{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"PEARLIE   A BARNES","gend":1,"add":"730 CLAY ST","city":"EMPORIA","state":"VA","zip":"23847-9998","dob":"1960-06-24","age":"","mstatus":"","insh":"20023619*01","cliId":"","pno":"434\/634-3024","cno":"434\/634-3024","email":"","ename":"","eno":"","pphy":"SQUIRE, ROBERT HALL MD","ppno":"434\/634-6101","pcpadd":"6 DOCTORS DRIVE","pcpcity":"EMPORIA","pcpstate":"VA","pcpzip":23847,"pcpcounty":"","pcpid":104763,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"434\/430-5213","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/634-7117","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z00.00","K21.9","F41.9","F32.9","I10.","E66.01","G47.30","Z68.42","J45.909","E78.5","E55.9","E11.40","M54.9","R42.","Z01.419","B36.9","Z13.89","Z12.11","Z13.6","E11.9","K04.6","R22.0","M79.661","G47.10","R06.83","S01.21XA","S80.01XA","V89.2XXA"],"date":["2021-03-16","2021-03-16","2021-08-17","2021-03-16","2021-08-17","2021-08-17","2021-03-16","2021-03-16","2021-03-16","2021-03-16","2021-03-16","2021-03-16","2021-02-10","2021-02-10","2021-03-17","2021-03-17","2021-03-17","2021-03-17","2020-11-12","2021-08-17","2020-11-12","2020-11-12","2020-05-05","2021-08-17","2021-08-17","2021-07-23","2021-07-23","2021-07-23"],"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":[["","00591565810","CYCLOBENZAPR","10MG","30","Select","Select",""],["","00245531911","KLOR-CON ","20MEQ ER","30","Select","Select",""],["","00378020810","FUROSEMIDE ","20MG","30","Select","Select",""],["","69452015120","VITAMIN ","50000UNT","4","Select","Select",""],["","52565005630","TRIAMCINOLON ","0.10%","30","Select","Select",""],["","70710122600","AMITRIPTYLIN ","25MG","30","Select","Select",""],["","69097081312","GABAPENTIN ","100MG","30","Select","Select",""],["","59651000305","OMEPRAZOLE ","40MG","30","Select","Select",""],["","49884093547","DICLOFENAC ","1%","100","Select","Select",""],["","23155000101","HYDRALAZINE ","10MG","30","Select","Select",""],["","63481068447","VOLTAREN ","1%","100","Select","Select",""],["","00527221637","METOLAZONE ","5MG","30","Select","Select",""],["","00536100901","FERROUS ","325MG","90","Select","Select",""],["","00088222033","LANTUS ","100\/ML","10","Select","Select",""],["","00093742698","MONTELUKAST ","10MG","30","Select","Select",""],["","43547028810","BUPROPION ","100MG SR","90","Select","Select",""],["","65162044110","MECLIZINE ","12.5MG","30","Select","Select",""],["","68180098103","LISINOPRIL ","20MG","30","Select","Select",""],["","45802065078","LORATADINE ","10MG","30","Select","Select",""],["","69097083412","SERTRALINE ","50MG","45","Select","Select",""],["","08290328411","INSULIN ","1ML\/30G","30","Select","Select",""],["","57664047758","METOPROL ","50MG","60","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","00143122701","DICYCLOMINE ","20MG","40","Select","Select",""],["","66689000802","NYSTATIN ","100000","120","Select","Select",""],["","65162052110","PROMETHAZINE ","25MG","30","Select","Select",""],["","59746017710","CYCLOBENZAPR ","10MG","30","Select","Select",""],["","00093317431","ALBUTEROL ","HFA","8","Select","Select",""],["","00093716456","TOLTERODINE ","4MG ER","30","Select","Select",""],["","50742065601","CARISOPRODOL ","350MG","30","Select","Select",""],["","80777027399","MODERNA ","COVID-19","0","Select","Select",""],["","51672404801","CLOTRIM\/BETA ","DIPROP","15","Select","Select",""],["","00378932132","WIXELA ","250\/50","60","Select","Select",""],["","50428231183","MAG ","CHERRY","296","Select","Select",""],["","49483060450","IBUPROFEN ","800MG","30","Select","Select",""],["","33332032001","AFLURIA ","2020-21","0","Select","Select",""],["","70710113908","FLUCONAZOLE ","150MG","2","Select","Select",""],["","00093310905","AMOXICILLIN ","500MG","30","Select","Select",""],["","45802091987","CETIRIZINE ","10MG","30","Select","Select",""],["","53885024450","ONETOUCH ","ULTRA","50","Select","Select",""],["","50428028552","ACETAMINOPHN ","500MG","24","Select","Select",""],["","59779045870","CVS ","10MG","30","Select","Select",""],["","00378064205","PREDNISONE ","20MG","15","Select","Select",""],["","68382075810","METFORMIN ","500MG","180","Select","Select",""],["","59779048462","PAIN ","500MG","24","Select","Select",""],["","50111045001","TRAZODONE ","150MG","30","Select","Select",""],["","62559043130","HYDROCORTISO ","2.50%","30","Select","Select",""],["","65862050320","AMOX\/K ","875-125","20","Select","Select",""],["","00093742698","MONTELUKAST","10MG","30","Select","Select",""],["","57664047758","METOPROL","50MG","60","Select","Select",""],["","45802065078","LORATADINE","10MG","30","Select","Select",""],["","68180098103","LISINOPRIL","20MG","30","Select","Select",""],["","70710122600","AMITRIPTYLIN","25MG","30","Select","Select",""],["","00245531911","KLOR-CON","20MEQ ER","30","Select","Select",""],["","00378020810","FUROSEMIDE","20MG","30","Select","Select",""],["","00088222033","LANTUS","100\/ML","10","Select","Select",""],["","69452015120","VITAMIN","50000UNT","4","Select","Select",""],["","52565005630","TRIAMCINOLON","0.10%","30","Select","Select",""],["","63481068447","VOLTAREN","1%","100","Select","Select",""],["","49884093547","DICLOFENAC","1%","100","Select","Select",""],["","69097083412","SERTRALINE","50MG","45","Select","Select",""],["","59651000305","OMEPRAZOLE","40MG","30","Select","Select",""],["","08290328411","INSULIN","1ML\/30G","30","Select","Select",""],["","23155000101","HYDRALAZINE","10MG","30","Select","Select",""],["","43547028810","BUPROPION","100MG SR","90","Select","Select",""],["","00527221637","METOLAZONE","5MG","30","Select","Select",""],["","00536100901","FERROUS","325MG","90","Select","Select",""],["","69097081312","GABAPENTIN","100MG","30","Select","Select",""],["","65162052110","PROMETHAZINE","25MG","30","Select","Select",""],["","66689000802","NYSTATIN","100000","120","Select","Select",""],["","65162044110","MECLIZINE","12.5MG","30","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","00143122701","DICYCLOMINE","20MG","40","Select","Select",""],["","00093317431","ALBUTEROL","HFA","8","Select","Select",""],["","50428231183","MAG","CHERRY","296","Select","Select",""],["","33332032001","AFLURIA","2020-21","0","Select","Select",""],["","00378932132","WIXELA","250\/50","60","Select","Select",""],["","70710113908","FLUCONAZOLE","150MG","2","Select","Select",""],["","00093310905","AMOXICILLIN","500MG","30","Select","Select",""],["","00093716456","TOLTERODINE","4MG ER","30","Select","Select",""],["","50742065601","CARISOPRODOL","350MG","30","Select","Select",""],["","00378064205","PREDNISONE","20MG","15","Select","Select",""],["","53885024450","ONETOUCH","ULTRA","50","Select","Select",""],["","51672404801","CLOTRIM\/BETA","DIPROP","15","Select","Select",""],["","80777027399","MODERNA","COVID-19","0","Select","Select",""],["","68382075810","METFORMIN","500MG","180","Select","Select",""],["","50111045001","TRAZODONE","150MG","30","Select","Select",""],["","45802091987","CETIRIZINE","10MG","30","Select","Select",""],["","59779045870","CVS","10MG","30","Select","Select",""],["","62559043130","HYDROCORTISO","2.50%","30","Select","Select",""],["","59779048462","PAIN","500MG","24","Select","Select",""],["","65862050320","AMOX\/K","875-125","20","Select","Select",""],["","43547026810","ROPINIROLE","0.25MG","30","Select","Select",""],["","49483060450","IBUPROFEN","800MG","30","Select","Select",""],["","50428028552","ACETAMINOPHN","500MG","24","Select","Select",""],["","43547026810","ROPINIROLE ","TAB 0.25MG","30","Select","Select",""],["","00002143380","TRULICITY ","INJ 0.75\/0.5","4","Select","Select",""],["","00093221001","SUCRALFATE ","TAB 1GM","120","Select","Select",""],["","00310621030","FARXIGA ","TAB 10MG","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":""}]}]}