{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"A   ECYOJNOTLEHS ","gend":1,"add":"OB OP149 X","city":"RAVEN","state":"VA","zip":"24639-9998","dob":"1965-10-02","age":"","mstatus":"","insh":"49400210*82","cliId":"","pno":"95\/6724834-8","cno":"","email":"","ename":"","eno":"","pphy":"O'QUINN, ANGEL J DO","ppno":"276\/964-6771","pcpadd":"1 CLINIC DR","pcpcity":"RICHLANDS","pcpstate":"VA","pcpzip":24641,"pcpcounty":"","pcpid":"","pcpname":"CLINCH VALLEY PHYSICIANS ASSOCIATES LLC","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"SOUTHWEST","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M54.40","Z20.828","M54.5","K21.9","K59.09","G47.09","I10.","I25.2","R30.0","R11.0","R31.9","R55.","R23.1","R26.81","R42.","R31.29","Z72.0","Z88.0","M54.42","M25.552","D12.0","K62.1","K57.30","K64.0","Z86.73","E78.2","Z13.6","R06.02","D12.2","K64.8","R76.8","K59.00","Z86.010","R10.11","R07.2","N18.9","R79.89","F17.210","R07.9","N17.9","E86.0","Z09.","E53.8","I51.7","Z01.810","I45.81","I11.9","I50.32"],"date":["2020-12-30","2020-12-30","2021-02-25","2021-02-25","2021-02-25","2021-02-25","2021-02-25","2020-09-10","2020-10-22","2020-10-06","2020-11-10","2020-09-10","2020-09-10","2020-09-10","2020-09-10","2020-10-22","2020-10-22","2020-10-22","2020-03-09","2020-03-09","2019-08-16","2019-08-27","2019-08-27","2019-08-16","2019-10-10","2019-11-14","2019-11-14","2019-11-14","2019-08-27","2019-08-27","2019-01-09","2019-04-25","2019-08-16","2019-02-06","2019-05-05","2019-05-05","2019-05-05","2019-08-16","2019-05-05","2019-05-05","2019-05-05","2019-08-16","2019-07-18","2019-11-14","2019-08-08","2019-08-08","2019-11-14","2019-11-14"],"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":{"indx":[false,false],"comment":["",""],"score":["",""]}},{"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":[["","60505024701","MIRTAZAPINE","TAB 15MG","30","Select","Select",""],["","00591565810","CYCLOBENZAPR","TAB 10MG","90","Select","Select",""],["","51991045757","POLYETH","POW 3350 NF","510","Select","Select",""],["","00536123441","ASPIRIN","TAB 81MG EC","30","Select","Select",""],["","00093001298","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","69097094615","ATORVASTATIN","TAB 40MG","30","Select","Select",""],["","","BISACODYL","TAB 5MG EC","","Select","Select",""],["","57237007710","ONDANSETRON","TAB 4MG ODT","28","Select","Select",""],["","","TELMISARTAN","TAB 80MG","","Select","Select",""],["","29300012410","MELOXICAM","TAB 7.5MG","60","Select","Select",""],["","55111025501","CARVEDILOL","TAB 25MG","60","Select","Select",""],["","67877019990","AMLODIPINE","TAB 10MG","30","Select","Select",""],["","69315011610","FUROSEMIDE","TAB 20MG","30","Select","Select",""],["","52817032000","BACLOFEN","TAB 10MG","90","Select","Select",""],["","00904645760","DOK","CAP 100MG","60","Select","Select",""],["","75834010901","CHLORTHALID","TAB 25MG","15","Select","Select",""],["","80777027399","MODERNA","INJ COVID-19","0","Select","Select",""],["","45802048678","DOCUSATE","CAP 100MG","60","Select","Select",""],["","59779060027","CVS","TAB 81MG EC","30","Select","Select",""],["","50428348640","GENTLE","TAB 5MG EC","30","Select","Select",""],["","00536106210","STOOL","CAP 100MG","60","Select","Select",""],["","00113030603","CLEARLAX","POW ","510","Select","Select",""],["","","GABAPENTIN","CAP 100MG","","Select","Select",""],["","00536338101","STIM","TAB 5MG EC","30","Select","Select",""],["","51660014390","VALSARTAN","TAB 320MG","30","Select","Select",""],["","","FLUCONAZOLE","TAB 150MG","","Select","Select",""],["","","DOXYCYCL","TAB 100MG","","Select","Select",""],["","","CIPROFLOXACN","TAB 500MG","","Select","Select",""],["","50742061610","METOPROL","TAB 50MG ER","30","Select","Select",""],["","43386009019","GAVILYTE-G","SOL ","4000","Select","Select",""],["","00093736698","LOSARTAN","TAB 100MG","30","Select","Select",""],["","43598051030","ESOMEPRA","CAP 40MG DR","30","Select","Select",""],["","52268001201","SUPREP","SOL PREP KIT","354","Select","Select",""],["","43598044874","NICOTINE","DIS 21MG\/24H","28","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":""}]}]}