","S06.9X9A","R45.1","G89.11","R00.0","E16.2","R13.10","S06.1X7A","I62.01","M79.2","G44.309","M54.12","M25.511","J38.2","R49.0","J30.9","F10.231","F10.20","S02.2XXK","E11.9","I10.","K76.0","I95.9","J95.821","R90.89","E87.2","Z20.822","R06.82","K86.1","Z79.84","Z79.899","Z87.891","K86.81","R40.20","D69.6","E87.1","E87.5","R41.841","R41.89","S06.6X9S","R47.9","I69.391","R13.12","I69.098","V58.89","R26.81","R26.89","M62.81","R53.81","Z91.81","R56.9","G56.01","E11.65","G47.09","E53.8","E55.9","Z79.4","K21.9","I45.81","Z01.818","M79.641","E11.8","Z86.2","J38.3","S06.9X9S","R63.4","F12.90","S09.92XA","R26.0","D61.810","K71.7","S06.301A","R82.90","Z79.891","R51.9","D64.9","R53.83","E87.6","Z98.890","D70.9","S02.2XXA","S01.21XA","F10.239","W01.190A","F10.220","G31.2","K70.10","F10.230","S02.40DA","R04.2","Z23.","R74.01","F10.129","S09.90XA","A41.9","J96.00","N17.9","D50.0","Z48.811","U07.1","K52.9","N13.30","N20.0","E46.","R64.","R50.9","D47.3","D53.9","G50.8","G43.719","S06.5XAA","E11.42","R53.1","M25.512","G44.321","M25.531","G50.1","R11.2","R11.14","R94.31","E43.","Z51.89","Z80.9","Z99.89","S06.9X0A","G93.6","R54.","F10.288","E87.8","R40.2430","J96.02","S06.5X0A","M19.012","I15.9","Z09.","R26.9","H47.323","H35.40","E08.311","F41.9","F51.04","Z00.00","Z87.898","Z12.5"],"date":["2021-10-22","2021-10-22","2022-03-11","2021-12-28","2022-01-15","2022-01-16","2021-12-08","2021-12-08","2021-12-08","2021-12-28","2022-08-31","2022-01-09","2022-01-02","2022-01-15","2021-12-28","2021-12-28","2023-09-14","2022-01-09","2022-06-20","2021-12-28","2021-12-28","2022-03-11","2021-12-28","2021-12-28","2021-12-28","2021-12-28","2023-06-20","2022-01-15","2022-01-12","2022-11-22","2022-01-12","2022-03-18","2022-03-01","2022-03-01","2022-05-12","2022-06-03","2022-05-05","2022-06-03","2023-03-20","2023-03-20","2023-03-20","2021-10-28","2022-01-04","2021-10-28","2023-09-14","2023-09-14","2022-11-22","2021-12-28","2022-01-08","2021-12-28","2022-01-15","2021-12-28","2021-12-28","2022-11-22","2023-01-30","2022-02-28","2022-02-28","2021-12-28","2021-12-28","2021-12-28","2022-01-15","2022-01-15","2022-05-24","2022-02-09","2022-02-09","2022-02-09","2022-02-17","2022-02-17","2022-04-07","2022-05-24","2022-05-24","2022-05-24","2022-05-24","2022-05-24","2022-05-24","2022-05-24","2023-02-28","2022-12-05","2022-06-20","2022-06-20","2023-09-14","2023-09-14","2022-09-19","2022-11-22","2023-01-19","2023-01-19","2023-01-19","2023-09-14","2023-01-19","2023-01-19","2023-01-19","2023-01-19","2021-10-16","2021-12-23","2022-01-04","2022-01-04","2022-01-24","2022-02-28","2022-02-28","2023-09-14","2022-03-21","2022-03-21","2022-03-21","2023-04-12","2021-10-17","2021-10-16","2021-10-16","2021-10-16","2021-10-16","2021-10-17","2021-10-17","2021-10-17","2021-10-17","2021-10-17","2021-10-17","2021-10-17","2021-10-17","2021-12-08","2021-12-08","2022-01-06","2022-01-09","2022-01-09","2022-01-09","2022-01-15","2022-01-15","2022-01-16","2022-01-16","2022-01-15","2022-11-21","2022-01-15","2022-01-15","2022-02-11","2022-02-11","2022-04-18","2022-11-30","2023-06-20","2023-09-05","2022-03-11","2022-08