{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" ALUAPNITSUA","gend":1,"add":"OL 40302EVA LAY","city":"PETERSBURG","state":"VA","zip":"23803-9998","dob":"1959-03-07","age":"","mstatus":"","insh":"33200210*86","cliId":"","pno":"16\/4087082-5","cno":"804\/615-2807","email":"","ename":"","eno":"","pphy":"MCLEOD, JEFFREY L MD","ppno":"804\/763-1058","pcpadd":"#108 5001 W VILLAGE GREEN","pcpcity":"MIDLOTHIAN","pcpstate":"VA","pcpzip":23112,"pcpcounty":"","pcpid":105855,"pcpname":"Jeff McLeod, MD","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"804\/873-4199","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R07.9","Z93.3","K94.19","R11.2","R10.0","K94.13","R06.02","J44.9","R94.31","NO DATA","I48.91","K21.9","N12.","V62.84","F33.3","N39.0","N28.1","N18.9","F41.9","F17.210","Z87.442","Z93.2","Z88.5","Z88.6","Z88.0","R52.","R10.32","R51.9","K91.89","J96.11","K83.8","N28.89","D72.829","D75.1","E87.6","F17.200","I48.0","Z20.822","M79.7","Z79.02","F31.4","F20.0","F25.1","R07.89","T71.193A","M79.89","M79.641","F41.8","M51.37","I73.9","F41.0","E78.00","E55.9","Z79.899","R07.81","Y04.0XXD","I49.1","I51.7","R00.0","R06.89","K50.012","S41.111A","R11.0","F31.32","B35.1","G40.909","M79.675","F43.21","Z91.14","J43.9","F43.10","G89.29","Z59.0","Z91.5","Z62.810","Z88.2","Z79.51","Z51.81","J44.1","G43.909","F25.0"],"date":["2020-12-22","2021-06-28","2021-02-24","2021-06-02","2021-02-24","2021-02-25","2021-06-29","2021-07-23","2021-06-23","2021-02-27","2021-02-27","2021-02-27","2021-06-02","2021-07-15","2021-07-08","2020-09-12","2021-02-26","2020-09-12","2021-07-28","2021-07-15","2020-09-12","2021-02-22","2021-07-15","2021-07-15","2021-07-15","2020-09-12","2020-09-12","2020-12-22","2021-02-26","2021-02-26","2021-02-26","2021-02-26","2021-02-26","2021-02-26","2021-02-26","2021-07-23","2021-05-06","2021-02-26","2021-07-15","2021-05-06","2021-05-25","2021-06-04","2021-10-20","2021-05-06","2021-06-18","2020-07-26","2020-07-26","2021-02-22","2021-02-22","2021-02-22","2021-02-22","2021-02-22","2021-02-22","2021-07-15","2021-04-28","2021-04-28","2021-06-23","2021-06-23","2021-06-23","2021-06-29","2021-02-26","2021-05-06","2021-05-06","2021-07-14","2021-07-23","2021-07-23","2021-07-23","2021-07-19","2021-07-15","2021-07-15","2021-07-28","2021-07-15","2021-07-15","2021-07-15","2021-07-15","2021-07-15","2021-07-15","2021-07-17","2021-06-27","2021-07-18","2021-07-28"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}},{"a":[]}]},{"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":[]}]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","00173069700","ADVAIR ","500\/50","60","Select","Select",""],["","55111019630","CLOPIDOGREL ","75MG","90","Select","Select",""],["","69315090401","LORAZEPAM ","0.5MG","15","Select","Select",""],["","00597015561","STIOLTO ","2.5-2.5","4","Select","Select",""],["","00597010061","SPIRIVA ","2.5MCG","4","Select","Select",""],["","76204060005","IPRATROPIUM\/ ","ALBUTER","90","Select","Select",""],["","62175061746","PANTOPRAZOLE ","40MG","90","Select","Select",""],["","65862017760","CEFDINIR ","300MG","14","Select","Select",""],["","69452015120","VITAMIN ","50000UNT","25","Select","Select",""],["","00406012301","HYDROCO\/APAP ","5-325MG","5","Select","Select",""],["","67877021905","CEPHALEXIN ","500MG","14","Select","Select",""],["","68462015713","ONDANSETRON ","4MG