{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DAVID   W PHILLIPS","gend":0,"add":"173 DEERFIELD DR","city":"ROSE HILL","state":"VA","zip":"24281-9998","dob":"1980-07-10","age":"","mstatus":"","insh":"900047994*01","cliId":"8JX6HQ3AV73","pno":"606\/670-8807","cno":"606\/670-8807","email":"","ename":"","eno":"","pphy":"MOLONY, PATRICK A MD","ppno":"276\/546-5212","pcpadd":"127 HEALTH CARE DR STE 8","pcpcity":"PENNINGTON GAP","pcpstate":"VA","pcpzip":24277,"pcpcounty":"","pcpid":171020,"pcpname":"","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"SOUTHWEST","aligned":"Y","ano":"606\/670-7505","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"276\/546-1525","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K29.70","E66.9","Z74.01","K81.0","E80.6","E66.01","R79.89","Z68.45","Z20.822","I10.","R30.0","F41.9","K21.9","R56.9","E03.9","J30.1","B37.2","G47.33","R53.81","K80.50","K92.0","I95.9","R10.0","E80.7","R07.9","K80.20","K83.1","K80.70","Z48.815","F41.8","F17.220","M10.9","Z90.49","R50.9","Z97.8","K56.699","R09.02","R11.2","J06.9","R91.8","R05.","R10.84","R13.10","J18.9","R06.02","F33.0","R26.2","R19.7","J96.01","J96.02","K56.609","J98.59","J44.0","E87.2","E66.2","I11.9","K59.1","E78.5","E87.6","F32.9","K80.62","R74.8","Z51.81","Z79.899","R07.89","K80.10","F17.290","R10.9"],"date":["2021-06-02","2021-06-02","2021-10-06","2021-10-06","2021-06-14","2021-11-03","2021-06-14","2021-10-06","2021-09-05","2021-11-03","2021-05-05","2021-11-03","2021-11-03","2021-11-03","2021-10-06","2021-05-05","2021-09-06","2021-10-06","2021-11-03","2021-08-11","2021-06-02","2021-06-02","2021-06-15","2021-06-15","2021-06-14","2021-06-15","2021-06-15","2021-06-18","2021-10-06","2021-10-06","2021-10-06","2021-10-06","2021-10-06","2021-06-29","2021-08-19","2021-07-03","2021-11-03","2021-08-28","2021-08-28","2021-08-28","2021-08-28","2021-08-28","2021-08-28","2021-09-08","2021-09-05","2021-09-08","2021-09-08","2021-09-08","2021-09-08","2021-09-08","2021-07-03","2021-09-05","2021-09-05","2021-09-05","2021-09-06","2021-09-05","2021-09-07","2021-09-06","2021-09-07","2021-09-07","2021-08-11","2021-06-14","2021-11-03","2021-06-14","2021-06-14","2021-08-11","2021-09-06","2021-06-23"],"priorHcc":["","",null,null,"",null,"",null,null,null,"",null,null,null,null,"",null,null,null,null,"","","","",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null]}},{"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":[["","43547035411","LISINOPRIL","","30","Select","Select",""],["","16714004112","ALLOPURINOL","","30","Select","Select",""],["","228202996","ALPRAZOLAM","","60","Select","Select",""],["","53746054205","POTASSIUM CHLORIDE ER","","30","Select","Select",""],["","59651000205","OMEPRAZOLE","","60","Select","Select",""],["","16714076903","NYSTATIN","","60","Select","Select",""],["","16714048502","DIVALPROEX SODIUM ER ","","120","Select","Select",""],["","68180096503","LEVOTHYROXINE SODIUM ","","30","Select","Select",""],["","65862085901","FAMOTIDINE","","60","Select","Select",""],["","16714048502","DIVALPROEX SODIUM ER","","120","Select","Select",""],["","68180096503","LEVOTHYROXINE SODIUM","","30","Select","Select",""],["","29300022746","METRONIDAZOLE","","3","Select","Select",""],["","00406012305","HYDROCODONE\/ACETAMINOPHEN","","10","Select","Select",""],["","31722072250","LEVOFLOXACIN","","1","Select","Select",""],["","62011035001","HM NICOTINE TRANSDERMAL SYSTEM STEP 2","","28","Select","Select",""],["","65862039010","ONDANSETRON ODT","","9","Select","Select",""],["","00781507701","LORATADINE","10MG","90","Select","Select",""],["","68180012202","CEPHALEXIN","500MG","14","Select","Select",""],["","62011006001","HM CHEST CONGESTION RELIEF","400MG","15","Select","Select",""],["","16714039102","CEFDINIR","300MG","10","Select","Select",""],["","16714076903","NYSTATIN                                                              ","POW 100000","60","Select","Select",""],["","00228202996","ALPRAZOLAM                                                            ","TAB 0.5MG","60","Select","Select",""],["","00406012305","HYDROCODONE\/ACETAMINOPHEN                                             ","TAB 5-325MG","10","Select","Select",""],["","68180096503","LEVOTHYROXINE SODIUM                                                  ","TAB 25MCG","30","Select","Select",""],["","53746054205","POTASSIUM CHLORIDE ER                                                 ","CAP 10MEQ ER","30","Select","Select",""],["","59651000205","OMEPRAZOLE                                                            ","CAP 20MG","60","Select","Select",""],["","43547035411","LISINOPRIL                                                            ","TAB 20MG","30","Select","Select",""],["","16714048502","DIVALPROEX SODIUM ER                                                  ","TAB 500MG ER","120","Select","Select",""],["","65862039010","ONDANSETRON ODT                                                       ","TAB 4MG ODT","9","Select","Select",""],["","16714004112","ALLOPURINOL                                                           ","TAB 100MG","30","Select","Select",""],["","31722072250","LEVOFLOXACIN                                                          ","TAB 500MG","1","Select","Select",""],["","00781507701","LORATADINE                                                            ","TAB 10MG","90","Select","Select",""],["","29300022746","METRONIDAZOLE                                                         ","TAB 500MG","3","Select","Select",""],["","65862085901","FAMOTIDINE                                                            ","TAB 20MG","60","Select","Select",""],["","16714039102","CEFDINIR                                                              ","CAP 300MG","10","Select","Select",""],["","65862056099","PANTOPRAZOLE SODIUM                                                   ","TAB 40MG","30","Select","Select",""],["","68180012202","CEPHALEXIN                                                            ","CAP 500MG","14","Select","Select",""],["","62011006001","HM CHEST CONGESTION RELIEF                                            ","TAB 400MG","15","Select","Select",""],["","62011035001","HM NICOTINE TRANSDERMAL SYSTEM STEP 2                                 ","DIS 14MG\/24H","28","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","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","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":""}]}]}