{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DANA   L SOURS","gend":1,"add":"108 S MAYRE LN","city":"LURAY","state":"VA","zip":"22835-9998","dob":"1982-06-18","age":"","mstatus":"","insh":"1057617*01","cliId":"","pno":"540\/773-5566","cno":"540\/773-5566","email":"","ename":"","eno":"","pphy":"SWITZER, DAVID MD","ppno":"540\/843-4624","pcpadd":"STE B 250 MEMORIAL DRIVE","pcpcity":"LURAY","pcpstate":"VA","pcpzip":22835,"pcpcounty":"","pcpid":167496,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"NORTHERN & WINCHESTER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"540\/843-4626","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F11.20","E53.8","R41.89","G40.109","R41.3","N75.0","N76.4","N93.9","L40.9","L28.1","L81.0","M79.604","G89.4","M54.40","M96.1","R07.9","B37.3","R11.2","E03.9","F31.9","J45.909","F31.63","F41.1","F43.10","N39.0","R31.9","F41.9","Z20.822","Z12.11","Z80.0","D12.3","K63.5","K63.89","D72.829","E05.00","M54.2","S82.154S","Z76.89","G47.00","Z13.220","K21.0","Z87.891","Z88.5","Z88.8","Z88.0","Z09.","L98.9","N89.8","R52.","R06.9","R09.02","N90.89","R10.84","E86.0","R11.0","K29.00","R10.33","F11.23","R50.9","M25.462"],"date":["2020-05-18","2020-09-03","2020-11-13","2020-09-03","2020-11-05","2021-02-26","2021-06-10","2021-03-01","2021-06-10","2020-03-09","2020-03-09","2021-01-07","2021-01-07","2020-08-25","2021-01-07","2021-07-08","2021-03-07","2021-03-15","2021-11-04","2020-07-04","2020-07-04","2021-03-14","2021-03-14","2021-03-29","2021-03-09","2021-03-09","2021-03-09","2021-03-09","2021-04-29","2021-04-29","2021-04-29","2021-04-29","2021-04-29","2021-06-10","2021-11-04","2021-06-10","2021-06-10","2021-06-10","2021-06-10","2021-06-10","2020-01-03","2021-02-18","2021-02-18","2021-02-18","2021-02-18","2021-04-23","2021-02-08","2021-02-08","2021-03-15","2021-02-24","2021-02-24","2021-03-07","2021-03-15","2021-03-15","2021-03-15","2020-07-04","2020-07-04","2020-07-05","2021-03-05","2021-11-04"],"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":[["","13668000801","ZOLPIDEM ","10MG","30","Select","Select",""],["","57237007810","ONDANSETRON ","8MG ODT","20","Select","Select",""],["","58406001004","ENBREL ","25\/0.5ML","2","Select","Select",""],["","72305011230","EUTHYROX ","112MCG","30","Select","Select",""],["","45802004935","TRIAMCINOLON ","0.50%","30","Select","Select",""],["","00406577101","METHADONE ","10MG","42","Select","Select",""],["","63304069205","CLINDAMYCIN ","150MG","30","Select","Select",""],["","69452015120","VITAMIN ","50000UNT","4","Select","Select",""],["","16714008210","HYDROXYZ ","25MG","90","Select","Select",""],["","00781518592","LEVOTHYROXIN ","112MCG","90","Select","Select",""],["","68382032010","POT  CHLORIDE","10MEQ ER","60","Select","Select",""],["","13668008630","OLANZAPINE ","5MG ODT","14","Select","Select",""],["","67877014601","TEMAZEPAM ","15MG","14","Select","Select",""],["","67877021905","CEPHALEXIN ","500MG","21","Select","Select",""],["","69547035302","NARCAN ","","2","Select","Select",""],["","50111033402","METRONIDAZOL ","500MG","14","Select","Select",""],["","59762501701","FLUCONAZOLE ","150MG","3","Select","Select",""],["","42858010250","OXYCOD\/APAP ","5-325MG","6","Select","Select",""],["","69238112001","OXAPROZIN ","600MG","20","Select","Select",""],["","67877012405","SILVER ","1%","50","Select","Select",""],["","65862085901","FAMOTIDINE ","20MG","30","Select","Select",""],["","16714045301","QUETIAPINE ","50MG","30","Select","Select",""],["","31722072250","LEVOFLOXACIN ","500MG","6","Select","Select",""],["","00378312501","DOXEPIN ","25MG","14","Select","Select",""],["","60505024801","MIRTAZAPINE ","30MG","90","Select","Select",""],["","13668000801","ZOLPIDEM","10MG","30","Select","Select",""],["","16714008210","HYDROXYZ","25MG","90","Select","Select",""],["","00781518592","LEVOTHYROXIN","112MCG","30","Select","Select",""],["","72305011230","EUTHYROX","112MCG","30","Select","Select",""],["","45802004935","TRIAMCINOLON","0.50%","30","Select","Select",""],["","58406001004","ENBREL","25\/0.5ML","2","Select","Select",""],["","00054457125","METHADONE","10MG","21","Select","Select",""],["","68382032010","POT CHLORIDE","10MEQ ER","60","Select","Select",""],["","57237007810","ONDANSETRON","8MG ODT","20","Select","Select",""],["","63304069205","CLINDAMYCIN","150MG","30","Select","Select",""],["","69547035302","NARCAN","","2","Select","Select",""],["","69452015120","VITAMIN","50000UNT","4","Select","Select",""],["","67877021905","CEPHALEXIN","500MG","21","Select","Select",""],["","13668008630","OLANZAPINE","5MG ODT","14","Select","Select",""],["","57237000511","FLUCONAZOLE","150MG","3","Select","Select",""],["","16714045301","QUETIAPINE","50MG","30","Select","Select",""],["","67877014601","TEMAZEPAM","15MG","14","Select","Select",""],["","42858010250","OXYCOD\/APAP","5-325MG","16","Select","Select",""],["","69238112001","OXAPROZIN","600MG","20","Select","Select",""],["","67877012405","SILVER","1%","50","Select","Select",""],["","65862085901","FAMOTIDINE","20MG","30","Select","Select",""],["","31722072250","LEVOFLOXACIN","500MG","6","Select","Select",""],["","00378312501","DOXEPIN","25MG","14","Select","Select",""],["","60505024801","MIRTAZAPINE","30MG","90","Select","Select",""],["","50111033402","METRONIDAZOL","500MG","14","Select","Select",""],["","16571020150","DICLOFENAC ","TAB 75MG DR","20","Select","Select",""],["","69238110002","DOXYCYCL ","CAP 100MG","14","Select","Select",""],["","68462029855","CLOTRIM\/BETA ","CRE DIPROP","45","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":""}]}]}