{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MICHELLE   L PENN","gend":1,"add":"610 MADISON ST","city":"EMPORIA","state":"VA","zip":"23847-9998","dob":"1990-09-22","age":"","mstatus":"","insh":"5088399*01","cliId":"","pno":4343217169,"cno":4343217169,"email":"","ename":"","eno":"","pphy":"POWERS, LINDA P MD","ppno":4345842025,"pcpadd":"514 W ATLANTIC ST","pcpcity":"SOUTH HILL","pcpstate":"VA","pcpzip":"23970-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":4344472240,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F41.9","F41.0","F44.4","G47.33","F31.13","J02.0","Z20.828","K29.70","K21.9","K44.9","F41.1","E55.9","G43.909","F44.5","R25.1","Z68.42","J30.9","R51.9","F33.1","F33.0","U07.1","J45.21","F43.12","R71.8","R42.","Z03.818","R07.9","J06.9","Z72.0","J02.9","R06.02","F17.210","E66.01","J45.909","Z88.1","T43.205A","F41.8","R00.0","R94.31","I49.3","R53.83","F44.9","R56.9","I73.00","R06.00","E53.8","G43.109","G47.9","N92.6","M22.2X2","M23.92","M25.562","Z51.81","G47.39","I10.","Z86.16","R55.","F33.2","Z91.199","R03.0","R00.2","G44.209","E66.9","S83.92XA","Y93.56","G47.8","L98.9","R06.09","Z23.","Z76.89","R07.89","D72.829","NO DATA","F43.10","Z20.822","Z79.899","R05.9","K59.00","R35.0","J45.20","J45.998"],"date":["2022-09-07","2023-01-06","2023-01-06","2023-01-27","2022-09-25","2022-10-03","2022-10-03","2022-10-17","2023-01-04","2022-10-26","2023-01-27","2023-01-27","2023-01-27","2023-01-27","2023-01-27","2023-01-27","2022-09-07","2021-12-22","2021-05-02","2021-11-03","2022-04-07","2022-04-07","2022-10-24","2021-01-21","2022-11-18","2022-01-24","2021-12-23","2022-04-06","2022-11-18","2021-10-13","2023-01-04","2023-01-04","2023-01-04","2023-01-04","2022-01-09","2021-08-11","2021-08-29","2023-01-31","2023-01-31","2021-10-04","2022-06-30","2022-11-18","2022-11-18","2021-01-12","2021-10-14","2021-01-12","2021-01-12","2021-01-12","2021-01-12","2021-10-05","2021-12-07","2021-12-07","2022-04-29","2022-09-07","2022-10-05","2022-10-05","2022-10-05","2022-10-24","2022-11-18","2022-11-09","2023-03-04","2021-01-26","2021-01-26","2021-05-07","2021-05-07","2021-10-27","2021-10-27","2021-06-18","2021-10-06","2022-01-24","2021-01-07","2021-02-04","2022-01-06","2022-01-06","2022-01-09","2022-01-09","2022-01-09","2022-03-04","2022-03-04","2022-10-26","2021-10-14"],"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":[["","00378064110","PREDNISONE","10 MG","18","Select","Select",""],["","74312058912","B-12","SUB 5000MCG","8","Select","Select",""],["","65862001330","SERTRALINE","TAB 100MG","90","Select","Select",""],["","00093506101","HYDROXYZ HCL","TAB 25MG","28","Select","Select",""],["","00093342501","LORAZEPAM","TAB 0.5MG","30","Select","Select",""],["","69238110005","DOXYCYCL HYC","CAP 100MG","20","Select","Select",""],["","69315012701","FOLIC ACID","TAB 1000MCG","30","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","00904671740","CETIRIZINE","TAB 10MG","90","Select","Select",""],["","00093005301","BUSPIRONE","TAB 5MG","60","Select","Select",""],["","43547028910","BUPROPION","TAB 150MG SR","180","Select","Select",""],["","69097012303","TOPIRAMATE","50 MG","30","Select","Select",""],["","49483060450","IBUPROFEN","TAB 800MG","21","Select","Select",""],["","65862019105","CYCLOBENZAPR","TAB 10MG","21","Select","Select",""],["","00603254428","BUT\/APAP\/CAF","TAB ","15","Select","Select",""],["","00310737020","BUDES\/FORMOT","AER 160-4.5","10","Select","Select",""],["","00173071920","FLOVENT HFA","AER 110MCG","12","Select","Select",""],["","00186037020","SYMBICORT","AER 160-4.5","10","Select","Select",""],["","68382005101","MELOXICAM","TAB 15MG","15","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","00093310905","AMOXICILLIN","500 MG","21","Select","Select",""],["","00121075908","PREDNISOLONE","SOL 