{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CHRISTIE   R HOLMES","gend":1,"add":"3400 N WATERSIDE DR","city":"LANEXA","state":"VA","zip":"23089-9998","dob":"1971-12-01","age":"","mstatus":"","insh":"900048068*01","cliId":"2RG6XT8GF88","pno":"757\/969-9361","cno":"757\/969-9361","email":"","ename":"","eno":"","pphy":"THOMAS, DENNIS L MD","ppno":"804\/932-4388","pcpadd":"1850 POCAHONTAS TRAIL","pcpcity":"QUINTON","pcpstate":"VA","pcpzip":23141,"pcpcounty":"","pcpid":671676,"pcpname":"","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"757\/969-9361, 804\/966-5580","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/932-9860","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["T14.90XA","Z79.899","E11.9","E55.9","E78.2","I10.","F20.0","M54.5","F20.9","E78.00","F17.210","S29.012A","M54.9","X50.0XXA","M25.511","M54.12","M54.2","R85.82","R35.0","M19.011","M47.22","M43.12","Z98.1","Z01.419","N89.8","Z86.19","S23.3XXA"],"date":["2021-06-19","2021-11-15","2021-11-15","2021-11-15","2021-11-15","2021-11-15","2021-08-05","2021-06-19","2021-06-19","2021-06-19","2021-06-19","2021-09-21","2021-09-21","2021-09-21","2021-10-18","2021-11-17","2021-11-17","2021-08-30","2021-11-15","2021-10-18","2021-10-18","2021-10-18","2021-10-18","2021-08-30","2021-08-30","2021-08-30","2021-09-21"],"priorHcc":["",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":[["","310620530","FARXIGA ","","30","Select","Select",""],["","50111056101","TRAZODONE HYDROCHLORIDE","","60","Select","Select",""],["","65862070560","ZIPRASIDONE HCL ","","30","Select","Select",""],["","65862059501","DIVALPROEX SODIUM ER ","","180","Select","Select",""],["","52565004215","NYSTATIN\/TRIAMCINOLONE","","15","Select","Select",""],["","70436006001","BUPROPION HYDROCHLORIDE ER (SR) ","","60","Select","Select",""],["","72578008801","NYSTATIN\/TRIAMCINOLONE ACETONIDE","","-15","Select","Select",""],["","49483060450","IBUPROFEN ","","90","Select","Select",""],["","65862059501","DIVALPROEX SODIUM ER","","180","Select","Select",""],["","49483060450","IBUPROFEN","","90","Select","Select",""],["","70436006001","BUPROPION HYDROCHLORIDE ER (SR)","","60","Select","Select",""],["","65862070560","ZIPRASIDONE HCL","","30","Select","Select",""],["","65162055310","METAXALONE","","30","Select","Select",""],["","00310620530","FARXIGA","","30","Select","Select",""],["","68180051303","LISINOPRIL","5MG","90","Select","Select",""],["","00093317431","ALBUTEROL SULFATE HFA","HFA","8","Select","Select",""],["","00093226301","AMOXICILLIN","500MG","15","Select","Select",""],["","00472016630","NYSTATIN","100000","30","Select","Select",""],["","70377002911","ATORVASTATIN CALCIUM","40MG","90","Select","Select",""],["","00603188016","LIDOCAINE","5%","28","Select","Select",""],["","00603533815","PREDNISONE","10MG","21","Select","Select",""],["","50428016183","CVS D3","2000UNIT","90","Select","Select",""],["","16571020106","DICLOFENAC SODIUM DR","75MG DR","30","Select","Select",""],["","69584061250","METHOCARBAMOL","750MG","18","Select","Select",""],["","69097084507","CYCLOBENZAPRINE HYDROCHLORIDE","5MG","20","Select","Select",""],["","49483060450","IBUPROFEN                                                             ","TAB 800MG","90","Select","Select",""],["","00115174801","METAXALONE                                                            ","TAB 800MG","-30","Select","Select",""],["","65862059501","DIVALPROEX SODIUM ER                                                  ","TAB 500MG ER","180","Select","Select",""],["","70436006001","BUPROPION HYDROCHLORIDE ER (SR)                                       ","TAB 200MG SR","60","Select","Select",""],["","50111056101","TRAZODONE HYDROCHLORIDE                                               ","TAB 100MG","60","Select","Select",""],["","52565004215","NYSTATIN\/TRIAMCINOLONE                                                ","OIN ","15","Select","Select",""],["","72578008801","NYSTATIN\/TRIAMCINOLONE ACETONIDE                                      ","OIN ","-15","Select","Select",""],["","00310620530","FARXIGA                                                               ","TAB 5MG","30","Select","Select",""],["","65862070560","ZIPRASIDONE HCL                                                       ","CAP 80MG","30","Select","Select",""],["","00093317431","ALBUTEROL SULFATE HFA                                                 ","AER HFA","8","Select","Select",""],["","00093226301","AMOXICILLIN                                                           ","TAB 500MG","15","Select","Select",""],["","00603188016","LIDOCAINE                                                             ","PAD 0.05","28","Select","Select",""],["","68180051303","LISINOPRIL                                                            ","TAB 5MG","90","Select","Select",""],["","00603533815","PREDNISONE                                                            ","PAK 10MG","21","Select","Select",""],["","70377002911","ATORVASTATIN CALCIUM                                                  ","TAB 40MG","90","Select","Select",""],["","50428016183","CVS D3                                                                ","CAP 2000UNIT","90","Select","Select",""],["","00093727298","PIOGLITAZONE HYDROCHLORIDE                                            ","TAB 30MG","90","Select","Select",""],["","00472016615","NYSTATIN                                                              ","OIN 100000","15","Select","Select",""],["","69097084507","CYCLOBENZAPRINE HYDROCHLORIDE                                         ","TAB 5MG","20","Select","Select",""],["","69584061250","METHOCARBAMOL                                                         ","TAB 750MG","18","Select","Select",""],["","69097015907","MELOXICAM                                                             ","TAB 15MG","30","Select","Select",""],["","16571020106","DICLOFENAC SODIUM DR                                                  ","TAB 75MG DR","30","Select","Select",""],["","65862042005","SULFAMETHOXAZOLE\/TRIMETHOPRIM DS                                      ","TAB 800-160","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":""}]}]}