{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JACQUELINE L WILKINSON","gend":1,"add":"151 ROSE LN APT 116","city":"APPOMATTOX","state":"VA","zip":24522,"dob":"1947-06-13","age":"","mstatus":"","insh":"900036182*01","cliId":"","pno":"434\/664-9507","cno":"434\/664-9507    ","email":"","ename":"","eno":"","pphy":"ALLEGA, GIULIANA MD","ppno":"434\/315-2850","pcpadd":"935 SOUTH MAIN STREET","pcpcity":"FARMVILLE","pcpstate":"VA","pcpzip":23901,"pcpcounty":"","pcpid":135922,"pcpname":"","plan":"OHP - OPTIMA","program":"MEDICARE","lob":"DSNP","region":"Lynchburg","aligned":"Y","ano":"434\/664-9507, ","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["S80.02XA","N39.0","E66.01","Z88.5","Z88.8","E03.9","E11.65","F32.9","I10.","M17.12","Z79.1","Z79.82","Z79.84","Z79.899","Z96.612","M79.605","S72.92XK","R53.1","W19.XXXA","E87.2","E11.9","Z99.3","E78.5","M19.90","E87.6","Z91.81","G89.4","I25.10","I48.0","F42.9","K21.9","E87.5","F33.9","F41.9","R26.2","N39.41","M62.81","Z72.3","A41.9","K44.9","M17.0","R29.6","M81.0","D64.9","S70.12XA","R09.02","W05.0XXA","R43.9","R05.","Z20.828","Z79.4","Z82.49","M19.019","Z23.","L03.313","F31.31","F41.1","I69.354","Z68.43","Z82.3","Z83.3","T43.211A","G47.33","Z88.1","G62.9","E66.9","R30.0","F31.9","H69.83","L40.9","E87.1","H16.149","M25.569","R00.0","S72.402K","S72.002K","E55.9","Z12.11","R52.","M25.562","S89.91XA","M17.11","B37.2","M16.12","M25.561","Z76.89","U07.1"],"date":["2020-07-08","2020-05-04","2020-11-01","2020-09-01","2020-09-01","2021-03-22","2020-05-04","2020-11-01","2021-02-25","2020-05-04","2020-08-05","2020-09-01","2020-09-01","2021-03-22","2020-05-04","2020-07-08","2020-07-08","2020-09-09","2020-09-07","2020-09-09","2021-03-22","2021-01-04","2020-09-07","2020-09-09","2020-09-07","2020-09-09","2021-02-25","2020-09-09","2020-09-09","2020-09-09","2020-09-20","2020-09-09","2020-09-09","2021-01-04","2020-09-09","2021-01-04","2020-10-28","2020-10-28","2020-11-01","2020-11-01","2021-01-04","2020-09-01","2020-07-06","2021-03-22","2020-07-08","2020-11-01","2020-09-01","2020-11-01","2020-11-16","2020-11-01","2020-11-01","2020-11-01","2021-01-04","2020-11-16","2021-03-05","2021-04-22","2021-04-22","2020-02-12","2020-09-01","2020-09-01","2020-09-01","2020-08-05","2020-08-05","2020-08-05","2020-09-10","2020-09-10","2021-01-04","2020-07-06","2020-03-09","2020-07-06","2020-07-06","2020-07-06","2020-09-01","2020-09-01","2020-05-04","2020-05-04","2020-06-24","2020-07-23","2020-07-08","2020-07-08","2020-09-01","2020-09-01","2020-02-01","2020-05-04","2020-06-24","2020-06-24","2020-11-01"],"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":[["","13668021630","ARIPIPRAZOLE","TAB 2MG","30","Select","Select",""],["","69315090610","LORAZEPAM","TAB 2MG","60","Select","Select",""],["","50383027201","DICLOFENAC","GEL 0.01","400","Select","Select",""],["","69238184001","LEVOTHYROXIN","TAB 200MCG","30","Select","Select",""],["","16729030017","TRAZODONE","TAB 100MG","30","Select","Select",""],["","68382018105","BUSPIRONE","TAB 10MG","90","Select","Select",""],["","378456005","POT CHLORIDE","TAB 8MEQ ER","270","Select","Select",""],["","67877022310","GABAPENTIN","CAP 300MG","90","Select","Select",""],["","68180051902","LISINOP\/HCTZ","TAB 20-12.5","180","Select","Select",""],["","832154011","HALOPERIDOL","TAB 5MG","-60","Select","Select",""],["","67877032105","IBUPROFEN","TAB 800MG","90","Select","Select",""],["","71093013206","METFORMIN","TAB 500MG","30","Select","Select",""],["","378240501","TRIFLUOPERAZ","TAB 5MG","60","Select","Select",""],["","8290846603","INSULIN SYRG","MIS 0.5\/30G","100","Select","Select",""],["","904615760","VITAMIN D","TAB 2000UNIT","60","Select","Select",""],["","51660052605","ALLERGY RELF","TAB 