-03","2023-09-05","2022-05-26","2022-06-03","2022-11-23","2022-11-23","2022-11-21","2022-11-23","2023-02-13","2021-11-29","2021-12-28","2022-01-02","2022-01-02","2022-01-02","2022-01-02","2022-01-02","2022-01-02","2022-01-02","2022-01-24","2022-08-03","2022-11-22","2022-12-05","2022-03-11","2023-07-03","2023-07-03","2023-07-03","2023-09-05","2023-09-05","2023-09-14","2023-09-14","2023-09-14"],"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":[["","57664047758","METOPROL TAR","TAB 50MG","180","Select","Select",""],["","69315012710","FOLIC ACID","1 MG","30","Select","Select",""],["","67877056310","METFORMIN","TAB 1000MG","60","Select","Select",""],["","65862048901","QUETIAPINE","TAB 25MG","60","Select","Select",""],["","10135013201","THIAMINE HCL","TAB 100MG","30","Select","Select",""],["","10006073021","VITAMIN B1","TAB 100MG","30","Select","Select",""],["","65862050320","AMOX\/K CLAV","TAB 875-125","20","Select","Select",""],["","65862098799","POT CHLORIDE","TAB 10MEQ ER","30","Select","Select",""],["","55111032201","GLIMEPIRIDE","TAB 4MG","60","Select","Select",""],["","10702001801","OXYCODONE","TAB 5MG","18","Select","Select",""],["","64980052810","SODIUM BICAR","TAB 650MG","120","Select","Select",""],["","10702025350","BUT\/APAP\/CAF","TAB ","60","Select","Select",""],["","50111056001","TRAZODONE","TAB 50MG","90","Select","Select",""],["","69097094312","GABAPENTIN","300 MG","90","Select","Select",""],["","53885000810","ONETOUCH DEL","MIS PLUS 33G","100","Select","Select",""],["","53885027150","ONETOUCH","TES VERIO","50","Select","Select",""],["","59779014139","ACID CONTROL","TAB 10MG","60","Select","Select",""],["","45802065078","LORATADINE","10 MG","30","Select","Select",""],["","00032122401","CREON","CAP 24000UNT","270","Select","Select",""],["","64980028101","GLIPIZIDE ER","10 MG","90","Select","Select",""],["","69452015120","VITAMIN D","2 1250 MCG","12","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","16571020106","DICLOFENAC","TAB 75MG DR","30","Select","Select",""],["","00955172805","INSULIN GLAR","INJ 100U\/ML","15","Select","Select",""],["","50428048545","CVS B-1","TAB 100MG","30","Select","Select",""],["","08290320550","BD PEN NEEDL","MIS 32GX4MM","100","Select","Select",""],["","65162019050","NAPROXEN","TAB 500MG","60","Select","Select",""],["","70710122600","AMITRIPTYLIN","TAB 25MG","30","Select","Select",""],["","00597015330","JARDIANCE","25 MG","90","Select","Select",""],["","00088221905","LANTUS SOLOS","INJ 100\/ML","15","Select","Select",""],["","00378668910","PANTOPRAZOLE","TAB 40MG","60","Select","Select",""],["","00002143611","EMGALITY","INJ 120MG\/ML","2","Select","Select",""],["","08290320550","NANO","2ND GEN PEN NEEDLE 32GX 5\/32\"","100","Select","Select",""],["","53885027210","ONETOUCH VERIO TEST STRIP","","100","Select","Select",""],["","70710122600","AMITRIPTYLINE HCL","25 MG","30","Select","Select",""],["","10702025350","BUTALBITAL-ACETAMINOPHEN-CAFFE","50-325-40","60","Select","Select",""],["","67877056310","METFORMIN HCL","1000 MG","180","Select","Select",""],["","50111056001","TRAZODONE HCL","50 