15MG\/5ML","15","Select","Select",""],["","00006483703","PNEUMOVAX 23","INJ 25\/0.5","0","Select","Select",""],["","00173085910","BREO ELLIPTA","INH 100-25","60","Select","Select",""],["","00904676320","ROBAFEN","LIQ 200\/10ML","120","Select","Select",""],["","63736012301","VITRON-C","TAB 65-125","30","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","00228202910","ALPRAZOLAM","0.5 MG","42","Select","Select",""],["","00832105410","BACLOFEN","TAB 10MG","15","Select","Select",""],["","49483070210","FLUOXETINE","CAP 20MG","90","Select","Select",""],["","31722071390","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","45802006435","TRIAMCINOLON","CRE 0.001","45","Select","Select",""],["","65862057490","MONTELUKAST","TAB 10MG","30","Select","Select",""],["","31722070530","VALACYCLOVIR","TAB 1GM","21","Select","Select",""],["","16729013616","CLONAZEPAM","TAB 0.5MG","30","Select","Select",""],["","55111064501","OMEPRAZOLE","CAP 40MG","90","Select","Select",""],["","00085720601","DULERA","AER 100-5MCG","13","Select","Select",""],["","54838011770","SILTUSSIN SA","SYP 100\/5ML","120","Select","Select",""],["","68180072305","CEFDINIR","SUS 250\/5ML","100","Select","Select",""],["","11822771100","RA TUSSIN","LIQ 100\/5ML","118","Select","Select",""],["","62756052269","SUMATRIPTAN","TAB 100MG","9","Select","Select",""],["","64380073706","VITAMIN D","2 1250 MCG","4","Select","Select",""],["","50428062110","MELATONIN","TAB 3MG","30","Select","Select",""],["","00172392670","DIAZEPAM","TAB 5MG","30","Select","Select",""],["","00023650110","UBRELVY","TAB 100MG","10","Select","Select",""],["","16714069101","FLUCONAZOLE","TAB 100MG","4","Select","Select",""],["","11527075534","SOD FLUORIDE","GEL 0.011","100","Select","Select",""],["","65862085901","FAMOTIDINE","TAB 20MG","30","Select","Select",""],["","70710145701","AZITHROMYCIN","SUS 100\/5ML","30","Select","Select",""],["","65162006205","SUCRALFATE","SUS 1GM\/10ML","280","Select","Select",""],["","65862049001","QUETIAPINE","TAB 50MG","30","Select","Select",""],["","65862050320","AMOX\/K CLAV","TAB 875-125","14","Select","Select",""],["","65862039010","ONDANSETRON","TAB 4MG ODT","10","Select","Select",""],["","00121092716","PROMETHAZINE","SOL 6.25\/5ML","140","Select","Select",""],["","16571066001","MECLIZINE","TAB 12.5MG","30","Select","Select",""],["","63824005718","MUCINEX D","TAB 60-600MG","20","Select","Select",""],["","59779044870","CVS NICOTINE","DIS 21MG\/24H","45","Select","Select",""],["","31722016860","DULOXETINE","CAP 20MG","30","Select","Select",""],["","70461032203","FLUCLVX QUAD","INJ 2022-23","0","Select","Select",""],["","00536589688","NICOTINE TD","DIS 21MG\/24H","28","Select","Select",""],["","00168027740","CLINDAMYCIN","CRE 2% VAG","40","Select","Select",""],["","16571066401","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","80681013100","VITAMIN D3","CAP 5000UNIT","30","Select","Select",""],["","68180067801","OSELTAMIVIR","SUS 6MG\/ML","60","Select","Select",""],["","42799060501","LOPERAMIDE","CAP 2MG","30","Select","Select",""],["","00093005401","BUSPIRONE HCL","10 MG","60","Select","Select",""],["","08290320109","ULTRA-FINE SHORT PEN NEEDLE","31 GX5\/16\"","100","Select","Select",""],["","00378668910","PANTOPRAZOLE SODIUM","40 MG","30","Select","Select",""],["","00169280015","SAXENDA","3 MG\/0.5ML","15","Select","Select",""],["","33342002208","LEVOFLOXACIN","500 MG","10","Select","Select",""],["","65862039010","ONDANSETRON ODT","4 MG","10","Select","Select",""],["","16571040250","CETIRIZINE HCL","10 MG","30","Select","Select",""],["","31722016930","DULOXETINE HCL","30 MG","60","Select","Select",""],["","68180065208","DOXYCYCLINE MONOHYDRATE","100 MG","14","Select","Select",""],["","66993001968","ALBUTEROL SULFATE HFA","90 MCG","18","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":""}]}]}