{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DORA   A CALTON","gend":1,"add":"118 SOURWOOD DR","city":"DUFFIELD","state":"VA","zip":"24244-9998","dob":"1954-07-31","age":"","mstatus":"","insh":"900045505*01","cliId":"","pno":"276\/431-1171","cno":"","email":"","ename":"","eno":"","pphy":"WINEGAR, J BRYSTON MD","ppno":"276\/431-2648","pcpadd":"121 ADVANCED TECHNOLOGY DR","pcpcity":"DUFFIELD","pcpstate":"VA","pcpzip":24244,"pcpcounty":"","pcpid":"","pcpname":"HOLSTON MEDICAL GROUP PC","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"SOUTHWEST","aligned":"Y","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"276\/431-2082","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11.9","M10.9","I89.0","I83.893","E11.628","I10.","E66.9","Z68.33","Z79.84","H10.45","H04.201","Z96.1","H52.02","H52.4","H43.393","Z48.00","I87.2","K62.5","Z86.010","K64.4","J01.90","M79.89","R06.83","R25.2","D69.3","E66.01","E11.40","I83.891","D69.6","D50.9","I20.9","I83.892","Z68.35","R60.0","R21.","M65.342","Z13.820","Z00.00","J44.9","M50.30","K74.60","D69.2","I83.93","R52.","Z87.19","Z68.34"],"date":["2021-10-07","2021-06-15","2021-12-15","2021-12-15","2021-12-15","2021-12-09","2021-12-15","2021-12-09","2021-12-09","2021-07-20","2021-07-20","2021-07-20","2021-07-20","2021-07-20","2021-07-20","2021-09-09","2021-12-15","2021-11-08","2021-10-26","2021-10-26","2021-06-15","2021-06-15","2021-06-15","2021-07-29","2021-12-06","2021-12-06","2021-12-06","2021-11-30","2021-09-08","2021-01-26","2021-09-15","2021-12-08","2021-07-08","2021-10-07","2021-07-08","2021-03-15","2021-03-15","2021-03-15","2021-03-15","2021-03-15","2021-03-15","2021-03-15","2021-06-29","2021-07-29","2021-10-07","2021-10-07"],"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":[["","31722088390","ROSUVASTATIN CALCIUM                                                  ","10MG","30","Select","Select",""],["","59651006605","OLOPATADINE HYDROCHLORIDE                                             ","0.20%","2","Select","Select",""],["","60505082901","FLUTICASONE PROPIONATE                                                ","50MCG","16","Select","Select",""],["","00054429931","FUROSEMIDE                                                            ","40MG","60","Select","Select",""],["","00115166001","PROPRANOLOL HYDROCHLORIDE                                             ","20MG","180","Select","Select",""],["","68462034690","LEVOCETIRIZINE DIHYDROCHLORIDE                                        ","5MG","90","Select","Select",""],["","64980027903","GLIPIZIDE ER                                                          ","2.5MG","30","Select","Select",""],["","00378668999","PANTOPRAZOLE SODIUM                                                   ","40MG","30","Select","Select",""],["","65702071210","ACCU-CHEK GUIDE                                                       ","GUIDE","100","Select","Select",""],["","69238183107","LEVOTHYROXINE SODIUM                                                  ","50MCG","90","Select","Select",""],["","68180051303","LISINOPRIL                                                            ","5MG","90","Select","Select",""],["","16729013516","ALLOPURINOL                                                           ","300MG","90","Select","Select",""],["","43598043611","NITROGLYCERIN                                                         ","0.4MG","25","Select","Select",""],["","00378108601","COLCHICINE                                                            ","0.6MG","-3","Select","Select",""],["","00143992801","CIPROFLOXACIN HYDROCHLORIDE                                           ","500MG","10","Select","Select",""],["","68180016013","AZITHROMYCIN                                                          ","250MG","6","Select","Select",""],["","68180096301","ALBUTEROL SULFATE HFA                                                 ","HFA","-8","Select","Select",""],["","70461012103","FLUAD QUADRIVALENT 2021-2022                                          ","2021-22","0","Select","Select",""],["","62559043130","HYDROCORTISONE                                                        ","2.50%","30","Select","Select",""],["","10572010001","PEG-3350\/ELECTROLYTES                                                 ","ELECTROL","-8000","Select","Select",""],["","00054032756","FLUTICASONE PROPIONATE\/SALMETEROL                                     ","250\/50","-60","Select","Select",""],["","59762040101","SUCRALFATE                                                            ","1GM","120","Select","Select",""],["","00378932132","WIXELA INHUB                                                          ","250\/50","60","Select","Select",""],["","00185012201","NITROFURANTOIN MONOHYDRATE                                            ","100MG","14","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":""}]}]}