10MG","30","Select","Select",""],["","13668001005","CITALOPRAM","TAB 20MG","90","Select","Select",""],["","245531511","KLOR-CON 8","TAB 8MEQ ER","42","Select","Select",""],["","60505006501","OMEPRAZOLE","CAP 20MG","90","Select","Select",""],["","43547040011","CYCLOBENZAPR","TAB 10MG","90","Select","Select",""],["","67405060203","FLUCONAZOLE","TAB 100MG","14","Select","Select",""],["","43547040211","FUROSEMIDE","TAB 40MG","30","Select","Select",""],["","68382025501","OXYBUTYNIN","TAB 5MG ER","30","Select","Select",""],["","65862001501","AMOXICILLIN","TAB 875MG","10","Select","Select",""],["","69097015807","MELOXICAM","TAB 7.5MG","60","Select","Select",""],["","45802005911","NYSTATIN","CRE 100000","30","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","20","Select","Select",""],["","574200815","NYSTOP","POW 100000","15","Select","Select",""],["","0","COMPOUND"," ","115","Select","Select",""],["","88221905","LANTUS SOLOS","INJ 100\/ML","3","Select","Select",""],["","42806064801","DIPHENHYDRAM","CAP 25MG","12","Select","Select",""],["","168009960","KETOCONAZOLE","CRE 0.02","60","Select","Select",""],["","88222033","LANTUS","INJ 100\/ML","10","Select","Select",""],["","74305841","K-TAB","TAB 8MEQ CR","270","Select","Select",""],["","51672127406","BETAMETH DIP","CRE 0.0005","45","Select","Select",""],["","45802037632","AUG BETAMET","CRE 0.0005","50","Select","Select",""],["","57664050289","TIZANIDINE","TAB 2MG","-10","Select","Select",""],["","781803401","TRIFLUOPERAZINE HYDROCHLORIDE","","60","Select","Select",""],["","42806064801","DIPHENHYDRAMINE HYDROCHLORIDE","","12","Select","Select",""],["","43547040011","CYCLOBENZAPRINE HYDROCHLORIDE","","90","Select","Select",""],["","67877032105","IBUPROFEN ","","90","Select","Select",""],["","69315090605","LORAZEPAM ","","60","Select","Select",""],["","69238184001","LEVOTHYROXINE SODIUM ","","30","Select","Select",""],["","378456005","POTASSIUM CHLORIDE ER","","270","Select","Select",""],["","16729029917","TRAZODONE HYDROCHLORIDE","","30","Select","Select",""],["","16729020216","BUSPIRONE HYDROCHLORIDE","","90","Select","Select",""],["","68180051902","LISINOPRIL\/HYDROCHLOROTHIAZIDE","","180","Select","Select",""],["","13668001005","CITALOPRAM HYDROBROMIDE","","90","Select","Select",""],["","50383027201","DICLOFENAC SODIUM","","400","Select","Select",""],["","51224000760","METFORMIN HYDROCHLORIDE ER","","90","Select","Select",""],["","45802037632","AUGMENTED BETAMETHASONE DIPROPIONATE","","50","Select","Select",""],["","904615760","VITAMIN D ","","90","Select","Select",""],["","378240501","TRIFLUOPERAZINE HCL","","60","Select","Select",""],["","8290846603","B-D INSULIN SYRINGE ULTRAFINE\/0.5ML\/30G X 1\/2\"","","100","Select","Select",""],["","65862000899","METFORMIN HYDROCHLORIDE","","-60","Select","Select",""],["","51660052605","ALLERGY RELIEF","","30","Select","Select",""],["","88221905","LANTUS SOLOSTAR ","","3","Select","Select",""],["","68382025501","OXYBUTYNIN CHLORIDE ER","","30","Select","Select",""],["","69097015807","MELOXICAM ","","60","Select","Select",""],["","51672127406","BETAMETHASONE DIPROPIONATE","","45","Select","Select",""],["","0","","","115","Select","Select",""],["","57664050289","TIZANIDINE HCL","","-10","Select","Select",""],["","31722057330","ESOMEPRAZOLE MAGNESIUM","","-14","Select","Select",""],["","64380090190","TRIAMCINOLONE ACETONIDE","","430","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":[[["Select","Select","","","","","Select","",""],["Select","Select","","","","","Select","",""],["Select","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Select","Select","","","","","Select","",""],["No","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":""}]}]}