MG","90","Select","Select",""],["","42858010250","OXYCODONE-ACETAMINOPHEN","5 MG-325MG","12","Select","Select",""],["","00002143611","EMGALITY PEN","120 MG\/ML","1","Select","Select",""],["","65862098799","POTASSIUM CHLORIDE","10 MEQ","90","Select","Select",""],["","00088221905","LANTUS SOLOSTAR","100\/ML (3)","15","Select","Select",""],["","00054327099","FLUTICASONE PROPIONATE","50 MCG","16","Select","Select",""],["","00378668910","PANTOPRAZOLE SODIUM","40 MG","60","Select","Select",""],["","72888000500","METOPROLOL TARTRATE","50 MG","180","Select","Select",""],["","29300014801","QUETIAPINE FUMARATE","50 MG","90","Select","Select",""],["","65862001905","CEPHALEXIN","500 MG","8","Select","Select",""],["","57664047758","METOPROL TAR TAB","50MG","180","Select","Select",""],["","64980052810","SODIUM BICAR TAB","650MG","120","Select","Select",""],["","10702001801","OXYCODONE TAB","5MG","18","Select","Select",""],["","69097094312","GABAPENTIN CAP","300MG","90","Select","Select",""],["","67877056310","METFORMIN TAB","1000MG","180","Select","Select",""],["","65862098799","POT CHLORIDE TAB","10MEQ ER","30","Select","Select",""],["","69315012710","FOLIC ACID TAB","1000MCG","30","Select","Select",""],["","00527169505","BUT\/APAP\/CAF TAB","","30","Select","Select",""],["","29300014801","QUETIAPINE TAB","50MG","90","Select","Select",""],["","50111056101","TRAZODONE TAB","100MG","90","Select","Select",""],["","53885027150","ONETOUCH TES VERIO","","50","Select","Select",""],["","53885065701","ONETOUCH KIT VERIO","","1","Select","Select",""],["","53885000810","ONETOUCH DEL MIS PLUS","33G","100","Select","Select",""],["","45802065078","LORATADINE TAB","10MG","90","Select","Select",""],["","59779014139","ACID CONTROL TAB","10MG","60","Select","Select",""],["","10135013201","THIAMINE HCL TAB","100MG","30","Select","Select",""],["","69452015120","VITAMIN D CAP","50000UNT","4","Select","Select",""],["","64980028101","GLIPIZIDE ER TAB","10MG","90","Select","Select",""],["","00032122401","CREON CAP","24000UNT","270","Select","Select",""],["","00054327099","FLUTICASONE SPR","50MCG","16","Select","Select",""],["","16571020106","DICLOFENAC TAB","75MG DR","30","Select","Select",""],["","65162019050","NAPROXEN TAB","500MG","60","Select","Select",""],["","50428048545","CVS B-","1 TAB 100MG","30","Select","Select",""],["","00597015230","JARDIANCE TAB","10MG","30","Select","Select",""],["","00955172805","INSULIN GLAR INJ","100U\/ML","15","Select","Select",""],["","70710122600","AMITRIPTYLIN TAB","25MG","30","Select","Select",""],["","00002143611","EMGALITY INJ","120MG\/ML","2","Select","Select",""],["","00378668910","PANTOPRAZOLE TAB","40MG","180","Select","Select",""],["","00088221905","LANTUS SOLOS INJ","100\/ML","15","Select","Select",""],["","08290320550","BD PEN NEEDL MIS","32GX4MM","100","Select","Select",""],["","00023320503","LUMIGAN","0.01 %","7.5","Select","Select",""],["","64380078706","BUSPIRONE HCL","7.5 MG","60","Select","Select",""],["","50742061510","METOPROLOL SUCCINATE","25 MG","90","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":""}]}]}