{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"GENNIE   S THOMAS","gend":1,"add":"27308 FLANK RD","city":"NORTH DINWIDDIE","state":"VA","zip":"23805-9998","dob":"1955-12-28","age":"","mstatus":"","insh":"900048847*01","cliId":"8RY2FH1AU93","pno":"804\/324-8897","cno":"804\/324-8897","email":"","ename":"","eno":"","pphy":"FLEENOR, ELLEN T MD","ppno":"804\/733-5591","pcpadd":"321 C POPLAR DRIVE","pcpcity":"PETERSBURG","pcpstate":"VA","pcpzip":23805,"pcpcounty":"","pcpid":107405,"pcpname":"","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/733-3506","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z12.2","F17.210","R91.8","I70.0","M19.90","Z23.","Z11.59","Z00.00","Z11.52","I10.","G25.81","G62.9","Z91.89","F32.9","F41.9","I87.1","N28.1"],"date":["2021-08-04","2021-08-04","2021-08-04","2021-08-04","2021-09-24","2021-11-23","2021-09-10","2021-09-10","2021-09-10","2021-09-22","2021-09-22","2021-09-22","2021-09-22","2021-09-22","2021-09-22","2021-08-03","2021-08-03"],"priorHcc":["","","","",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":[["","76204060060","IPRATROPIUM BROMIDE\/ALBUTEROL SULFATE","ALBUTER","180","Select","Select",""],["","16571040250","CETIRIZINE HYDROCHLORIDE","10MG","30","Select","Select",""],["","51672411103","PHENYTOIN SODIUM EXTENDED","100MG","180","Select","Select",""],["","00093206406","CILOSTAZOL","100MG","60","Select","Select",""],["","68001039708","FAMOTIDINE","20MG","30","Select","Select",""],["","00093720210","PRAVASTATIN SODIUM","40MG","30","Select","Select",""],["","00173068220","VENTOLIN HFA","","18","Select","Select",""],["","60505265601","TRIAMTERENE\/HYDROCHLOROTHIAZIDE","37.5-25","30","Select","Select",""],["","55111015810","OMEPRAZOLE","20MG","30","Select","Select",""],["","00603254428","BUTALBITAL\/ACETAMINOPHEN\/CAFFEINE","","90","Select","Select",""],["","45802014167","CICLOPIROX NAIL LACQUER","0.08","7","Select","Select",""],["","00093506101","HYDROXYZINE HYDROCHLORIDE","25MG","60","Select","Select",""],["","00071036924","DILANTIN","100MG","180","Select","Select",""],["","68462010530","ONDANSETRON HYDROCHLORIDE","4MG","20","Select","Select",""],["","31722072610","MONTELUKAST SODIUM","10MG","30","Select","Select",""],["","68462025701","ROPINIROLE HYDROCHLORIDE","3MG","30","Select","Select",""],["","00093075305","ATENOLOL","100MG","90","Select","Select",""],["","65862052401","GABAPENTIN","800MG","270","Select","Select",""],["","69097012815","AMLODIPINE BESYLATE","10MG","90","Select","Select",""],["","43547039950","CYCLOBENZAPRINE HYDROCHLORIDE","5MG","60","Select","Select",""],["","58160082311","SHINGRIX","50\/0.5ML","-1","Select","Select",""],["","65862020399","LOSARTAN POTASSIUM","100MG","90","Select","Select",""],["","57237001999","DULOXETINE HYDROCHLORIDE","60MG","30","Select","Select",""],["","76204060060","IPRATROPIUM BROMIDE\/ALBUTEROL SULFATE                                 ","SOL ALBUTER","180","Select","Select",""],["","65862052401","GABAPENTIN                                                            ","TAB 800MG","270","Select","Select",""],["","00093075305","ATENOLOL                                                              ","TAB 100MG","90","Select","Select",""],["","00603254428","BUTALBITAL\/ACETAMINOPHEN\/CAFFEINE                                     ","TAB ","90","Select","Select",""],["","55111015810","OMEPRAZOLE                                                            ","CAP 20MG","30","Select","Select",""],["","45802014167","CICLOPIROX NAIL LACQUER                                               ","SOL 0.08","7","Select","Select",""],["","16571040250","CETIRIZINE HYDROCHLORIDE                                              ","TAB 10MG","30","Select","Select",""],["","65862020399","LOSARTAN POTASSIUM                                                    ","TAB 100MG","90","Select","Select",""],["","66993001968","ALBUTEROL SULFATE HFA                                                 ","AER HFA","18","Select","Select",""],["","60505265601","TRIAMTERENE\/HYDROCHLOROTHIAZIDE                                       ","TAB 37.5-25","30","Select","Select",""],["","00093506101","HYDROXYZINE HYDROCHLORIDE                                             ","TAB 25MG","60","Select","Select",""],["","68462010530","ONDANSETRON HYDROCHLORIDE                                             ","TAB 4MG","20","Select","Select",""],["","00071036924","DILANTIN                                                              ","CAP 100MG","180","Select","Select",""],["","00173068220","VENTOLIN HFA                                                          ","AER ","18","Select","Select",""],["","43547039950","CYCLOBENZAPRINE HYDROCHLORIDE                                         ","TAB 5MG","60","Select","Select",""],["","00093720210","PRAVASTATIN SODIUM                                                    ","TAB 40MG","30","Select","Select",""],["","69097012815","AMLODIPINE BESYLATE                                                   ","TAB 10MG","90","Select","Select",""],["","57237001999","DULOXETINE HYDROCHLORIDE                                              ","CAP 60MG","30","Select","Select",""],["","68462025701","ROPINIROLE HYDROCHLORIDE                                              ","TAB 3MG","30","Select","Select",""],["","51672411103","PHENYTOIN SODIUM EXTENDED                                             ","CAP 100MG","-180","Select","Select",""],["","31722072610","MONTELUKAST SODIUM                                                    ","TAB 10MG","30","Select","Select",""],["","00093206406","CILOSTAZOL                                                            ","TAB 100MG","60","Select","Select",""],["","68001039708","FAMOTIDINE                                                            ","TAB 20MG","30","Select","Select",""],["","58160082311","SHINGRIX                                                              ","INJ 50\/0.5ML","-1","Select","Select",""],["","00173086910","ANORO ELLIPTA                                                         ","AER 62.5-25","60","Select","Select",""],["","42806016101","HYDROXYZINE HCL                                                       ","TAB 50MG","60","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","",""],["Yes","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":""}]}]}