{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SHERYL   D WOLFORD WYCHE","gend":1,"add":"303 CHURCH ST TRLR 9","city":"EMPORIA","state":"VA","zip":"23847-9998","dob":"1989-01-19","age":"","mstatus":"","insh":"1308935*01","cliId":"","pno":"434\/637-3727","cno":"434\/637-3727","email":"","ename":"","eno":"","pphy":"ANDERSON, MICHAEL S MD","ppno":"434\/634-6101","pcpadd":"6 DOCTORS DRIVE","pcpcity":"EMPORIA","pcpstate":"VA","pcpzip":23847,"pcpcounty":"","pcpid":104763,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/634-7107","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F33.1","F31.32","H90.3","H57.11","H16.121","F60.9","F41.1","Z20.828","F31.30","R43.2","R43.9","J34.89","Z68.32","N76.0","G43.909","E55.9","E78.5","R51.9","Z79.899","Z13.6","T23.102A","Z90.710","Z88.8","F17.210","T23.002A","S02.2XXA","J31.0","J34.2","M54.2","H10.32","Z91.09","Z90.49","H53.142","I63.9","R53.1","R20.8","M25.519","K59.09","K21.0","R10.12","K44.9","R11.2"],"date":["2020-07-08","2020-09-22","2020-02-18","2020-06-17","2020-06-17","2021-09-03","2020-03-16","2020-11-01","2021-08-12","2021-04-05","2021-04-05","2021-04-05","2021-04-05","2021-03-08","2021-03-08","2021-03-08","2021-03-08","2021-03-08","2021-03-08","2021-03-08","2020-02-09","2020-06-14","2020-06-14","2020-06-14","2020-02-09","2020-07-15","2020-02-10","2020-02-10","2020-06-02","2020-06-14","2020-06-14","2020-06-14","2020-06-14","2020-07-23","2020-07-23","2020-07-23","2020-03-10","2020-07-16","2020-07-16","2020-07-16","2020-07-16","2020-07-16"],"priorHcc":["","","","","",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":[["","69097012303","TOPIRAMATE ","50MG","60","Select","Select",""],["","61874011530","VRAYLAR ","1.5MG","60","Select","Select",""],["","42858010301","OXYCOD\/APAP ","7.5-325","28","Select","Select",""],["","65862039010","ONDANSETRON ","4MG ODT","15","Select","Select",""],["","00591565810","CYCLOBENZAPR ","10MG","30","Select","Select",""],["","00093083205","CLONAZEPAM ","0.5MG","60","Select","Select",""],["","10702025350","BUT\/APAP\/CAF ","","30","Select","Select",""],["","65862052890","VENLAFAXINE ","75MG ER","30","Select","Select",""],["","71930005552","APAP\/CODEINE ","300-30MG","30","Select","Select",""],["","70710113908","FLUCONAZOLE ","150MG","1","Select","Select",""],["","50383077916","LACTULOSE ","10GM\/15","900","Select","Select",""],["","66993068130","OLANZAPINE ","5MG","30","Select","Select",""],["","00093816601","QUETIAPINE ","50MG","60","Select","Select",""],["","00121092716","PROMETHAZINE ","6.25\/5ML","140","Select","Select",""],["","31722071390","PANTOPRAZOLE ","40MG","30","Select","Select",""],["","00378064205","PREDNISONE ","20MG","15","Select","Select",""],["","68180016013","AZITHROMYCIN ","250MG","6","Select","Select",""],["","00378041510","DIPHEN\/ATROP ","2.5MG","20","Select","Select",""],["","70377002811","ATORVASTATIN ","20MG","30","Select","Select",""],["","63304069301","CLINDAMYCIN ","300MG","20","Select","Select",""],["","00093031401","KETOROLAC ","10MG","20","Select","Select",""],["","00093101042","MUPIROCIN ","2%","22","Select","Select",""],["","69452015120","VITAMIN ","50000UNT","4","Select","Select",""],["","65862050320","AMOX\/K ","875-125","20","Select","Select",""],["","43386035801","HYDROCO\/APAP ","10-325MG","28","Select","Select",""],["","80777027399","MODERNA ","COVID-19","0","Select","Select",""],["","50111033401","METRONIDAZOL ","500MG","14","Select","Select",""],["","58160084252","BOOSTRIX ","","1","Select","Select",""],["","51991074790","DULOXETINE ","30MG","30","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","65862042005","SMZ\/TMP ","800-160","14","Select","Select",""],["","00054327099","FLUTICASONE ","50MCG","16","Select","Select",""],["","69097012303","TOPIRAMATE","50MG","60","Select","Select",""],["","00054327099","FLUTICASONE","50MCG","16","Select","Select",""],["","00591565810","CYCLOBENZAPR","10MG","30","Select","Select",""],["","61874011530","VRAYLAR","1.5MG","60","Select","Select",""],["","00093083205","CLONAZEPAM","0.5MG","60","Select","Select",""],["","65862039010","ONDANSETRON","4MG ODT","15","Select","Select",""],["","10702025350","BUT\/APAP\/CAF","","30","Select","Select",""],["","42858010301","OXYCOD\/APAP","7.5-325","28","Select","Select",""],["","00093816601","QUETIAPINE","50MG","60","Select","Select",""],["","50383077916","LACTULOSE","10GM\/15","900","Select","Select",""],["","31722071390","PANTOPRAZOLE","40MG","30","Select","Select",""],["","65862052890","VENLAFAXINE","75MG ER","30","Select","Select",""],["","71930005552","APAP\/CODEINE","300-30MG","30","Select","Select",""],["","00378064205","PREDNISONE","20MG","5","Select","Select",""],["","68180016013","AZITHROMYCIN","250MG","6","Select","Select",""],["","66993068130","OLANZAPINE","5MG","30","Select","Select",""],["","00378041510","DIPHEN\/ATROP","2.5MG","20","Select","Select",""],["","00093031401","KETOROLAC","10MG","20","Select","Select",""],["","70377002811","ATORVASTATIN","20MG","30","Select","Select",""],["","50111033401","METRONIDAZOL","500MG","14","Select","Select",""],["","69452015120","VITAMIN","50000UNT","4","Select","Select",""],["","70710113908","FLUCONAZOLE","150MG","1","Select","Select",""],["","43386035801","HYDROCO\/APAP","10-325MG","28","Select","Select",""],["","65862050320","AMOX\/K","875-125","20","Select","Select",""],["","58160084252","BOOSTRIX","","1","Select","Select",""],["","00093101042","MUPIROCIN","2%","22","Select","Select",""],["","51991074790","DULOXETINE","30MG","30","Select","Select",""],["","80777027399","MODERNA","COVID-19","0","Select","Select",""],["","00121092716","PROMETHAZINE","6.25\/5ML","140","Select","Select",""],["","55111029236","SUMATRIPTAN","50MG","9","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","65862042005","SMZ\/TMP","800-160","14","Select","Select",""],["","63304069301","CLINDAMYCIN","300MG","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","",""],["Yes","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":""}]}]}