{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KIMBERLEY A BAILEY","gend":1,"add":"9103 FAYEMONT DR APT 203","city":"MECHANICSVILLE","state":"VA","zip":"23116-9998","dob":"1971-03-09","age":"","mstatus":"","insh":"8670641*01","cliId":"","pno":8043042777,"cno":8043042777,"email":"","ename":"","eno":"","pphy":"GLADFELTER, BAMBI DO","ppno":8047469055,"pcpadd":"7571 COLD HARBOR ROAD SUITE 1,","pcpcity":"MECHANICSVILLE","pcpstate":"VA","pcpzip":"23111-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":8047302037,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z23.","E86.0","C19.","Z51.11","R11.2","G62.0","Z79.01","Z86.718","R10.30","K59.00","Z01.812","Z20.822","C18.9","I82.B11","M25.562","R03.0","Z12.11","K64.8","F41.9","E03.9","E66.01","Z98.0","Z68.43","Z79.899","Z85.048","F33.1","R27.0","I62.9","I10.","E07.9","Z79.890","Z87.891","R42.","C20.","T82.528A","Z68.42","T82.9XXA","N39.0","R30.0","F40.240","Z91.89","K63.5","K63.89","M79.89","M79.601","D70.1","R22.1","R10.9","K64.9","T78.40XA","R26.2"],"date":["2021-05-18","2021-08-06","2023-09-13","2022-11-29","2022-11-29","2021-11-30","2022-11-29","2022-11-29","2021-03-16","2021-03-16","2021-03-26","2021-03-26","2021-03-30","2021-07-30","2022-07-25","2022-07-25","2022-09-28","2022-09-28","2022-09-28","2022-11-18","2022-09-28","2022-09-28","2022-09-28","2022-09-28","2022-09-28","2023-02-24","2022-11-18","2022-11-16","2022-11-18","2022-11-16","2022-11-16","2022-11-16","2022-11-18","2021-03-30","2021-08-04","2021-03-30","2022-11-29","2022-04-20","2022-04-20","2022-11-18","2022-11-18","2021-03-16","2021-03-16","2021-07-30","2021-07-30","2022-11-29","2022-11-29","2021-03-08","2022-09-28","2022-09-28","2022-11-17"],"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":[["","68462010530","ONDANSETRON","TAB 4MG","4","Select","Select",""],["","00378161001","DICYCLOMINE","CAP 10MG","60","Select","Select",""],["","10572010001","PEG-3350","SOL ELECTROL","4000","Select","Select",""],["","45963070911","METOPROL SUC","TAB 25MG ER","60","Select","Select",""],["","00591544305","PREDNISONE","TAB 20MG","10","Select","Select",""],["","00406051205","OXYCOD\/APAP","TAB 5-325MG","12","Select","Select",""],["","49884068905","METOCLOPRAM","TAB 10MG","30","Select","Select",""],["","00378623301","CITALOPRAM","TAB 40MG","90","Select","Select",""],["","00713052612","PROMETHEGAN","SUP 25MG","12","Select","Select",""],["","68180031909","BUPROPN HCL","TAB 150MG XL","90","Select","Select",""],["","43547028910","BUPROPION","TAB 150MG SR","90","Select","Select",""],["","00093117701","NEOMYCIN","TAB 500MG","6","Select","Select",""],["","00406055201","OXYCODONE","TAB 5MG","20","Select","Select",""],["","50111033402","METRONIDAZOL","TAB 500MG","3","Select","Select",""],["","11917004918","ACETAMIN","TAB 500MG","40","Select","Select",""],["","59746011506","PROCHLORPER","TAB 10MG","90","Select","Select",""],["","31604002674","D3","TAB 2000UNIT","30","Select","Select",""],["","31722072250","LEVOFLOXACIN","TAB 500MG","5","Select","Select",""],["","00093342605","LORAZEPAM","TAB 1MG","30","Select","Select",""],["","00054418325","DEXAMETHASON","TAB 2MG","40","Select","Select",""],["","00003089421","ELIQUIS","TAB 5MG","60","Select","Select",""],["","00003376474","ELIQUIS ST P","TAB 5MG","74","Select","Select",""],["","69238183701","LEVOTHYROXIN","TAB 137MCG","90","Select","Select",""],["","42806054701","VITAMIN D","2 1250 MCG","12","Select","Select",""],["","66993059402","AMPHET\/DEXTR","CAP 5MG ER","30","Select","Select",""],["","54092038101","ADDERALL