{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SHERRIE   D PARKS","gend":1,"add":"110 W RESERVOIR ST","city":"WYTHEVILLE","state":"VA","zip":"24382-9998","dob":"1958-11-22","age":"","mstatus":"","insh":"900039539*01","cliId":"","pno":"276\/724-7171","cno":"","email":"","ename":"","eno":"","pphy":"FQHC-MEDICAL CLINIC INC, BLAND COUNTY FQHC","ppno":"276\/688-4331","pcpadd":"12301 GRAPEFIELD ROAD","pcpcity":"BASTIAN","pcpstate":"VA","pcpzip":24314,"pcpcounty":"","pcpid":"","pcpname":"BLAND COUNTY MEDICAL CLINIC INC","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"ROANOKE ALLEGHANY","aligned":"Y","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"276\/688-4336","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N95.2","Z01.419","Z12.31","Z12.4","H25.12","H25.812","K62.5","K64.9","M54.41","Z71.3","Z71.82","Z68.28","M54.50","M79.604","M79.605","Z98.1","I10.","E55.9","E78.2","F17.200","Z79.890","E87.8","M54.17","F33.0","F41.1","R60.0","L29.9","Z68.29","H92.02","R51.9","Z12.11","M51.36","M43.16","H25.811","Z91.09","Z68.27","Z91.041","H25.813","H25.13","H25.11","M48.061","M25.78","B07.8","R25.1"],"date":["2020-08-07","2020-08-07","2021-02-04","2020-08-07","2021-04-15","2021-04-27","2021-06-14","2021-06-14","2021-06-14","2021-12-01","2021-12-01","2021-06-14","2021-11-29","2021-11-12","2021-11-12","2021-11-29","2021-09-08","2021-09-08","2021-09-08","2020-08-07","2021-09-08","2021-09-08","2021-12-01","2021-09-08","2021-09-08","2021-06-02","2021-09-08","2021-12-01","2020-10-30","2020-11-10","2021-05-23","2021-11-29","2021-11-29","2021-04-07","2021-09-08","2020-10-21","2020-11-10","2020-11-12","2021-02-22","2021-03-30","2021-11-29","2021-11-29","2021-09-08","2021-06-02"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}}]},{"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":[]},{"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":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","00591354060","BUPROPION HYDROCHLORIDE ER (SR)                                       ","100MG SR","60","Select","Select",""],["","68382066101","SPIRONOLACTONE                                                        ","50MG","30","Select","Select",""],["","61442010305","DICLOFENAC SODIUM DR                                                  ","75MG DR","60","Select","Select",""],["","64380073706","VITAMIN D                                                             ","50000UNT","8","Select","Select",""],["","65862067899","ALPRAZOLAM                                                            ","1MG","120","Select","Select",""],["","65862019405","FLUOXETINE HYDROCHLORIDE                                              ","40MG","30","Select","Select",""],["","60505082901","FLUTICASONE PROPIONATE                                                ","50MCG","16","Select","Select",""],["","68382014005","TOPIRAMATE                                                            ","100MG","90","Select","Select",""],["","70010075405","METHOCARBAMOL                                                         ","500MG","160","Select","Select",""],["","69315011710","FUROSEMIDE                                                            ","40MG","30","Select","Select",""],["","68462026430","ROSUVASTATIN CALCIUM                                                  ","40MG","30","Select","Select",""],["","62559053001","PROPRANOLOL HYDROCHLORIDE ER                                          ","60MG ER","30","Select","Select",""],["","69543021712","MAGNESIUM OXIDE                                                       ","400MG","30","Select","Select",""],["","47781010444","ESTRADIOL                                                             ","0.01%","42","Select","Select",""],["","69315030805","CIPROFLOXACIN HYDROCHLORIDE                                           ","0.3% OP","5","Select","Select",""],["","61314063705","PREDNISOLONE ACETATE                                                  ","1% OP","5","Select","Select",""],["","61314012605","KETOROLAC TROMETHAMINE                                                ","0.50%","5","Select","Select",""],["","65862057490","MONTELUKAST SODIUM                                                    ","10MG","12","Select","Select",""],["","00046087221","PREMARIN                                                              ","0.625MG","30","Select","Select",""],["","14539067501","HYDROXYZINE PAMOATE                                                   ","50MG","90","Select","Select",""],["","66267008360","DOCUSATE SODIUM                                                       ","100MG","60","Select","Select",""],["","47335093890","AZELASTINE HCL                                                        ","0.05%","6","Select","Select",""],["","10702000650","CYCLOBENZAPRINE HYDROCHLORIDE                                         ","5MG","90","Select","Select",""],["","00037683015","CORTIFOAM                                                             ","90MG","15","Select","Select",""],["","00378064205","PREDNISONE                                                            ","20MG","10","Select","Select",""],["","65862085901","FAMOTIDINE                                                            ","20MG","60","Select","Select",""],["","59746000103","METHYLPREDNISOLONE DOSE PACK                                          ","4MG","21","Select","Select",""],["","59762070702","DICLOFENAC EPOLAMINE                                                  ","1.30%","60","Select","Select",""],["","68047070221","DEXAMETHASONE 6-DAY DOSE PACK                                         ","6-DAY","21","Select","Select",""]]}},{"a":[]},{"a":[]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":[]}]},{"t":"Mini-Cog","q":[{"a":[]},{"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":"","a13":""}]}]}