{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DINA   M MCGRADY","gend":1,"add":"62 ROSSER DR","city":"LURAY","state":"VA","zip":"22835-9998","dob":"1969-03-09","age":"","mstatus":"","insh":"1592620*02","cliId":"","pno":"540\/743-1475","cno":"540\/743-1475","email":"","ename":"","eno":"","pphy":"DALE, JAMES G DO","ppno":"540\/743-2887","pcpadd":"135 MEMORIAL DRIVE","pcpcity":"LURAY","pcpstate":"VA","pcpzip":22835,"pcpcounty":"","pcpid":104675,"pcpname":"","plan":"OHP","program":"ACA","lob":"Small Group","region":"NORTHERN & WINCHESTER","aligned":"","ano":"540\/743-5747","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I48.0","S39.012A","G47.33","M25.521","M25.421","M70.21","M75.101","M75.41","M25.511","M19.011","G89.18","M75.21","S43.431A","S43.431D","H69.81","H69.83","Z96.22","H92.11","H93.8X1","Z01.419","Z12.31","Z12.12","M19.012","M79.644","M79.89","M25.541","G89.29","M25.512","Z79.899","Z79.52","R05.","R09.81","R68.83","R07.89","Z20.822","Z02.1","W10.8XXA","M67.813","Z01.810","I10.","R06.09","S32.021A","R29.890","M79.602","S32.012A","M48.061","S32.022A","S62.102A","W17.89XA","S52.572A","S52.602A","W11.XXXA","S52.532A","J45.20","S52.592A","S52.692A","S32.029A","R29.6","S52.612A","S52.502A","S32.001A","S32.009A","S69.92XA","M25.551","S32.022D","W19.XXXD","S52.202A","S52.532D","S52.232A","I48.91","M53.2X4","H65.23","K59.00","M79.651","Z90.710","Z88.8","Z88.2","Z82.49","Z80.52","S52.502D","S52.602D"],"date":["2020-12-22","2020-04-17","2021-07-19","2020-02-26","2020-01-23","2020-02-26","2020-03-10","2020-07-06","2020-11-05","2020-07-06","2020-07-06","2020-07-06","2020-07-06","2020-11-05","2020-06-29","2021-07-05","2020-12-29","2020-06-22","2020-06-22","2020-06-18","2020-06-18","2020-06-18","2021-06-18","2021-06-18","2021-06-18","2021-06-18","2021-06-18","2021-06-18","2020-11-24","2020-11-24","2021-07-02","2021-01-17","2021-01-17","2021-01-17","2021-07-13","2021-03-15","2020-01-23","2020-06-09","2020-06-17","2021-07-19","2020-03-10","2021-07-17","2021-07-17","2021-07-15","2021-07-13","2021-07-13","2021-07-19","2021-07-13","2021-07-19","2021-07-16","2021-07-19","2021-07-13","2021-07-19","2021-07-19","2021-07-13","2021-07-13","2021-07-13","2021-07-27","2021-07-13","2021-07-19","2021-07-19","2021-07-13","2021-07-13","2021-07-19","2021-07-14","2021-07-14","2021-07-16","2021-07-27","2021-07-13","2021-07-13","2021-07-13","2021-07-13","2021-07-13","2021-07-13","2021-07-13","2021-07-13","2021-07-13","2021-07-13","2021-07-13","2021-07-27","2021-07-27"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}},{"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":[["","29300022019","MONTELUKAST","10MG","90","Select","Select",""],["","31722070190","LOSARTAN","50MG","90","Select","Select",""],["","68645051054","HYDROCHLOROT","25MG","90","Select","Select",""],["","00003089421","ELIQUIS","5MG","180","Select","Select",""],["","00054327099","FLUTICASONE","50MCG","16","Select","Select",""],["","00093005805","TRAMADOL","50MG","28","Select","Select",""],["","00555089902","ESTRADIOL","0.5MG","30","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","00093031401","KETOROLAC","10MG","20","Select","Select",""],["","50742061510","METOPROL","25MG ER","180","Select","Select",""],["","10702001801","OXYCODONE","5MG","60","Select","Select",""],["","59746017310","PREDNISONE","10MG","70","Select","Select",""],["","00228202950","ALPRAZOLAM","0.5MG","10","Select","Select",""],["","00093317431","ALBUTEROL","HFA","8","Select","Select",""],["","55111065001","METAXALONE","800MG","120","Select","Select",""],["","16571020150","DICLOFENAC","75MG DR","60","Select","Select",""],["","57896098110","ASPIRIN","81MG EC","28","Select","Select",""],["","42806071401","BENZONATATE","100MG","20","Select","Select",""],["","50111078751","AZITHROMYCIN","250MG","6","Select","Select",""],["","00003089421","ELIQUIS ","5MG","180","Select","Select",""],["","00054327099","FLUTICASONE ","50MCG","16","Select","Select",""],["","31722070190","LOSARTAN ","50MG","90","Select","Select",""],["","00093005805","TRAMADOL ","50MG","30","Select","Select",""],["","29300022019","MONTELUKAST ","10MG","90","Select","Select",""],["","68645051054","HYDROCHLOROT ","25MG","90","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","00093317431","ALBUTEROL ","HFA","8","Select","Select",""],["","59746017310","PREDNISONE ","10MG","70","Select","Select",""],["","45963070996","METOPROL ","25MG ER","180","Select","Select",""],["","00555089902","ESTRADIOL ","0.5MG","30","Select","Select",""],["","10702001801","OXYCODONE ","5MG","60","Select","Select",""],["","00093031401","KETOROLAC ","10MG","20","Select","Select",""],["","57896098110","ASPIRIN ","81MG EC","28","Select","Select",""],["","55111065001","METAXALONE ","800MG","120","Select","Select",""],["","00228202950","ALPRAZOLAM ","0.5MG","10","Select","Select",""],["","16571020150","DICLOFENAC ","75MG DR","60","Select","Select",""],["","50111078751","AZITHROMYCIN ","250MG","6","Select","Select",""],["","42806071401","BENZONATATE ","100MG","20","Select","Select",""],["","70010075401","METHOCARBAM ","500MG","20","Select","Select",""],["","50228018010","GABAPENTIN ","300MG","20","Select","Select",""],["","60758011905","PREDNISOLONE ","1% OP","5","Select","Select",""],["","24208041005","OFLOXACIN ","0.3%OTIC","5","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","",""],["N\/A","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","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":""}]}]}