{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"WANDA EMORE","gend":1,"add":"700 WIDE GAP ROAD","city":"LEXINGTON","state":"VA","zip":"24450-9998","dob":"1967-12-21","age":"","mstatus":"","insh":"1889524*01","cliId":"","pno":"540\/464-1074","cno":"540\/464-1074","email":"","ename":"","eno":"","pphy":"SAILER, JANE MD","ppno":"540\/258-1700","pcpadd":"730 MCCULLOCH STREET","pcpcity":"GLASGOW","pcpstate":"VA","pcpzip":24555,"pcpcounty":"","pcpid":208528,"pcpname":"","plan":"OHP","program":"ACA","lob":"Small Group","region":"ROANOKE ALLEGHANY","aligned":"","ano":"540\/460-6148","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":["J01.00","M79.651","M79.7","H69.83","F41.9","J01.90","Z12.31","E03.9","D25.9","N85.2","D22.5","N92.1","N83.209","L71.0","J30.1","L90.5","E78.5","D50.9","R09.81","N95.1","M18.12","E55.9","M54.30","L70.0","L30.8","L82.1","L90.8","L85.9","I78.1","L85.3","L65.0","L21.9","Z12.83","N92.0","Z01.419","U07.1","R93.89","J34.89","R05.9","R53.83","R52.","R51.9","R50.9","H66.002","H66.92"],"date":["2021-02-08","2021-02-19","2021-07-02","2021-10-29","2021-07-02","2020-02-01","2021-02-12","2021-01-29","2021-11-03","2020-12-11","2021-04-05","2020-06-05","2021-11-03","2020-06-22","2020-08-28","2021-04-16","2021-01-29","2021-01-29","2020-07-03","2020-12-11","2020-12-22","2021-01-29","2021-04-08","2020-01-17","2020-01-17","2020-01-17","2020-01-17","2020-01-17","2020-01-17","2020-01-17","2020-01-17","2020-01-17","2020-01-17","2020-04-17","2021-11-03","2021-10-14","2021-11-03","2021-11-12","2021-10-13","2021-10-13","2021-10-13","2021-10-13","2021-10-13","2021-10-13","2021-10-18"],"priorHcc":["","","",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":[["","45802046564","KETOCONAZOLE","2%","120","Select","Select",""],["","66993096045","METRONIDAZOL","0.75%","45","Select","Select",""],["","00143924920","AMOX\/K","875-125","20","Select","Select",""],["","00054327099","FLUTICASONE","50MCG","48","Select","Select",""],["","45802010401","OLOPATADINE","0.60%","-30","Select","Select",""],["","29300022019","MONTELUKAST","10MG","90","Select","Select",""],["","43547040111","FUROSEMIDE","20MG","30","Select","Select",""],["","13668048450","MINOCYCLINE","100MG","30","Select","Select",""],["","65162067684","AZELASTINE","0.10%","30","Select","Select",""],["","47781065790","LEVOTHYROXIN","125MCG","90","Select","Select",""],["","72305012530","EUTHYROX","125MCG","90","Select","Select",""],["","68462010340","FLUCONAZOLE","150MG","2","Select","Select",""],["","68645052254","SERTRALINE","50MG","30","Select","Select",""],["","69238110005","DOXYCYCL","100MG","6","Select","Select",""],["","00143928501","AMOXICILLIN","875MG","20","Select","Select",""],["","66993096045","METRONIDAZOL ","0.75%","45","Select","Select",""],["","45802046564","KETOCONAZOLE ","2%","-120","Select","Select",""],["","13668048450","MINOCYCLINE ","100MG","30","Select","Select",""],["","00143924920","AMOX\/K ","875-125","20","Select","Select",""],["","43547040111","FUROSEMIDE ","20MG","30","Select","Select",""],["","45802010401","OLOPATADINE ","0.60%","-30","Select","Select",""],["","00781518692","LEVOTHYROXIN ","125MCG","90","Select","Select",""],["","29300022019","MONTELUKAST ","10MG","90","Select","Select",""],["","00054327099","FLUTICASONE ","50MCG","48","Select","Select",""],["","72305012530","EUTHYROX ","125MCG","90","Select","Select",""],["","65162067684","AZELASTINE ","0.10%","30","Select","Select",""],["","55111014512","FLUCONAZOLE ","150MG","2","Select","Select",""],["","69238110005","DOXYCYCL ","100MG","6","Select","Select",""],["","68645052254","SERTRALINE ","50MG","30","Select","Select",""],["","00143928501","AMOXICILLIN ","875MG","20","Select","Select",""],["","00527193206","CLARITHROMYC","500MG","20","Select","Select",""],["","60505082701","IPRATROPIUM","0.06%","15","Select","Select",""],["","69452014430","BENZONATATE","200MG","30","Select","Select",""],["","59746000103","METHYLPRED","4MG","21","Select","Select",""],["","00527193206","CLARITHROMYC ","TAB 500MG","-20","Select","Select",""],["","69452014430","BENZONATATE ","CAP 200MG","30","Select","Select",""],["","60505082701","IPRATROPIUM ","SPR 0.0006","15","Select","Select",""],["","00603533831","PREDNISONE ","PAK 10MG","48","Select","Select",""],["","59746000103","METHYLPRED ","TAB 4MG","21","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":""}]}]}