{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"OMA   G MEADOWS","gend":1,"add":"846 APPLE VALLEY RD","city":"MARION","state":"VA","zip":"24354-9998","dob":"1948-05-10","age":"","mstatus":"","insh":"900044336*01","cliId":"8QE8MF6CP43","pno":"276\/646-0069","cno":"276\/646-0069","email":"","ename":"","eno":"","pphy":"BAKER, WILLIAM J MD","ppno":"276\/258-4100","pcpadd":"STE 213 16000 JOHNSTON MEM DR","pcpcity":"ABINGDON","pcpstate":"VA","pcpzip":24211,"pcpcounty":"","pcpid":164367,"pcpname":"","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"SOUTHWEST","aligned":"Y","ano":"Non-DSNP","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":["L03.113","I10.","F41.9","E78.5","E11.65","D64.9","M18.9","M85.80","Z23.","Z79.84","Z87.891","Z96.611","Z96.612","Z88.5","M79.644","R60.9","S60.511A","E11.9","W55.03XA","H16.143","H16.223","R32.","R39.81","Z72.3","S51.852A","M79.89","L53.9","R21.","Z79.899","W55.01XS"],"date":["2021-03-08","2021-06-29","2021-03-08","2021-03-08","2021-03-08","2021-03-08","2021-03-08","2021-03-08","2021-03-08","2021-06-26","2021-06-26","2021-03-08","2021-03-08","2021-03-08","2021-03-08","2021-03-25","2021-03-06","2021-06-29","2021-03-07","2021-05-07","2021-05-07","2021-03-21","2021-03-21","2021-03-21","2021-06-26","2021-06-26","2021-06-26","2021-06-26","2021-06-26","2021-06-29"],"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":[["","60505017009","PRAVASTATIN","TAB 40MG","90","Select","Select",""],["","33342007810","VALSART\/HCTZ","TAB 320-25MG","90","Select","Select",""],["","65862019401","FLUOXETINE","CAP 40MG","30","Select","Select",""],["","16729017301","AMITRIPTYLIN","TAB 50MG","30","Select","Select",""],["","61314064705","TOBRA\/DEXAME","SUS 0.3-0.1%","5","Select","Select",""],["","50383026505","LOTEPREDNOL","SUS 0.005","5","Select","Select",""],["","65862018501","CLINDAMYCIN","CAP 150MG","30","Select","Select",""],["","69238110002","DOXYCYCL HYC","CAP 100MG","14","Select","Select",""],["","70010006510","METFORMIN","TAB 1000MG","60","Select","Select",""],["","16729017301","AMITRIPTYLINE HYDROCHLORIDE ","","30","Select","Select",""],["","65862019401","FLUOXETINE HYDROCHLORIDE","","30","Select","Select",""],["","33342007810","VALSARTAN\/HYDROCHLOROTHIAZIDE","","90","Select","Select",""],["","60505017009","PRAVASTATIN SODIUM ","","90","Select","Select",""],["","65862018501","CLINDAMYCIN HCL ","","30","Select","Select",""],["","69238110002","DOXYCYCLINE HYCLATE","","14","Select","Select",""],["","23155010410","METFORMIN HYDROCHLORIDE","","60","Select","Select",""],["","61314064705","TOBRAMYCIN\/DEXAMETHASONE","","5","Select","Select",""],["","68682029905","LOTEPREDNOL ETABONATE","","-5","Select","Select",""],["","16729017301","AMITRIPTYLINE HYDROCHLORIDE","","30","Select","Select",""],["","65862018501","CLINDAMYCIN HCL","","30","Select","Select",""],["","60505017009","PRAVASTATIN SODIUM","","90","Select","Select",""],["","00781185220","AMOXICILLIN\/CLAVULANATE POTASSIUM","","20","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":[[["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","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":""}]}]}