{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"PATRICIA A BROWN","gend":1,"add":"3217 TRENTON ST TRLR 30","city":"HOPEWELL","state":"VA","zip":"23860-9998","dob":"1968-09-16","age":"","mstatus":"","insh":"8706808*01","cliId":"","pno":4848616281,"cno":4848616281,"email":"","ename":"","eno":"","pphy":"MISSERI, MARIA NP","ppno":8044588583,"pcpadd":"1012 WINSTON CHURCHILL DR,","pcpcity":"HOPEWELL","pcpstate":"VA","pcpzip":"23860-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":8045412724,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H11.33","I10.","E11.9","E78.5","Z04.9","R07.89","U07.1","B34.9","J44.9","E11.65","F17.210","Z98.891","Z79.4","H10.31","L53.9","R22.9","B35.1","L84.","M21.621","E11.41","R55.","R51.9","R11.0","R42.","M79.671","M79.89","J32.9","R07.9","F17.200","Z20.822","Z79.84","Z01.810","L29.9","R21.","R06.00","E78.2","Z68.31","K57.92","N76.0","K21.9","E11.69","E08.3511","I21.4","R79.1","M20.42","L03.213","H15.101","H15.001","H02.843","H10.9","M25.774","Z01.812","E78.00","E11.3511","R68.83","R94.31","R10.13","K57.32","H10.45","H25.013","E11.3213","H04.123","H43.393","I50.30","I20.9","R11.2","R63.0"],"date":["2021-02-26","2023-06-21","2023-06-21","2022-06-30","2021-12-19","2022-01-25","2022-01-25","2022-01-25","2022-12-02","2022-12-02","2023-04-25","2022-01-25","2022-01-25","2022-09-23","2022-09-23","2022-09-23","2022-10-05","2022-10-05","2022-12-02","2022-10-05","2023-01-28","2023-01-28","2023-01-28","2023-01-28","2023-03-07","2023-03-07","2021-10-08","2021-10-08","2022-12-02","2022-03-01","2022-06-30","2022-02-18","2022-06-30","2022-06-30","2021-02-11","2021-02-11","2021-02-11","2021-06-18","2021-09-18","2021-09-18","2021-12-13","2021-12-13","2022-01-25","2022-01-25","2022-03-04","2022-09-23","2022-09-23","2022-09-23","2022-09-23","2021-03-01","2022-12-02","2022-03-01","2022-12-02","2021-12-13","2021-12-19","2023-06-21","2023-06-21","2021-04-13","2021-10-27","2021-10-27","2021-10-27","2021-10-27","2021-10-27","2022-01-26","2022-01-26","2023-06-21","2023-06-21"],"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":[["","00378718505","METFORMIN","TAB 500MG","90","Select","Select",""],["","43598044828","NICOTINE TD","DIS 21MG\/24H","28","Select","Select",""],["","65162062711","TRAMADOL HCL","TAB 50MG","30","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","32","Select","Select",""],["","57237000511","FLUCONAZOLE","TAB 150MG","1","Select","Select",""],["","50228014610","HYDROCHLOROT","CAP 12.5MG","30","Select","Select",""],["","59651005230","EZETIMIBE","10 MG","90","Select","Select",""],["","31722001701","FAMOTIDINE","20 MG","28","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","68180096301","ALBUTEROL","AER HFA","8","Select","Select",""],["","68180016011","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","00173086910","ANORO ELLIPT","AER 62.5-25","60","Select","Select",""],["","57237007810","ONDANSETRON","TAB 8MG ODT","18","Select","Select",""],["","00406051205","OXYCOD\/APAP","TAB 5-325MG","35","Select","Select",""],["","00093314705","CEPHALEXIN","CAP 500MG","14","Select","Select",""],["","64380080707","IBUPROFEN","TAB 800MG","60","Select","Select",""],["","50111033402","METRONIDAZOL","TAB 500MG","30","Select","Select",""],["","00054418625","DEXAMETHASON","TAB 6MG","3","Select","Select",""],["","31722072690","MONTELUKAST","TAB 10MG","90","Select","Select",""],["","68180029407","DULOXETINE","CAP 20MG","90","Select","Select",""],["","68180035202","SERTRALINE","TAB 50MG","30","Select","Select",""],["","00378668877","PANTOPRAZOLE","TAB 20MG","30","Select","Select",""],["","69452015120","VITAMIN D","CAP 50000UNT","4","Select","Select",""],["","00363010706","WAL-DRYL","CAP 25MG","20","Select","Select",""],["","24208091055","ERYTHROMYCIN","OIN 5MG\/GM","4","Select","Select",""],["","00904530660","BANOPHEN","CAP 25MG","20","Select","Select",""],["","68382070718","DOXYCYC