{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"COURTNEY   M WRENN","gend":1,"add":"630 MAIN ST APT B","city":"SMITHFIELD","state":"VA","zip":"23430-9998","dob":"1983-02-25","age":"","mstatus":"","insh":"1372722*01","cliId":"","pno":"757\/371-4779","cno":"757\/371-4779","email":"","ename":"","eno":"","pphy":"POPE, THOMAS C MD","ppno":"757\/357-3331","pcpadd":"201 GUMWOOD DR","pcpcity":"SMITHFIELD","pcpstate":"VA","pcpzip":23430,"pcpcounty":"","pcpid":131791,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"757\/775-1094","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":["D50.8","E11.43","Z79.4","E03.9","I10.","E55.9","Z98.84","E11.65","M54.9","N30.00","E11.21","R81.","E66.9","Z23.","M77.12","N92.4","T78.40XA","H04.123","E11.3292","H15.101","L93.0","E11.9","B07.0","L60.3","M65.9","S50.12XA","S50.11XA","S76.012A","M20.5X1","M20.11","M20.12","Z01.818","R10.2","Z00.00","Z68.33","E78.5","F32.1","Z13.89","J06.9","J02.9","S20.229A","S50.00XA","M21.6X1","M21.6X2","Z68.36","Z45.89","Z46.81","N92.6","Z68.41","N63.14","Z68.34","Z01.812","Z32.02","Z20.822","R23.4","G47.33","D48.61","NO DATA","M51.36","G89.29","Z96.41","Z88.6","R11.0"],"date":["2021-07-21","2021-09-14","2021-10-21","2021-08-26","2021-10-21","2021-08-26","2021-10-21","2021-09-14","2020-10-08","2021-10-21","2020-12-31","2020-12-31","2021-08-26","2020-11-16","2021-04-27","2021-07-16","2021-02-16","2020-08-24","2020-08-24","2020-08-24","2020-08-24","2021-10-21","2020-11-24","2020-11-24","2020-12-30","2020-12-02","2020-10-21","2020-12-30","2021-02-09","2021-02-09","2021-02-09","2021-07-08","2021-02-16","2020-01-13","2021-04-26","2020-01-13","2020-07-13","2020-01-13","2020-09-25","2020-09-25","2020-10-09","2020-10-09","2021-02-09","2021-02-09","2020-12-07","2021-02-16","2020-08-20","2021-07-08","2021-07-08","2021-07-28","2021-07-28","2021-05-05","2021-05-05","2021-04-21","2021-04-26","2021-07-16","2021-08-31","2021-08-31","2021-10-05","2021-10-05","2021-10-21","2021-10-21","2021-10-21"],"priorHcc":["",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":[["","00597015230","JARDIANCE ","10MG","30","Select","Select",""],["","50111043303","TRAZODONE ","50MG","30","Select","Select",""],["","00002751001","HUMALOG ","100\/ML","20","Select","Select",""],["","00781217660","CEFDINIR ","300MG","20","Select","Select",""],["","00169406013","VICTOZA ","18MG\/3ML","9","Select","Select",""],["","47781030801","NITROFUR ","100MG","30","Select","Select",""],["","00781320695","CEFTRIAXONE ","250MG","1","Select","Select",""],["","65862000899","METFORMIN ","500MG","180","Select","Select",""],["","65862042001","SMZ\/TMP ","800-160","14","Select","Select",""],["","69452015120","VITAMIN ","50000UNT","4","Select","Select",""],["","00143992950","CIPROFLOXACN ","750MG","14","Select","Select",""],["","61442010305","DICLOFENAC ","75MG DR","60","Select","Select",""],["","64380080807","IBUPROFEN ","600MG","60","Select","Select",""],["","10702001801","OXYCODONE ","5MG","10","Select","Select",""],["","00002773701","INSULIN ","100\/ML","70","Select","Select",""],["","68462010340","FLUCONAZOLE ","150MG","3","Select","Select",""],["","50111033401","METRONIDAZOL ","500MG","4","Select","Select",""],["","65862064230","AZITHROMYCIN ","500MG","2","Select","Select",""],["","08290320119","BD  PEN NEEDL","31GX5MM","100","Select","Select",""],["","31722053401","METHOCARBAM ","750MG","90","Select","Select",""],["","00781261305","AMOXICILLIN ","500MG","21","Select","Select",""],["","00185012201","NITROFURANTN ","100MG","10","Select","Select",""],["","59762444002","METHYLPRED ","4MG","21","Select","Select",""],["","57237021990","PIOGLITAZONE ","15MG","90","Select","Select",""],["","00527293441","PREDNISONE ","20MG","10","Select","Select",""],["","68180012202","CEPHALEXIN ","500MG","28","Select","Select",""],["","49884072703","DOXYCYC ","100MG","14","Select","Select",""],["","00406051201","OXYCOD\/APAP ","5-325MG","10","Select","Select",""],["","16729022601","SPIRONOLACT ","50MG","30","Select","Select",""],["","50111043303","TRAZODONE","50MG","30","Select","Select",""],["","00597015230","JARDIANCE","10MG","30","Select","Select",""],["","68462010340","FLUCONAZOLE","150MG","2","Select","Select",""],["","16729022601","SPIRONOLACT","50MG","30","Select","Select",""],["","00002751001","HUMALOG","100\/ML","20","Select","Select",""],["","00169406013","VICTOZA","18MG\/3ML","9","Select","Select",""],["","47781030801","NITROFUR","100MG","14","Select","Select",""],["","00781217660","CEFDINIR","300MG","20","Select","Select",""],["","65862000899","METFORMIN","500MG","180","Select","Select",""],["","00781320695","CEFTRIAXONE","250MG","1","Select","Select",""],["","65862064230","AZITHROMYCIN","500MG","2","Select","Select",""],["","57664022388","OXYCODONE","5MG","10","Select","Select",""],["","31722053401","METHOCARBAM","750MG","90","Select","Select",""],["","50111033401","METRONIDAZOL","500MG","4","Select","Select",""],["","61442010305","DICLOFENAC","75MG DR","60","Select","Select",""],["","00185012201","NITROFURANTN","100MG","10","Select","Select",""],["","08290320119","BD PEN NEEDL","31GX5MM","100","Select","Select",""],["","00002773701","INSULIN","100\/ML","70","Select","Select",""],["","59762444002","METHYLPRED","4MG","21","Select","Select",""],["","57237021990","PIOGLITAZONE","15MG","90","Select","Select",""],["","65862042001","SMZ\/TMP","800-160","14","Select","Select",""],["","69452015120","VITAMIN","50000UNT","4","Select","Select",""],["","64380080807","IBUPROFEN","600MG","60","Select","Select",""],["","00781261305","AMOXICILLIN","500MG","21","Select","Select",""],["","68180012202","CEPHALEXIN","500MG","28","Select","Select",""],["","00143992950","CIPROFLOXACN","750MG","14","Select","Select",""],["","00527293441","PREDNISONE","20MG","10","Select","Select",""],["","49884072703","DOXYCYC","100MG","14","Select","Select",""],["","00406051201","OXYCOD\/APAP","5-325MG","10","Select","Select",""],["","52817033200","CYCLOBENZAPR ","TAB 10MG","60","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","",""],["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":""}]}]}