{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KATRINA HODGES","gend":1,"add":"114 N OAK AVE","city":"HENRICO","state":"VA","zip":"23075-9998","dob":"1970-12-07","age":"","mstatus":"","insh":"9291903*01","cliId":"","pno":8049978208,"cno":8049978208,"email":"","ename":"","eno":"","pphy":"KING, TONY R MD","ppno":8042304913,"pcpadd":"1606 HULL ST STE A,","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":"23224-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":8042331841,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F33.1","F11.20","J18.9","A41.9","R91.8","I26.99","F41.1","G89.4","F32.1","M79.7","R11.2","Z79.01","Z12.11","Z01.419","F17.210","Z90.710","Z79.899","Z03.89","E55.9","E78.2","Z13.6","Z12.39","Z13.1","D64.9","Z68.27","J45.909","F41.9","R65.20","I95.9","U07.1","A15.0","J96.01","J45.901","J45.31","Z13.39","F51.4","Z12.31","L85.3","F14.20","F33.2","F11.21","F10.10","R07.9","A49.01","J98.4","R78.81","F17.200","N39.0","Z91.19","Z86.711","A15.7","J10.08","J86.0","J47.9","Z20.822","Z79.82","Z86.15","Z79.51","J44.1","R06.02","F31.9","B95.7","B96.20","Z68.23","J18.1","R76.12","J15.211","T40.3X5A","Z51.5","R05.9","A15.9","R05.8","C79.9","G89.3","Z68.26","C34.90","R59.0","R07.89","N30.00","E87.1","R79.89","R65.21","J18.8","J84.89","NO DATA","D63.8","R09.02","D84.9","E87.2","G62.9","E87.6","B96.89","Z86.11","Z87.891","J10.1","J45.41","R20.2","K59.00","R20.0","G56.01"],"date":["2021-06-18","2023-06-20","2022-03-22","2022-02-11","2022-09-26","2022-03-22","2023-05-16","2022-04-14","2022-11-10","2023-05-17","2022-08-22","2022-08-22","2023-05-16","2022-11-02","2023-05-16","2022-11-02","2023-05-17","2022-04-13","2022-07-11","2022-12-23","2022-07-11","2022-07-11","2022-07-11","2022-09-26","2022-09-26","2023-01-09","2023-01-26","2022-02-02","2022-01-26","2022-03-22","2022-02-16","2022-12-01","2022-12-01","2023-01-26","2021-02-03","2023-01-26","2021-02-03","2021-02-03","2021-05-18","2021-05-18","2021-05-18","2021-05-18","2023-01-09","2022-03-22","2022-03-22","2022-02-22","2022-03-22","2022-03-22","2022-02-11","2022-11-29","2022-08-04","2022-11-29","2022-11-29","2022-11-29","2022-11-29","2023-01-09","2022-11-29","2022-11-29","2023-01-09","2023-01-09","2021-04-01","2022-02-10","2022-02-10","2022-02-10","2022-03-22","2022-03-22","2022-03-22","2022-03-22","2022-01-26","2022-01-26","2022-02-09","2022-02-09","2022-01-07","2022-01-25","2021-12-22","2022-01-07","2022-01-07","2023-01-09","2022-01-24","2022-01-24","2022-01-24","2022-02-08","2022-02-08","2022-02-08","2022-02-08","2022-02-08","2022-02-08","2022-01-25","2022-01-25","2022-01-25","2022-01-25","2022-01-25","2022-02-08","2022-02-22","2022-11-29","2022-11-29","2023-08-28","2023-05-16","2023-08-28","2023-09-18"],"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":[["","71093011105","GABAPENTIN","600 MG","90","Select","Select",""],["","69097052444","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","69097015907","MELOXICAM","TAB 15MG","30","Select","Select",""],["","00781107905","ALPRAZOLAM","1 MG","90","Select","Select",""],["","65162052110","PROMETHAZINE","TAB 25MG","100","Select","Select",""],["","50111056001","TRAZODONE","TAB 50MG","30","Select","Select",""],["","69452015120","VITAMIN D","2 1250 MCG","4","Select","Select",""],["","00085113201","PROVENTIL","AER HFA","7","Select","Select",""],["","69097014260","ALBUTEROL","AER HFA","7","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","45802049383","AMMONIUM LAC","CRE 0.12","140","Select","Select",""],["","69097083412","SERTRALINE","TAB 50MG","30","Select","Select",""],["","70377002911","ATORVASTATIN","TAB 40MG","90","Select","Select",""],["","00093310905","AMOXICILLIN","CAP 500MG","21","Select","Select",""],["","71930005552","APAP\/CODEINE","TAB 300-30MG","16","Select","Select",""],["","49483060450","IBUPROFEN","TAB 800MG","21","Select","Select",""],["","10702001801","OXYCODONE","TAB 5MG","28","Select","Select",""],["","45802000403","HYDROCORT","CRE 