{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JUDITH   D COINS","gend":1,"add":"1770 FAIRVIEW CHURCH RD","city":"HUDDLESTON","state":"VA","zip":"24104-9998","dob":"1962-03-17","age":"","mstatus":"","insh":"1596504*01","cliId":"","pno":"540\/537-0644","cno":"540\/537-0644","email":"","ename":"","eno":"","pphy":"COX, BRANDON MD","ppno":"540\/297-7181","pcpadd":"4830 RUCKER RD","pcpcity":"MONETA","pcpstate":"VA","pcpzip":24121,"pcpcounty":"","pcpid":156228,"pcpname":"","plan":"OHP","program":"ACA","lob":"Small Group","region":"ROANOKE ALLEGHANY","aligned":"","ano":"344-9246","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"540\/297-6145","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K59.09","E11.43","K31.84","Z91.018","Z71.9","E03.9","Z01.411","N95.9","N95.2","U07.1","D21.9","N85.4","E10.65","E89.0","M75.82","E10.9","E78.5","G47.00","N60.01","Z98.890","N60.09","M25.50","E10.29","E10.43","R80.9","K31.9","G56.02","M54.2","R49.0","M75.32","K63.89","F41.9","R10.31","K64.8","K57.30","T78.1XXD","R11.0","Z12.11","R07.9","I47.1","R00.2","L30.9","R73.9","R05.","R09.81","R52.","G44.209","R50.9","J02.9","Z20.822","L82.1","L98.1","L57.0","N83.202","D25.9","R53.83","Z91.81","M54.5","M25.522","R29.6","K21.9","L92.3","E55.9","M54.16","R79.89","E78.49","K75.9","E11.9","I10.","Z79.4","Z82.49"],"date":["2021-05-04","2021-05-04","2021-05-04","2021-05-04","2021-05-04","2021-09-28","2020-11-10","2020-11-10","2020-11-10","2021-04-15","2020-06-02","2020-03-13","2020-06-02","2020-08-26","2020-06-15","2020-12-23","2020-12-23","2020-12-23","2021-02-03","2021-02-03","2021-02-03","2021-03-24","2020-08-26","2020-08-26","2020-08-26","2020-08-26","2020-09-11","2020-10-23","2020-10-23","2020-06-15","2020-08-07","2020-08-07","2020-08-14","2020-08-07","2020-08-07","2020-08-20","2021-04-10","2020-08-31","2021-10-01","2020-10-09","2021-09-29","2020-05-07","2021-04-10","2021-04-10","2021-04-10","2021-04-10","2021-04-10","2021-04-10","2021-04-10","2021-04-10","2021-06-04","2021-06-04","2021-06-25","2020-08-14","2020-08-14","2020-02-17","2020-02-17","2020-02-17","2020-02-17","2020-02-17","2021-05-04","2021-06-25","2021-06-28","2021-07-02","2021-07-02","2021-09-10","2021-10-15","2021-10-01","2021-10-01","2021-10-01","2021-10-01"],"priorHcc":["","","","","",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":[["","00088222033","LANTUS","100\/ML","30","Select","Select",""],["","53885024510","ONETOUCH","ULTRA BL","400","Select","Select",""],["","00228202950","ALPRAZOLAM","0.5MG","30","Select","Select",""],["","65862020190","LOSARTAN","25MG","30","Select","Select",""],["","00074662490","SYNTHROID","100MCG","90","Select","Select",""],["","54092054701","MOTEGRITY","2MG","30","Select","Select",""],["","50428016183","CVS","2000UNIT","30","Select","Select",""],["","00002751001","HUMALOG","100\/ML","-30","Select","Select",""],["","08627001601","DEXCOM","TRANSMIT","1","Select","Select",""],["","57599000101","FREESTYLE KIT SENSOR","SENSOR","1","Select","Select",""],["","50111043401","TRAZODONE","100MG","30","Select","Select",""],["","65862039010","ONDANSETRON","4MG ODT","30","Select","Select",""],["","51672127401","BETAMETH","0.05%","45","Select","Select",""],["","08290320122","BD PEN NEEDL","32GX4MM","100","Select","Select",""],["","00169266015","TRESIBA","100UNIT","-30","Select","Select",""],["","69097052444","DICLOFENAC","1%","500","Select","Select",""],["","00168000615","TRIAMCINOLON","0.10%","30","Select","Select",""],["","00548585000","GLUCAGON","1MG","1","Select","Select",""],["","08290328438","INSULIN","0.3\/31G","400","Select","Select",""],["","69097081312","GABAPENTIN","100MG","90","Select","Select",""],["","59779020216","HAIR","2% WOMEN","60","Select","Select",""],["","52268001201","SUPREP","PREP KIT","354","Select","Select",""],["","65162052110","PROMETHAZINE","25MG","30","Select","Select",""],["","00088222033","LANTUS ","100\/ML","30","Select","Select",""],["","50111043401","TRAZODONE ","100MG","30","Select","Select",""],["","65862020190","LOSARTAN ","25MG","30","Select","Select",""],["","53885024510","ONETOUCH ","ULTRA BL","400","Select","Select",""],["","00074929690","SYNTHROID ","112MCG","90","Select","Select",""],["","08290328438","INSULIN ","0.3\/31G","-400","Select","Select",""],["","00228202950","ALPRAZOLAM ","0.5MG","30","Select","Select",""],["","65862039010","ONDANSETRON ","4MG ODT","30","Select","Select",""],["","54092054701","MOTEGRITY ","2MG","30","Select","Select",""],["","51672127401","BETAMETH ","0.05%","45","Select","Select",""],["","08627005303","DEXCOM ","SENSOR","9","Select","Select",""],["","00169266015","TRESIBA ","100UNIT","15","Select","Select",""],["","50428016183","CVS ","2000UNIT","30","Select","Select",""],["","52268001201","SUPREP ","PREP KIT","354","Select","Select",""],["","57599000101","FREESTYLE    KIT SENSOR","SENSOR","7","Select","Select",""],["","00002751001","HUMALOG ","100\/ML","-30","Select","Select",""],["","08290320122","BD  PEN NEEDL","32GX4MM","100","Select","Select",""],["","00548585000","GLUCAGON ","1MG","1","Select","Select",""],["","69097052444","DICLOFENAC ","1%","500","Select","Select",""],["","59779020216","HAIR ","2% WOMEN","60","Select","Select",""],["","69097081312","GABAPENTIN ","100MG","90","Select","Select",""],["","00168000615","TRIAMCINOLON ","0.10%","30","Select","Select",""],["","65162052110","PROMETHAZINE ","25MG","30","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","",""],["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":""}]}]}