{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CLARA   E WILLIAMS","gend":1,"add":"21541 EAST COLONIAL TRAIL HWY","city":"ALBERTA","state":"VA","zip":23821,"dob":"1990-10-13","age":"","mstatus":"","insh":"1035412*01","cliId":"","pno":"434\/298-8663","cno":"434\/298-8663","email":"","ename":"","eno":"","pphy":"RIVAS, JUAN MD","ppno":"434\/949-7211","pcpadd":"8380 BOYDTON PLANK RD","pcpcity":"ALBERTA","pcpstate":"VA","pcpzip":23821,"pcpcounty":"","pcpid":104706,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/949-7134","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M10.9","F33.0","F90.0","F33.1","Z20.828","R51.9","R10.2","J01.00","F33.42","Z11.59","F41.8","K21.9","M79.672","L23.7"],"date":["2021-01-07","2021-03-05","2021-07-02","2020-12-08","2021-03-25","2021-07-11","2020-10-05","2021-06-06","2021-07-02","2021-01-26","2020-10-21","2020-10-21","2021-01-26","2021-09-23"],"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":[["","68645052254","SERTRALINE ","50MG","30","Select","Select",""],["","42195095510","BUT\/APAP\/CAF ","","60","Select","Select",""],["","31722071390","PANTOPRAZOLE ","40MG","30","Select","Select",""],["","16571040250","CETIRIZINE ","10MG","30","Select","Select",""],["","43598065530","BUPROPN ","150MG XL","30","Select","Select",""],["","00228305911","AMPHET\/DEXTR ","10MG ER","30","Select","Select",""],["","00527128201","DICYCLOMINE ","20MG","20","Select","Select",""],["","57237007710","ONDANSETRON ","4MG ODT","10","Select","Select",""],["","16714008110","HYDROXYZ ","10MG","60","Select","Select",""],["","67877031901","IBUPROFEN ","400MG","20","Select","Select",""],["","54092038501","ADDERALL ","15MG","30","Select","Select",""],["","31722054301","INDOMETHACIN ","50MG","60","Select","Select",""],["","29300013501","CLONIDINE ","0.1MG","30","Select","Select",""],["","65162071110","GUANFACINE ","1MG","30","Select","Select",""],["","59417010310","VYVANSE ","30MG","30","Select","Select",""],["","59762444002","METHYLPRED ","4MG","21","Select","Select",""],["","69238110005","DOXYCYCL ","100MG","14","Select","Select",""],["","00143924920","AMOX\/K ","875-125","42","Select","Select",""],["","42195095510","BUT\/APAP\/CAF","","60","Select","Select",""],["","68645052254","SERTRALINE","50MG","30","Select","Select",""],["","16571040250","CETIRIZINE","10MG","30","Select","Select",""],["","57237007710","ONDANSETRON","4MG ODT","10","Select","Select",""],["","31722071390","PANTOPRAZOLE","40MG","30","Select","Select",""],["","43598065530","BUPROPN","150MG XL","30","Select","Select",""],["","67877031901","IBUPROFEN","400MG","20","Select","Select",""],["","29300013501","CLONIDINE","0.1MG","30","Select","Select",""],["","59417010310","VYVANSE","30MG","30","Select","Select",""],["","16714008110","HYDROXYZ","10MG","60","Select","Select",""],["","00228305911","AMPHET\/DEXTR","10MG ER","30","Select","Select",""],["","31722054301","INDOMETHACIN","50MG","60","Select","Select",""],["","54092038301","ADDERALL","10MG","30","Select","Select",""],["","65162071110","GUANFACINE","1MG","30","Select","Select",""],["","59762444002","METHYLPRED","4MG","21","Select","Select",""],["","69238110005","DOXYCYCL","100MG","14","Select","Select",""],["","00143924920","AMOX\/K","875-125","42","Select","Select",""],["","68462013281","NORETH\/ETHIN","Jan-20","63","Select","Select",""],["","00603533932","PREDNISONE","20MG","21","Select","Select",""],["","00527128201","DICYCLOMINE","20MG","20","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","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["No","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":""}]}]}