{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CAMILLA   L BERRY","gend":1,"add":"748 LOWELL ST","city":"CLIFTON FORGE","state":"VA","zip":"24422-9998","dob":"1981-11-17","age":"","mstatus":"","insh":"20023859*01","cliId":"","pno":"540\/958-5479","cno":"540\/958-5479","email":"","ename":"","eno":"","pphy":"MONROE, JULIE DO","ppno":"540\/962-1122","pcpadd":"322 W RIVERSIDE ST","pcpcity":"COVINGTON","pcpstate":"VA","pcpzip":24426,"pcpcounty":"","pcpid":146405,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"ROANOKE ALLEGHANY","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"540\/839-4831","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["C50.511","Z17.1","C50.411","F31.9","F33.9","I10.","F31.2","Z79.899","S40.261A","L03.113","W57.XXXA","F31.60","NO DATA","R59.0","C50.911","Z71.83","T82.818A","D72.828","F17.200","Z51.11","G89.3","Z48.3","F17.210","Z90.11","T63.301A","D49.3","E11.9","F41.0","F32.9","Z17.0","R11.2","R44.3","K59.00","I51.7","C50.919","T82.828A","Z45.2","Z92.21","F41.8","F31.10","Z12.31","Z85.3","S43.401A","X58.XXXA","Z11.59","T63.391A","R94.31","J02.9","E86.0","R44.1","F30.9","Z20.822","N61.0","H66.93","Z72.0","M79.89","G62.0","T45.1X5S","R11.0","L98.9","R60.0","F31.13"],"date":["2020-04-02","2020-12-16","2021-02-04","2020-09-01","2020-09-01","2021-02-05","2021-10-20","2020-12-03","2020-12-07","2020-12-07","2020-12-07","2020-12-16","2021-01-24","2020-03-30","2021-04-27","2020-03-30","2020-08-06","2020-08-18","2021-04-23","2020-09-01","2020-12-03","2020-10-26","2021-06-17","2020-10-26","2020-12-03","2020-12-03","2020-12-03","2020-12-03","2020-12-03","2021-02-04","2021-04-27","2021-04-27","2021-04-27","2020-03-11","2020-12-03","2020-07-09","2020-10-12","2020-09-30","2021-02-05","2021-04-25","2021-06-17","2021-06-17","2020-04-10","2020-04-10","2020-10-09","2020-12-03","2021-04-23","2020-01-18","2021-01-24","2021-04-22","2021-04-22","2021-04-22","2020-02-05","2020-08-16","2020-08-16","2020-09-11","2020-12-16","2020-12-16","2020-12-16","2021-02-05","2020-09-11","2021-04-23"],"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":[["","00591024005","LORAZEPAM ","0.5MG","30","Select","Select",""],["","55111025660","ZIPRASIDONE ","20MG","60","Select","Select",""],["","10702001801","OXYCODONE ","5MG","5","Select","Select",""],["","43598075205","BUPROPION ","150MG SR","30","Select","Select",""],["","42571025201","CLINDAMYCIN ","300MG","14","Select","Select",""],["","00054418425","DEXAMETHASON ","4MG","50","Select","Select",""],["","69097094312","GABAPENTIN ","300MG","90","Select","Select",""],["","57237007630","ONDANSETRON ","8MG","10","Select","Select",""],["","59746011506","PROCHLORPER ","10MG","30","Select","Select",""],["","42747072601","SANCUSO ","3.1MG","2","Select","Select",""],["","65162062710","TRAMADOL ","50MG","5","Select","Select",""],["","16729003101","METHYLDOPA ","500MG","60","Select","Select",""],["","00093001198","PANTOPRAZOLE ","20MG","60","Select","Select",""],["","65162019050","NAPROXEN ","500MG","60","Select","Select",""],["","13107003105","MIRTAZAPINE ","15MG","30","Select","Select",""],["","64380080807","IBUPROFEN ","600MG","30","Select","Select",""],["","62332000191","FAMOTIDINE ","20MG","30","Select","Select",""],["","00406052301","OXYCOD\/APAP ","10-325MG","10","Select","Select",""],["","43598016630","OLANZAPINE ","10MG","30","Select","Select",""],["","0","","","300","Select","Select",""],["","00591207030","LIDO\/PRILOCN ","2.5-2.5%","30","Select","Select",""],["","68382013610","LOSARTAN ","50MG","30","Select","Select",""],["","69238111601","BUSPIRONE ","7.5MG","60","Select","Select",""],["","68462010340","FLUCONAZOLE ","150MG","1","Select","Select",""],["","69547035302","NARCAN ","","2","Select","Select",""],["","46122044958","GNP ","4MG MINT","60","Select","Select",""],["","69315011610","FUROSEMIDE ","20MG","10","Select","Select",""],["","00781261305","AMOXICILLIN ","500MG","20","Select","Select",""],["","55111018015","TIZANIDINE ","4MG","90","Select","Select",""],["","00591352530","LIDOCAINE ","5%","20","Select","Select",""],["","72205000792","CAPECITABINE ","500MG","112","Select","Select",""],["","65862042005","SMZ\/TMP ","800-160","14","Select","Select",""],["","00536110888","NICOTINE ","21MG\/24H","14","Select","Select",""],["","00135047502","NICORETTE ","4MG MINT","60","Select","Select",""],["","00093506201","HYDROXYZ ","50MG","120","Select","Select",""],["","55111025660","ZIPRASIDONE","20MG","60","Select","Select",""],["","43598075205","BUPROPION","150MG SR","30","Select","Select",""],["","42571025201","CLINDAMYCIN","300MG","14","Select","Select",""],["","68462010530","ONDANSETRON","4MG","30","Select","Select",""],["","16729003101","METHYLDOPA","500MG","60","Select","Select",""],["","10702001801","OXYCODONE","5MG","5","Select","Select",""],["","13107003105","MIRTAZAPINE","15MG","30","Select","Select",""],["","65162062710","TRAMADOL","50MG","5","Select","Select",""],["","59746011506","PROCHLORPER","10MG","30","Select","Select",""],["","00054418425","DEXAMETHASON","4MG","24","Select","Select",""],["","00591207030","LIDO\/PRILOCN","2.5-2.5%","30","Select","Select",""],["","00406052301","OXYCOD\/APAP","10-325MG","10","Select","Select",""],["","65162019050","NAPROXEN","500MG","60","Select","Select",""],["","43598016630","OLANZAPINE","10MG","30","Select","Select",""],["","42747072601","SANCUSO","3.1MG","2","Select","Select",""],["","69097094312","GABAPENTIN","300MG","90","Select","Select",""],["","62332000191","FAMOTIDINE","20MG","30","Select","Select",""],["","68462010340","FLUCONAZOLE","150MG","1","Select","Select",""],["","69547035302","NARCAN","","2","Select","Select",""],["","00093001198","PANTOPRAZOLE","20MG","60","Select","Select",""],["","00781261305","AMOXICILLIN","500MG","20","Select","Select",""],["","55111018015","TIZANIDINE","4MG","90","Select","Select",""],["","68382013610","LOSARTAN","50MG","30","Select","Select",""],["","69238111601","BUSPIRONE","7.5MG","60","Select","Select",""],["","16714046801","CAPECITABINE","500MG","112","Select","Select",""],["","65862042005","SMZ\/TMP","800-160","14","Select","Select",""],["","00135047502","NICORETTE","4MG MINT","60","Select","Select",""],["","46122044958","GNP","4MG MINT","60","Select","Select",""],["","00536340501","NICOTINE","4MG","100","Select","Select",""],["","00093506201","HYDROXYZ","50MG","120","Select","Select",""],["","00591024005","LORAZEPAM","0.5MG","30","Select","Select",""],["","64380080807","IBUPROFEN","600MG","30","Select","Select",""],["","69315011610","FUROSEMIDE","20MG","10","Select","Select",""],["","00591352530","LIDOCAINE","5%","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":[[["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["No","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":""}]}]}