MONO","CAP 100MG","14","Select","Select",""],["","00781185220","AMOX\/K CLAV","TAB 875-125","14","Select","Select",""],["","68382005105","MELOXICAM","TAB 15MG","30","Select","Select",""],["","00406048410","APAP\/CODEINE","TAB 300-30MG","25","Select","Select",""],["","00143992801","CIPROFLOXACN","TAB 500MG","20","Select","Select",""],["","00536132701","ACETAMINOPHE","TAB 325MG","30","Select","Select",""],["","11822332470","ANTACID-ANTIGAS","200-200-20","355","Select","Select",""],["","65162063609","PANTOPRAZOLE SODIUM","20 MG","14","Select","Select",""],["","00406012301","HYDROCODONE-ACETAMINOPHEN","5 MG-325MG","5","Select","Select",""],["","00406051205","OXYCODONE-ACETAMINOPHEN","5 MG-325MG","42","Select","Select",""],["","68462019001","NAPROXEN","500 MG","30","Select","Select",""],["","00378718505","METFORMIN TAB","500MG","30","Select","Select",""],["","43598044828","NICOTINE TD DIS","21MG\/24H","28","Select","Select",""],["","65162062711","TRAMADOL HCL TAB","50MG","30","Select","Select",""],["","68180016011","AZITHROMYCIN TAB","250MG","6","Select","Select",""],["","00173086910","ANORO ELLIPT AER","62.5-25","60","Select","Select",""],["","60505082901","FLUTICASONE SPR","50MCG","16","Select","Select",""],["","59310057922","PROAIR HFA AER","","8","Select","Select",""],["","68180096301","ALBUTEROL AER HFA","","26","Select","Select",""],["","00172572960","FAMOTIDINE TAB","40MG","5","Select","Select",""],["","57237000511","FLUCONAZOLE TAB","150MG","1","Select","Select",""],["","69238115409","EZETIMIBE TAB","10MG","30","Select","Select",""],["","50228014610","HYDROCHLOROT CAP","12.5MG","30","Select","Select",""],["","00406051205","OXYCOD\/APAP TAB","5-325MG","35","Select","Select",""],["","64380080707","IBUPROFEN TAB","800MG","60","Select","Select",""],["","31722072690","MONTELUKAST TAB","10MG","90","Select","Select",""],["","68180029407","DULOXETINE CAP","20MG","90","Select","Select",""],["","00378668977","PANTOPRAZOLE TAB","40MG","90","Select","Select",""],["","68180035202","SERTRALINE TAB","50MG","30","Select","Select",""],["","69452015120","VITAMIN D CAP","50000UNT","4","Select","Select",""],["","00093314705","CEPHALEXIN CAP","500MG","14","Select","Select",""],["","57237007810","ONDANSETRON TAB","8MG ODT","18","Select","Select",""],["","00536132701","ACETAMINOPHE TAB","325MG","30","Select","Select",""],["","00363010706","WAL-DRYL CAP","25MG","20","Select","Select",""],["","00143992801","CIPROFLOXACN TAB","500MG","20","Select","Select",""],["","50111033402","METRONIDAZOL TAB","500MG","30","Select","Select",""],["","00904530660","BANOPHEN CAP","25MG","20","Select","Select",""],["","00054418625","DEXAMETHASON TAB","6MG","3","Select","Select",""],["","68382005105","MELOXICAM TAB","15MG","30","Select","Select",""],["","00574402435","ERYTHROMYCIN OIN","5MG\/GM","4","Select","Select",""],["","68382070718","DOXYCYC MONO CAP","100MG","14","Select","Select",""],["","00781185220","AMOX\/K CLAV TAB","875-125","14","Select","Select",""],["","00406048410","APAP\/CODEINE TAB","300-30MG","25","Select","Select",""],["","68180096301","ALBUTEROL SULFATE HFA","90 MCG","8.5","Select","Select",""],["","57237000299","HYDROCHLOROTHIAZIDE","12.5 MG","90","Select","Select",""],["","00002143380","TRULICITY","0.75MG\/0.5","2","Select","Select",""],["","60505082901","FLUTICASONE PROPIONATE","50 MCG","32","Select","Select",""],["","53885004601","ONETOUCH ULTRA","2","1","Select","Select",""],["","53885024510","ONETOUCH ULTRA TEST STRIP","","100","Select","Select",""],["","31722072690","MONTELUKAST SODIUM","10 MG","90","Select","Select",""],["","00173086910","ANORO ELLIPTA","62.5-25MCG","60","Select","Select",""],["","53885000810","ONETOUCH DELICA PLUS LANCET","33 GAUGE","100","Select","Select",""],["","53885013610","ONETOUCH DELICA","33 GAUGE","100","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":""}]}]}