{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CHARLES   L ANDERSON","gend":0,"add":"5234 SUGAR GROVE HWY","city":"SUGAR GROVE","state":"VA","zip":"24375-9998","dob":"1953-07-11","age":"","mstatus":"","insh":"20023128*01","cliId":"","pno":"276\/677-3124","cno":"276\/677-3124","email":"","ename":"","eno":"","pphy":"MYA, MOE M MD","ppno":"276\/781-2225","pcpadd":"1070 TERRACE DRIVE","pcpcity":"MARION","pcpstate":"VA","pcpzip":24354,"pcpcounty":"","pcpid":164367,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"SOUTHWEST","aligned":"","ano":"276\/706-2996","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"276\/783-8843","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["B35.1","M79.674","M79.675","E11.9","R33.9","I10.","J45.909","K21.9","G40.909","N40.1","R39.14","R33.8","R56.9","M81.0","J45.20","N52.8","K64.1","E29.1","Z12.5","H35.723","H35.033","G40.109","K59.00","N52.9","R97.20"],"date":["2021-09-22","2021-09-22","2021-09-22","2021-09-22","2020-11-02","2021-11-16","2020-11-04","2021-11-16","2021-11-16","2021-11-16","2021-08-03","2021-11-16","2020-03-05","2021-01-15","2021-11-16","2021-11-16","2021-05-11","2021-11-16","2021-05-11","2020-03-17","2020-03-17","2021-03-04","2020-04-29","2020-04-29","2020-01-29"],"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":[["","62332002531","THEOPHYLLINE","300MG ER","60","Select","Select",""],["","23155000810","HYDROCHLOROT ","25MG","30","Select","Select",""],["","65862032904","ALENDRONATE ","70MG","4","Select","Select",""],["","00093010901","CARBAMAZEPIN ","200MG","120","Select","Select",""],["","43386035701","HYDROCO\/APAP ","7.5-325","8","Select","Select",""],["","00173052100","SEREVENT ","50MCG","60","Select","Select",""],["","55111015810","OMEPRAZOLE ","20MG","30","Select","Select",""],["","45802028139","TESTOSTERONE ","1.62%","38","Select","Select",""],["","53746054201","POT  CHLORIDE","10MEQ ER","90","Select","Select",""],["","00093221001","SUCRALFATE ","1GM","120","Select","Select",""],["","00088165475","OS-CAL ","500-200","90","Select","Select",""],["","45802048678","DOCUSATE ","100MG","60","Select","Select",""],["","13517011201","PHENOBARB ","64.8MG","120","Select","Select",""],["","51672300302","HYDROCORT ","2.50%","28","Select","Select",""],["","68180065208","DOXYCYC ","100MG","56","Select","Select",""],["","65862042005","SMZ\/TMP ","800-160","6","Select","Select",""],["","57237001401","TAMSULOSIN ","0.4MG","60","Select","Select",""],["","62332002531","THEOPHYLLINE ","300MG ER","60","Select","Select",""],["","00597008717","ATROVENT ","17MCG","13","Select","Select",""],["","47781030301","NITROFURANTN ","100MG","20","Select","Select",""],["","50428317683","STOOL ","100MG","60","Select","Select",""],["","62559043130","HYDROCORTISO ","2.50%","28","Select","Select",""],["","10631040701","PROCTOSOL ","2.50%","28","Select","Select",""],["","00904546080","OYST ","500MG","30","Select","Select",""],["","68180065208","DOXYCYC","100MG","56","Select","Select",""],["","65862032904","ALENDRONATE","70MG","4","Select","Select",""],["","45802028139","TESTOSTERONE","1.62%","1","Select","Select",""],["","23155000810","HYDROCHLOROT","25MG","30","Select","Select",""],["","55111015810","OMEPRAZOLE","20MG","30","Select","Select",""],["","51672300302","HYDROCORT","2.50%","28","Select","Select",""],["","00093010901","CARBAMAZEPIN","200MG","120","Select","Select",""],["","53746054201","POT CHLORIDE","10MEQ ER","90","Select","Select",""],["","45802048678","DOCUSATE","100MG","60","Select","Select",""],["","43386035701","HYDROCO\/APAP","7.5-325","8","Select","Select",""],["","00173052100","SEREVENT","50MCG","60","Select","Select",""],["","00093221001","SUCRALFATE","1GM","120","Select","Select",""],["","00088165475","OS-CAL","500-200","90","Select","Select",""],["","65862042005","SMZ\/TMP","800-160","6","Select","Select",""],["","00597008717","ATROVENT","17MCG","13","Select","Select",""],["","13517011201","PHENOBARB","64.8MG","120","Select","Select",""],["","57237001401","TAMSULOSIN","0.4MG","60","Select","Select",""],["","47781030301","NITROFURANTN","100MG","20","Select","Select",""],["","62559043130","HYDROCORTISO","2.50%","30","Select","Select",""],["","10631040701","PROCTOSOL","2.50%","28","Select","Select",""],["","50428317683","STOOL","100MG","60","Select","Select",""],["","00904546080","OYST","500MG","30","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","",""],["Yes","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":""}]}]}