{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CLINT   E BILLER","gend":0,"add":"129 CHESTNUT DR","city":"LURAY","state":"VA","zip":"22835-9998","dob":"1975-09-18","age":"","mstatus":"","insh":"20023903*01","cliId":"","pno":"540\/742-4988","cno":"540\/742-4988","email":"","ename":"","eno":"","pphy":"LEE, R DAVID MD","ppno":"540\/743-2887","pcpadd":"135 MEMORIAL DRIVE","pcpcity":"LURAY","pcpstate":"VA","pcpzip":22835,"pcpcounty":"","pcpid":104675,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"NORTHERN & WINCHESTER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"540\/743-1288","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G50.0","F43.21","E11.9","Z20.818","R70.0","M31.6","Z79.899","M25.511","M25.551","M54.5","M25.512","M25.552","G89.29","M75.32","E11.65","D22.9","D18.01","L91.8","R20.9","R41.3","M06.9","R63.5","R51.","M70.62","M16.0","R79.82","M25.541","M25.542","H10.32","R05.","R06.02","R61.","Z12.11","J06.9","I10.","M62.81","M19.90","M79.671","M79.672","G57.90","E10.40","Z68.43","E11.8"],"date":["2020-02-07","2020-02-07","2021-01-27","2020-02-07","2021-06-02","2020-09-14","2021-08-16","2021-01-21","2021-03-24","2021-01-21","2021-08-16","2021-03-24","2021-08-16","2021-09-15","2020-09-08","2020-09-08","2020-11-24","2020-11-24","2020-11-24","2021-01-27","2021-01-27","2021-01-27","2020-03-31","2021-02-11","2021-02-11","2021-06-02","2021-08-16","2021-08-16","2020-04-29","2020-11-16","2020-11-16","2020-11-16","2020-12-08","2020-12-21","2020-12-08","2020-01-22","2021-09-03","2021-08-23","2021-09-03","2021-08-23","2021-08-23","2021-08-04","2021-08-04"],"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":[["","65162083366","DICLOFENAC ","1%","100","Select","Select",""],["","68645056854","ATORVASTATIN ","40MG","30","Select","Select",""],["","00006057762","JANUMET ","50-1000","60","Select","Select",""],["","00591352530","LIDOCAINE ","5%","90","Select","Select",""],["","00591365930","DESVENLAFAX ","50MG ER","30","Select","Select",""],["","10702000709","CYCLOBENZAPR ","10MG","30","Select","Select",""],["","59746017509","PREDNISONE ","20MG","42","Select","Select",""],["","68645055354","LISINOPRIL ","20MG","30","Select","Select",""],["","51672400501","CARBAMAZEPIN ","200MG","90","Select","Select",""],["","68382005105","MELOXICAM ","15MG","30","Select","Select",""],["","68645056259","IBUPROFEN ","600MG","20","Select","Select",""],["","63481068447","VOLTAREN ","1%","100","Select","Select",""],["","00406012301","HYDROCO\/APAP ","5-325MG","12","Select","Select",""],["","68180012202","CEPHALEXIN ","500MG","10","Select","Select",""],["","61314062810","POLYMYXIN ","TRIMETHP","10","Select","Select",""],["","00781286810","OMEPRAZOLE ","20MG DR","30","Select","Select",""],["","00228202950","ALPRAZOLAM ","0.5MG","2","Select","Select",""],["","16729048601","METHOTREXATE ","2.5MG","20","Select","Select",""],["","57237007710","ONDANSETRON ","4MG ODT","20","Select","Select",""],["","69315012710","FOLIC ","1000MCG","90","Select","Select",""],["","59762500005","SULFASALAZIN ","500MG","60","Select","Select",""],["","00169406013","VICTOZA ","18MG\/3ML","9","Select","Select",""],["","68645057390","GLIMEPIRIDE ","4MG","30","Select","Select",""],["","62332006230","LEFLUNOMIDE ","20MG","30","Select","Select",""],["","50111078751","AZITHROMYCIN ","250MG","6","Select","Select",""],["","00781261305","AMOXICILLIN ","500MG","30","Select","Select",""],["","13107008305","LORAZEPAM ","0.5MG","3","Select","Select",""],["","69547035302","NARCAN ","","2","Select","Select",""],["","08470795501","PEN  NEEDLES  ","30GX3\/16","100","Select","Select",""],["","42858010201","OXYCOD\/APAP ","5-325MG","28","Select","Select",""],["","81131038680","RELION ","31GX6MM","50","Select","Select",""],["","65162071009","COLCHICINE ","0.6MG","30","Select","Select",""],["","16714066102","GABAPENTIN ","100MG","100","Select","Select",""],["","68382005105","MELOXICAM","15MG","30","Select","Select",""],["","68645055354","LISINOPRIL","20MG","30","Select","Select",""],["","68645056854","ATORVASTATIN","40MG","30","Select","Select",""],["","00591365930","DESVENLAFAX","50MG ER","30","Select","Select",""],["","10702000709","CYCLOBENZAPR","10MG","30","Select","Select",""],["","00591352530","LIDOCAINE","5%","90","Select","Select",""],["","00006057762","JANUMET","50-1000","180","Select","Select",""],["","65162083366","DICLOFENAC","1%","100","Select","Select",""],["","59746017509","PREDNISONE","20MG","42","Select","Select",""],["","68645056259","IBUPROFEN","600MG","20","Select","Select",""],["","00406012301","HYDROCO\/APAP","5-325MG","12","Select","Select",""],["","13668026801","CARBAMAZEPIN","200MG","90","Select","Select",""],["","68180012202","CEPHALEXIN","500MG","10","Select","Select",""],["","61314062810","POLYMYXIN","TRIMETHP","10","Select","Select",""],["","00781286810","OMEPRAZOLE","20MG DR","30","Select","Select",""],["","00067815202","VOLTAREN","1%","100","Select","Select",""],["","68645057390","GLIMEPIRIDE","4MG","30","Select","Select",""],["","00781261305","AMOXICILLIN","500MG","30","Select","Select",""],["","50111078751","AZITHROMYCIN","250MG","6","Select","Select",""],["","16729048601","METHOTREXATE","2.5MG","20","Select","Select",""],["","69315012710","FOLIC","1000MCG","90","Select","Select",""],["","00228202950","ALPRAZOLAM","0.5MG","2","Select","Select",""],["","69547035302","NARCAN","","2","Select","Select",""],["","62332006230","LEFLUNOMIDE","20MG","30","Select","Select",""],["","00169406012","VICTOZA","18MG\/3ML","9","Select","Select",""],["","81131038680","RELION","31GX6MM","100","Select","Select",""],["","57237007710","ONDANSETRON","4MG ODT","20","Select","Select",""],["","59762500005","SULFASALAZIN","500MG","60","Select","Select",""],["","13107008305","LORAZEPAM","0.5MG","3","Select","Select",""],["","08470795501","PEN NEEDLES","30GX3\/16","100","Select","Select",""],["","42858010201","OXYCOD\/APAP","5-325MG","28","Select","Select",""],["","65162071009","COLCHICINE","0.6MG","30","Select","Select",""],["","67877022310","GABAPENTIN","300MG","100","Select","Select",""],["","72205001490","PREGABALIN ","CAP 100MG","60","Select","Select",""],["","00093009001","EPITOL ","TAB 200MG","90","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":""}]}]}