{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"GEORGE BEVILLE","gend":0,"add":"51 BRUNSWICK COMMONS COURT APT B","city":"LAWRENCEVILLE","state":"VA","zip":"23868-9998","dob":"1957-12-11","age":"","mstatus":"","insh":"20023884*01","cliId":"","pno":"434\/378-0724","cno":"434\/378-0724","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":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/634-7117","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R32.","R15.9","Z85.46","F11.20","Z79.891","M54.5","G89.29","M51.36","G25.81","M50.30","E11.9","H02.834","H02.831","H25.13","H35.033","E11.3292","H35.3131","H40.013","I25.110","M54.9","I49.5","Z45.010","I25.10","M54.2","J02.9","Z00.00","Z79.4","I25.119","I25.82","I44.2","E11.65","R00.1","I10.","Z11.59","E11.40","Z01.812","M48.02","K21.9","Z95.0","F17.210"],"date":["2021-08-30","2021-08-30","2021-08-30","2021-08-26","2021-06-10","2021-06-10","2021-08-26","2021-08-26","2021-06-10","2021-08-26","2021-03-01","2020-01-08","2020-01-08","2020-01-08","2020-01-08","2020-01-08","2020-01-08","2020-01-08","2020-05-21","2020-05-21","2020-09-25","2021-05-06","2021-06-23","2020-10-15","2020-04-07","2021-03-01","2021-03-01","2020-06-03","2020-06-03","2021-05-06","2020-10-15","2021-08-23","2020-01-24","2020-11-02","2021-03-02","2020-06-01","2020-11-04","2021-08-26","2021-08-23","2021-06-23"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","",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":[["","00904645780","DOK ","100MG","120","Select","Select",""],["","50228017805","GABAPENTIN ","800MG","90","Select","Select",""],["","00597002402","COMBIVENT ","20-100","4","Select","Select",""],["","11822316910","RA ","81MG EC","30","Select","Select",""],["","58160082311","SHINGRIX ","50MCG","1","Select","Select",""],["","42858010401","OXYCOD\/APAP ","10-325MG","120","Select","Select",""],["","42806031505","METFORMIN ","1000MG","60","Select","Select",""],["","68462063945","NITROGLYCERN ","0.4MG","25","Select","Select",""],["","00088221905","LANTUS ","100\/ML","12","Select","Select",""],["","27808015801","ROSUVASTATIN ","40MG","30","Select","Select",""],["","53885097301","ONETOUCH ","LANC DEV","1","Select","Select",""],["","00591234101","METAXALONE ","800MG","50","Select","Select",""],["","65862019430","FLUOXETINE ","40MG","30","Select","Select",""],["","50742061501","METOPROL ","25MG ER","15","Select","Select",""],["","38415051001","LANCING ","","1","Select","Select",""],["","08290320109","BD  PEN NEEDL","31GX8MM","100","Select","Select",""],["","00093221001","SUCRALFATE ","1GM","90","Select","Select",""],["","45802086803","POLYETH ","3350 NF","510","Select","Select",""],["","49483048112","ASPIRIN ","81MG EC","30","Select","Select",""],["","00904671772","CETIRIZINE ","10MG","30","Select","Select",""],["","00093310953","AMOXICILLIN ","500MG","30","Select","Select",""],["","67877019705","AMLODIPINE ","2.5MG","90","Select","Select",""],["","00069047103","CHANTIX ","0.5& 1MG","53","Select","Select",""],["","69547035302","NARCAN ","","2","Select","Select",""],["","43547026810","ROPINIROLE ","0.25MG","30","Select","Select",""],["","60505476606","APO-VARENICL ","1MG","56","Select","Select",""],["","11822060537","ALLERGY ","10MG","30","Select","Select",""],["","72647033104","METHYLPRED ","4MG","21","Select","Select",""],["","58160088552","FLUARIX ","2020-21","0","Select","Select",""],["","58160084252","BOOSTRIX ","","0","Select","Select",""],["","00002771559","BASAGLAR ","100UNIT","15","Select","Select",""],["","51672128402","TRIAMCINOLON ","0.10%","30","Select","Select",""],["","00378235193","ESOMEPRA ","40MG DR","30","Select","Select",""],["","80777027399","MODERNA ","COVID-19","0","Select","Select",""],["","31722071390","PANTOPRAZOLE ","40MG","30","Select","Select",""],["","68462063945","NITROGLYCERN","0.4MG","25","Select","Select",""],["","00088221905","LANTUS","100\/ML","12","Select","Select",""],["","00093221001","SUCRALFATE","1GM","90","Select","Select",""],["","65862019430","FLUOXETINE","40MG","30","Select","Select",""],["","00904645780","DOK","100MG","120","Select","Select",""],["","50228017805","GABAPENTIN","800MG","90","Select","Select",""],["","42858010401","OXYCOD\/APAP","10-325MG","120","Select","Select",""],["","50742061501","METOPROL","25MG ER","15","Select","Select",""],["","42806031505","METFORMIN","1000MG","60","Select","Select",""],["","27808015801","ROSUVASTATIN","40MG","90","Select","Select",""],["","53885027210","ONETOUCH","VERIO","100","Select","Select",""],["","00597002402","COMBIVENT","20-100","4","Select","Select",""],["","11822316910","RA","81MG EC","30","Select","Select",""],["","49483048112","ASPIRIN","81MG EC","30","Select","Select",""],["","38415051001","LANCING","","1","Select","Select",""],["","08290320109","BD PEN NEEDL","31GX8MM","100","Select","Select",""],["","00591234101","METAXALONE","800MG","50","Select","Select",""],["","00093310953","AMOXICILLIN","500MG","30","Select","Select",""],["","00904671772","CETIRIZINE","10MG","30","Select","Select",""],["","45802086803","POLYETH","3350 NF","510","Select","Select",""],["","69547035302","NARCAN","","2","Select","Select",""],["","11822060537","ALLERGY","10MG","30","Select","Select",""],["","67877019705","AMLODIPINE","2.5MG","90","Select","Select",""],["","00002771559","BASAGLAR","100UNIT","15","Select","Select",""],["","72647033104","METHYLPRED","4MG","21","Select","Select",""],["","58160084252","BOOSTRIX","","0","Select","Select",""],["","58160088552","FLUARIX","2020-21","0","Select","Select",""],["","51672128402","TRIAMCINOLON","0.10%","30","Select","Select",""],["","00069047103","CHANTIX","0.5& 1MG","53","Select","Select",""],["","80777027399","MODERNA","COVID-19","0","Select","Select",""],["","43547026810","ROPINIROLE","0.25MG","30","Select","Select",""],["","60505476606","APO-VARENICL","1MG","56","Select","Select",""],["","41100082071","MIRALAX","3350 NF","510","Select","Select",""],["","31722071390","PANTOPRAZOLE","40MG","30","Select","Select",""],["","00003089421","ELIQUIS","5MG","60","Select","Select",""],["","58160082311","SHINGRIX","50MCG","1","Select","Select",""],["","00378235193","ESOMEPRA","40MG DR","30","Select","Select",""],["","41100082071","MIRALAX ","POW 3350 NF","510","Select","Select",""],["","00003089421","ELIQUIS ","TAB 5MG","60","Select","Select",""],["","00310621030","FARXIGA ","TAB 10MG","30","Select","Select",""],["","08489830910","PEN  NEEDLES  ","MIS 31GX8MM","100","Select","Select",""],["","43386031214","GAVILAX ","POW ","510","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":""}]}]}