{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TAMIE   L BARNETTE","gend":1,"add":"331 SYCAMORE RD LOT 127","city":"DRYDEN","state":"VA","zip":"24243-9998","dob":"1984-08-24","age":"","mstatus":"","insh":"1575142*01","cliId":"","pno":"276\/393-6555","cno":"276\/393-6555","email":"","ename":"","eno":"","pphy":"VANZEE, WAYNE","ppno":"276\/383-4428","pcpadd":"241 MONARCH RD","pcpcity":"SAINT CHARLES","pcpstate":"VA","pcpzip":24282,"pcpcounty":"","pcpid":143432,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"SOUTHWEST","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"276\/383-4927","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z00.8","Z13.9","Z13.89","Z71.89","E03.8","R60.9","B35.9","F63.81","K21.9","M25.571","F41.1","R10.9","E03.9","R55."],"date":["2020-12-08","2020-12-08","2020-12-08","2020-12-08","2020-12-08","2020-12-08","2020-12-08","2020-12-08","2020-12-08","2020-12-08","2020-12-08","2020-02-14","2021-09-09","2021-09-09"],"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":[["","70710122600","AMITRIPTYLIN ","25MG","60","Select","Select",""],["","00904642281","PEG ","","60","Select","Select",""],["","00378668977","PANTOPRAZOLE ","40MG","30","Select","Select",""],["","00113061239","ALLERGY ","10MG","30","Select","Select",""],["","00904615760","VITAMIN ","2000UNIT","30","Select","Select",""],["","16729018317","HYDROCHLOROT ","25MG","30","Select","Select",""],["","31604002674","D3 ","2000UNIT","30","Select","Select",""],["","29300012410","MELOXICAM ","7.5MG","30","Select","Select",""],["","69238183801","LEVOTHYROXIN ","150MCG","30","Select","Select",""],["","45802065087","LORATADINE ","10MG","30","Select","Select",""],["","00781808926","AZITHROMYCIN ","250MG","6","Select","Select",""],["","00406012305","HYDROCO\/APAP ","5-325MG","12","Select","Select",""],["","68462029817","CLOTRIM\/BETA ","DIPROP","30","Select","Select",""],["","11917010303","WAL-ITIN ","10MG","90","Select","Select",""],["","69452015120","VITAMIN","50000UNT","9","Select","Select",""],["","16729018317","HYDROCHLOROT","25MG","30","Select","Select",""],["","00904642281","PEG","","60","Select","Select",""],["","69238183801","LEVOTHYROXIN","150MCG","30","Select","Select",""],["","00378668977","PANTOPRAZOLE","40MG","30","Select","Select",""],["","00113061239","ALLERGY","10MG","30","Select","Select",""],["","70710122600","AMITRIPTYLIN","25MG","60","Select","Select",""],["","29300012410","MELOXICAM","7.5MG","30","Select","Select",""],["","31604002674","D3","2000UNIT","30","Select","Select",""],["","45802065087","LORATADINE","10MG","90","Select","Select",""],["","00781808926","AZITHROMYCIN","250MG","6","Select","Select",""],["","00406012305","HYDROCO\/APAP","5-325MG","12","Select","Select",""],["","68462029817","CLOTRIM\/BETA","DIPROP","30","Select","Select",""],["","11917010303","WAL-ITIN","10MG","90","Select","Select",""],["","13811071910","NITROFURANTN","100MG","14","Select","Select",""],["","13811071910","NITROFURANTN ","CAP 100MG","14","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":""}]}]}