XR","CAP 5MG","30","Select","Select",""],["","65862042005","SMZ\/TMP DS","TAB 800-160","14","Select","Select",""],["","75826011510","PHENAZOPYRID","TAB 200MG","6","Select","Select",""],["","68180072003","AMLODIPINE","TAB 5MG","30","Select","Select",""],["","52268020101","SUTAB","TAB ","24","Select","Select",""],["","10135015401","BISACODYL","TAB 5MG EC","2","Select","Select",""],["","10572001201","SODIUM\/POTAS","SOL MAGNESIU","354","Select","Select",""],["","52268001201","SUPREP BOWEL","SOL PREP KIT","354","Select","Select",""],["","52268010001","GOLYTELY","SOL ","4000","Select","Select",""],["","69097052444","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","00406012405","HYDROCO\/APAP","TAB 7.5-325","30","Select","Select",""],["","70710116201","MECLIZINE","TAB 25MG","20","Select","Select",""],["","68462026190","ROSUVASTATIN","TAB 5MG","90","Select","Select",""],["","00280200020","BAYER ASA","TAB 325MG","30","Select","Select",""],["","00536100836","ASPIRIN","CHW 81MG","30","Select","Select",""],["","60505265301","TRAZODONE","TAB 50MG","60","Select","Select",""],["","59651039001","BUSPIRONE","TAB 7.5MG","60","Select","Select",""],["","68462026190","ROSUVASTATIN CALCIUM","5 MG","30","Select","Select",""],["","00093083205","CLONAZEPAM","0.5 MG","30","Select","Select",""],["","65862001230","SERTRALINE HCL","50 MG","30","Select","Select",""],["","42806041605","BUPROPION XL","300 MG","90","Select","Select",""],["","13668001105","CITALOPRAM HBR","40 MG","90","Select","Select",""],["","60505265301","TRAZODONE HCL","50 MG","180","Select","Select",""],["","45963067611","METOPROLOL SUCCINATE","50 MG","60","Select","Select",""],["","69238183701","LEVOTHYROXINE SODIUM","137 MCG","90","Select","Select",""],["","69452015120","VITAMIN D CAP","50000UNT","4","Select","Select",""],["","00378623301","CITALOPRAM TAB","40MG","30","Select","Select",""],["","54092038101","ADDERALL XR CAP","5MG","30","Select","Select",""],["","69238183701","LEVOTHYROXIN TAB","137MCG","90","Select","Select",""],["","66993059402","AMPHET\/DEXTR CAP","5MG ER","30","Select","Select",""],["","75826011510","PHENAZOPYRID TAB","200MG","6","Select","Select",""],["","68180032002","BUPROPN HCL TAB","300MG XL","90","Select","Select",""],["","45963070911","METOPROL SUC TAB","25MG ER","58","Select","Select",""],["","65862042005","SMZ\/TMP DS TAB","800-160","14","Select","Select",""],["","68462010530","ONDANSETRON TAB","4MG","4","Select","Select",""],["","10572010001","PEG-","3350 SOL ELECTROL","4000","Select","Select",""],["","69097052444","DICLOFENAC GEL","1%","100","Select","Select",""],["","68180072003","AMLODIPINE TAB","5MG","30","Select","Select",""],["","00406012405","HYDROCO\/APAP TAB","7.5-325","30","Select","Select",""],["","52268001201","SUPREP BOWEL SOL PREP KIT","","354","Select","Select",""],["","10572001201","SODIUM\/POTAS SOL MAGNESIU","","354","Select","Select",""],["","00536100836","ASPIRIN CHW","81MG","30","Select","Select",""],["","52268010001","GOLYTELY SOL","","4000","Select","Select",""],["","10135015401","BISACODYL TAB","5MG EC","2","Select","Select",""],["","00093342605","LORAZEPAM TAB","1MG","30","Select","Select",""],["","68462026190","ROSUVASTATIN TAB","5MG","30","Select","Select",""],["","00280200020","BAYER ASA TAB","325MG","30","Select","Select",""],["","60505265301","TRAZODONE TAB","50MG","60","Select","Select",""],["","59651039001","BUSPIRONE TAB","7.5MG","60","Select","Select",""],["","70710116201","MECLIZINE TAB","25MG","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":""}]}]}