0.025","28","Select","Select",""],["","00093117410","PENICILLN VK","TAB 500MG","28","Select","Select",""],["","00603188016","LIDOCAINE","PAD 0.05","5","Select","Select",""],["","00003089421","ELIQUIS","TAB 5MG","60","Select","Select",""],["","69584061250","METHOCARBAM","TAB 750MG","15","Select","Select",""],["","65862050320","AMOX\/K CLAV","TAB 875-125","28","Select","Select",""],["","69315012710","FOLIC ACID","TAB 1000MCG","90","Select","Select",""],["","59651024701","MIDODRINE","TAB 5MG","90","Select","Select",""],["","24658031205","DOXYCYCL HYC","TAB 100MG","10","Select","Select",""],["","23155013525","DOXYCYC MONO","TAB 100MG","40","Select","Select",""],["","59779060027","CVS ASPIRIN","TAB 81MG EC","30","Select","Select",""],["","43386009019","GAVILYTE-G","SOL ","4000","Select","Select",""],["","00536100901","FERROUS SULF","TAB 325MG","90","Select","Select",""],["","69339014919","GUAIF\/DM HBR","SYP 100-10\/5","236","Select","Select",""],["","00173071820","FLOVENT HFA","44 MCG","10.6","Select","Select",""],["","66993007896","FLUTICAS HFA","AER 44MCG","11","Select","Select",""],["","00310737020","BUDES\/FORMOT","AER 160-4.5","10","Select","Select",""],["","47335075649","IPRATROPIUM\/","SOL ALBUTER","90","Select","Select",""],["","00186037020","SYMBICORT","AER 160-4.5","10","Select","Select",""],["","69238126601","OSELTAMIVIR","CAP 75MG","10","Select","Select",""],["","59746017509","PREDNISONE","20 MG","15","Select","Select",""],["","53746052101","PROMETHAZINE HCL","25 MG","100","Select","Select",""],["","69097014260","ALBUTEROL SULFATE HFA","90 MCG","6.7","Select","Select",""],["","69842097417","DICLOFENAC SODIUM","1 %","50","Select","Select",""],["","24658031205","DOXYCYCLINE HYCLATE","100 MG","14","Select","Select",""],["","69097017353","IPRATROPIUM-ALBUTEROL","0.5-3MG\/3","90","Select","Select",""],["","59779060027","ASPIRIN EC","81 MG","30","Select","Select",""],["","10702001801","OXYCODONE TAB","5MG","28","Select","Select",""],["","53746052101","PROMETHAZINE TAB","25MG","100","Select","Select",""],["","71093011105","GABAPENTIN TAB","600MG","90","Select","Select",""],["","69452015120","VITAMIN D CAP","50000UNT","4","Select","Select",""],["","00781107905","ALPRAZOLAM TAB","1MG","90","Select","Select",""],["","69097014260","ALBUTEROL AER HFA","","7","Select","Select",""],["","65862050320","AMOX\/K CLAV TAB","875-125","28","Select","Select",""],["","59310057922","PROAIR HFA AER","","8","Select","Select",""],["","69315012710","FOLIC ACID TAB","1000MCG","30","Select","Select",""],["","59651024701","MIDODRINE TAB","5MG","90","Select","Select",""],["","00003089421","ELIQUIS TAB","5MG","60","Select","Select",""],["","69842097417","DICLOFENAC GEL","1%","50","Select","Select",""],["","24658031205","DOXYCYCL HYC TAB","100MG","10","Select","Select",""],["","45802000403","HYDROCORT CRE","2.5%","28","Select","Select",""],["","23155013525","DOXYCYC MONO TAB","100MG","40","Select","Select",""],["","43386009019","GAVILYTE-G SOL","","4000","Select","Select",""],["","59779060027","CVS ASPIRIN TAB","81MG EC","30","Select","Select",""],["","00536100901","FERROUS SULF TAB","325MG","90","Select","Select",""],["","00186037020","SYMBICORT AER","160-4.5","10","Select","Select",""],["","47335075649","IPRATROPIUM\/ SOL ALBUTER","","90","Select","Select",""],["","00310737020","BUDES\/FORMOT AER","160-4.5","10","Select","Select",""],["","69339014919","GUAIF\/DM HBR SYP","100-10\/5","236","Select","Select",""],["","00378064110","PREDNISONE TAB","10MG","30","Select","Select",""],["","50090091600","FLOVENT HFA AER","44MCG","11","Select","Select",""],["","66993007896","FLUTICAS HFA AER","44MCG","11","Select","Select",""],["","69238126601","OSELTAMIVIR CAP","75MG","10","Select","Select",""],["","00093216568","NALOXONE HCL","4 MG","2","Select","Select",""],["","59385004130","SYMPROIC","0.2 MG","30","Select","Select",""],["","70710122600","AMITRIPTYLINE HCL","25 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":""}]}]}