ODT","10","Select","Select",""],["","00143980350","DOXYCYCL ","100MG","14","Select","Select",""],["","69097081307","GABAPENTIN ","100MG","90","Select","Select",""],["","66993058697","FLUTIC\/SALME ","500\/50","60","Select","Select",""],["","45802014167","CICLOPIROX ","8%","7","Select","Select",""],["","23155050210","HYDROXYZ ","50MG","90","Select","Select",""],["","00173086910","ANORO ","62.5-25","60","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","13811071910","NITROFURANTN ","100MG","10","Select","Select",""],["","00254100752","ALBUTEROL ","HFA","7","Select","Select",""],["","55111016330","OLANZAPINE ","2.5MG","90","Select","Select",""],["","00069047103","CHANTIX ","0.5& 1MG","53","Select","Select",""],["","00527293437","PREDNISONE ","20MG","14","Select","Select",""],["","65862064130","AZITHROMYCIN ","250MG","5","Select","Select",""],["","65862001105","SERTRALINE ","25MG","30","Select","Select",""],["","68382011305","RISPERIDONE ","0.5MG","180","Select","Select",""],["","00904679480","ASPIRIN ","81MG","30","Select","Select",""],["","11822511120","RA ","5MG","20","Select","Select",""],["","64380071306","BENZONATATE ","200MG","28","Select","Select",""],["","00406012301","HYDROCO\/APAP","5-325MG","5","Select","Select",""],["","67877021905","CEPHALEXIN","500MG","14","Select","Select",""],["","68462015713","ONDANSETRON","4MG ODT","10","Select","Select",""],["","69097081307","GABAPENTIN","100MG","90","Select","Select",""],["","66993058697","FLUTIC\/SALME","500\/50","60","Select","Select",""],["","00597010061","SPIRIVA","2.5MCG","4","Select","Select",""],["","00173069700","ADVAIR","500\/50","60","Select","Select",""],["","55111019630","CLOPIDOGREL","75MG","90","Select","Select",""],["","69315090401","LORAZEPAM","0.5MG","15","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","00254100752","ALBUTEROL","HFA","7","Select","Select",""],["","13811071910","NITROFURANTN","100MG","10","Select","Select",""],["","00597015561","STIOLTO","2.5-2.5","4","Select","Select",""],["","00173086910","ANORO","62.5-25","60","Select","Select",""],["","62175061746","PANTOPRAZOLE","40MG","90","Select","Select",""],["","55111016330","OLANZAPINE","2.5MG","90","Select","Select",""],["","76204060005","IPRATROPIUM\/","ALBUTER","90","Select","Select",""],["","00904679480","ASPIRIN","81MG","30","Select","Select",""],["","65862017760","CEFDINIR","300MG","14","Select","Select",""],["","69452015120","VITAMIN","50000UNT","25","Select","Select",""],["","65862001105","SERTRALINE","25MG","30","Select","Select",""],["","43547034050","RISPERIDONE","0.5MG","30","Select","Select",""],["","00527293437","PREDNISONE","20MG","14","Select","Select",""],["","00069047103","CHANTIX","0.5& 1MG","53","Select","Select",""],["","65862064130","AZITHROMYCIN","250MG","5","Select","Select",""],["","45802014167","CICLOPIROX","8%","7","Select","Select",""],["","11822511120","RA","5MG","20","Select","Select",""],["","23155050210","HYDROXYZ","50MG","90","Select","Select",""],["","64380071306","BENZONATATE","200MG","28","Select","Select",""],["","00143980350","DOXYCYCL","100MG","14","Select","Select",""]]}},{"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":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[[["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""]]]},{"t":"Mini-Cog","q":[{"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":""}]}]}