{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JOSH   A WHITE","gend":0,"add":"750 HALIFAX RD LOT 33","city":"DANVILLE","state":"VA","zip":"24540-9998","dob":"1990-01-06","age":"","mstatus":"","insh":"900049308*01","cliId":"6K27RC3WC42","pno":"434\/770-5659","cno":"434\/770-5659","email":"","ename":"","eno":"","pphy":"BEATTY, GARRETT DO","ppno":"434\/799-4488","pcpadd":"SUITE 201 109 BRIDGE STREET","pcpcity":"DANVILLE","pcpstate":"VA","pcpzip":24541,"pcpcounty":"","pcpid":175182,"pcpname":"","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/773-6977","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R00.0","I82.403","E11.9","N31.9","I50.30","I10.","I45.81","D64.9","E55.9","F41.9","F31.9","R10.2","G82.20","R32.","L89.152","M50.00","G82.22","R33.9","I82.503","E66.9","J45.909","G47.33","G95.9","R26.2","K21.9","G62.9","R25.2","I82.90","Z79.84","D50.9","G47.00","Z91.041","Z86.718","M79.662","R15.9","N31.0","M79.605","E11.8","F12.10","E66.01","R94.31","I45.10","M48.02","D62.","K59.2","R06.9","R53.1","Z98.890","E11.69","T14.8XXD","T81.49XD","D50.0","T81.49XA","I82.409","Z45.2","F32.9","E78.5","B00.9","Z91.048"],"date":["2021-09-06","2021-09-06","2021-11-18","2021-09-27","2021-09-08","2021-11-18","2021-09-08","2021-09-08","2021-09-08","2021-11-13","2021-11-18","2021-09-23","2021-11-18","2021-09-27","2021-11-13","2021-11-13","2021-11-13","2021-11-15","2021-11-13","2021-11-13","2021-11-18","2021-11-13","2021-11-11","2021-11-11","2021-11-18","2021-11-18","2021-11-18","2021-11-18","2021-11-18","2021-11-18","2021-11-18","2021-10-01","2021-10-01","2021-10-01","2021-11-15","2021-09-27","2021-09-30","2021-11-15","2021-09-07","2021-09-07","2021-09-07","2021-09-07","2021-09-09","2021-09-09","2021-09-09","2021-09-30","2021-09-30","2021-11-02","2021-11-02","2021-09-04","2021-09-04","2021-09-23","2021-09-23","2021-09-23","2021-09-01","2021-09-09","2021-09-09","2021-09-09","2021-09-09"],"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,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":[["","16729018201","HYDROCHLOROTHIAZIDE","12.5MG","30","Select","Select",""],["","00115166003","PROPRANOLOL HYDROCHLORIDE","20MG","60","Select","Select",""],["","50428031180","CVS SALINE NASAL SPRAY","0.65%","45","Select","Select",""],["","69097014260","ALBUTEROL SULFATE HFA","HFA","7","Select","Select",""],["","50428040311","CVS GENTLE LAXATIVE","10MG","30","Select","Select",""],["","50111056001","TRAZODONE HYDROCHLORIDE","50MG","30","Select","Select",""],["","65862039010","ONDANSETRON ODT","4MG ODT","-90","Select","Select",""],["","57237001401","TAMSULOSIN HYDROCHLORIDE","0.4MG","30","Select","Select",""],["","67618010760","SLOW-MAG","","30","Select","Select",""],["","68382025701","OXYBUTYNIN CHLORIDE ER","15MG ER","90","Select","Select",""],["","43386035801","HYDROCODONE BITARTRATE\/ACETAMINOPHEN","10-325MG","20","Select","Select",""],["","00603020922","MAGNESIUM OXIDE","400MG","30","Select","Select",""],["","65862022960","LAMOTRIGINE","150MG","30","Select","Select",""],["","50428050854","CVS PURELAX","","30","Select","Select",""],["","76329301205","LIDOCAINE HCL JELLY","2% JELLY","80","Select","Select",""],["","76329301505","LIDOCAINE HCL","2%","80","Select","Select",""],["","62175061743","PANTOPRAZOLE SODIUM","40MG","30","Select","Select",""],["","53489011905","DOXYCYCLINE HYCLATE","100MG","60","Select","Select",""],["","70710134403","RAMELTEON","8MG","30","Select","Select",""],["","00003089421","ELIQUIS","5MG","60","Select","Select",""],["","50428063305","CVS ANTACID\/ANTI-GAS","ANTI-GAS","360","Select","Select",""],["","59779058401","CVS STOOL SOFTENER PLUS STIMULANT LAXATIVE","8.6-50MG","60","Select","Select",""],["","69097094312","GABAPENTIN","300MG","270","Select","Select",""],["","00245531911","KLOR-CON M20","20MEQ ER","60","Select","Select",""],["","00574050810","FERROUS GLUCONATE","324MG","90","Select","Select",""],["","00904052380","VITAMIN C","500MG","90","Select","Select",""],["","57896063506","SLOW MAGNESIUM CHLORIDE\/ CALCIUM","70-117MG","30","Select","Select",""],["","50428035636","CVS BALANCED B100","B100","30","Select","Select",""],["","00093310905","AMOXICILLIN","500MG","120","Select","Select",""],["","50428166371","CVS BISACODYL","10MG","30","Select","Select",""],["","60505025203","TIZANIDINE HYDROCHLORIDE","4MG","225","Select","Select",""],["","00832105515","BACLOFEN","20MG","120","Select","Select",""],["","00536478701","B COMPLEX","","30","Select","Select",""],["","50111056001","TRAZODONE HYDROCHLORIDE                                               ","TAB 50MG","30","Select","Select",""],["","65862039010","ONDANSETRON ODT                                                       ","TAB 4MG ODT","-90","Select","Select",""],["","57237001401","TAMSULOSIN HYDROCHLORIDE                                              ","CAP 0.4MG","30","Select","Select",""],["","16729018201","HYDROCHLOROTHIAZIDE                                                   ","TAB 12.5MG","30","Select","Select",""],["","00115166003","PROPRANOLOL HYDROCHLORIDE                                             ","TAB 20MG","60","Select","Select",""],["","50428031180","CVS SALINE NASAL SPRAY                                                ","SPR 0.0065","45","Select","Select",""],["","69097014260","ALBUTEROL SULFATE HFA                                                 ","AER HFA","7","Select","Select",""],["","50428040311","CVS GENTLE LAXATIVE                                                   ","SUP 10MG","30","Select","Select",""],["","65862022960","LAMOTRIGINE                                                           ","TAB 150MG","30","Select","Select",""],["","00115166103","PROPRANOLOL HCL                                                       ","TAB 40MG","-30","Select","Select",""],["","62175061743","PANTOPRAZOLE SODIUM                                                   ","TAB 40MG","30","Select","Select",""],["","62332049341","TIZANIDINE HYDROCHLORIDE                                              ","CAP 6MG","-120","Select","Select",""],["","68382025701","OXYBUTYNIN CHLORIDE ER                                                ","TAB 15MG ER","90","Select","Select",""],["","00832105515","BACLOFEN                                                              ","TAB 20MG","-120","Select","Select",""],["","00093310905","AMOXICILLIN                                                           ","CAP 500MG","120","Select","Select",""],["","50428028693","CVS VITAMIN C                                                         ","TAB 500MG","30","Select","Select",""],["","70710134403","RAMELTEON                                                             ","TAB 8MG","-30","Select","Select",""],["","76329301205","LIDOCAINE HCL JELLY                                                   ","GEL 2% JELLY","80","Select","Select",""],["","50428166371","CVS BISACODYL                                                         ","SUP 10MG","30","Select","Select",""],["","54629008001","SUPER B WITH C                                                        ","CAP ","100","Select","Select",""],["","50428063305","CVS ANTACID\/ANTI-GAS                                                  ","SUS ANTI-GAS","360","Select","Select",""],["","59779058401","CVS STOOL SOFTENER PLUS STIMULANT LAXATIVE                            ","TAB 8.6-50MG","60","Select","Select",""],["","67618010760","SLOW-MAG                                                              ","TAB ","30","Select","Select",""],["","70436001002","BUPROPION HYDROCHLORIDE ER (XL)                                       ","TAB 150MG XL","30","Select","Select",""],["","00574050801","FERROUS GLUCONATE                                                     ","TAB 324MG","90","Select","Select",""],["","00536478701","B COMPLEX                                                             ","CAP ","30","Select","Select",""],["","50428035636","CVS BALANCED B100                                                     ","TAB B100","30","Select","Select",""],["","31604002509","VITAMIN C                                                             ","CAP 500MG","90","Select","Select",""],["","00003089421","ELIQUIS                                                               ","TAB 5MG","-60","Select","Select",""],["","00603020922","MAGNESIUM OXIDE                                                       ","TAB 400MG","60","Select","Select",""],["","11845053501","B-COMPLEX W\/C                                                         ","CAP ","100","Select","Select",""],["","69097094312","GABAPENTIN                                                            ","CAP 300MG","90","Select","Select",""],["","53489011905","DOXYCYCLINE HYCLATE                                                   ","CAP 100MG","60","Select","Select",""],["","50428050854","CVS PURELAX                                                           ","PAK ","30","Select","Select",""],["","76329301505","LIDOCAINE HCL                                                         ","GEL 0.02","80","Select","Select",""],["","43386035801","HYDROCODONE BITARTRATE\/ACETAMINOPHEN                                  ","TAB 10-325MG","20","Select","Select",""],["","57896063506","SLOW MAGNESIUM CHLORIDE\/ CALCIUM                                      ","TAB 70-117MG","30","Select","Select",""],["","50428054089","CVS D3                                                                ","CAP 5000UNIT","180","Select","Select",""],["","00310621030","FARXIGA                                                               ","TAB 10MG","90","Select","Select",""],["","00245531911","KLOR-CON M20                                                          ","TAB 20MEQ ER","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":[[["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["No","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":""}]}]}