{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MARIA   R BRADLEY","gend":1,"add":"1804 NEWTON ST APT 2","city":"BRISTOL","state":"VA","zip":24201,"dob":"1960-07-01","age":"","mstatus":"","insh":"20024272*01","cliId":"","pno":"423\/430-7425","cno":"423\/430-7425","email":"","ename":"","eno":"","pphy":"WILSON, RACHEL C DO","ppno":"276\/466-0584","pcpadd":"410 STAGECOACH RD","pcpcity":"BRISTOL","pcpstate":"VA","pcpzip":24201,"pcpcounty":"","pcpid":171020,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"SOUTHWEST","aligned":"","ano":"423\/383-0640","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"276\/669-8583","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11.3313","E11.65","E11.3393","Z96.1","E11.8","Z79.4","E11.22","N18.4","E78.2","I10.","R68.89","J10.1","Z79.899","D64.9","R30.0","E88.9","E11.40","G63.","E11.649","R60.9","R07.89","I36.1","K04.7","J98.19","J69.0","J45.20","Z01.818","Z20.822","R93.2","R05.","R06.2","J40.","E11.3493","H35.033","R94.5","E11.3413","Z03.818"],"date":["2021-08-12","2021-09-09","2021-04-29","2021-04-29","2021-08-30","2021-09-09","2021-09-09","2021-09-09","2021-06-14","2021-06-14","2020-02-11","2020-02-11","2020-09-23","2020-09-23","2020-09-23","2020-12-21","2021-04-15","2020-12-21","2021-08-12","2020-10-07","2021-02-16","2020-01-28","2020-05-02","2020-01-27","2020-01-27","2021-09-09","2021-06-08","2021-06-08","2021-04-05","2021-08-12","2021-09-09","2021-04-05","2021-05-13","2021-05-13","2021-05-19","2021-09-09","2021-08-15"],"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":[["","29300013010","HYDROCHLOROT ","12.5MG","30","Select","Select",""],["","65862056090","PANTOPRAZOLE ","40MG","30","Select","Select",""],["","00378003210","METOPROL ","50MG","30","Select","Select",""],["","00168084401","DICLOFENAC ","3%","100","Select","Select",""],["","60505317007","OMEGA-3-ACID ","1GM","120","Select","Select",""],["","65862020290","LOSARTAN ","50MG","60","Select","Select",""],["","69238131409","PREGABALIN ","150MG","60","Select","Select",""],["","00093720110","PRAVASTATIN ","20MG","30","Select","Select",""],["","08214385034","UNIFINE ","31GX3\/16","100","Select","Select",""],["","69097012605","AMLODIPINE ","2.5MG","30","Select","Select",""],["","00310737020","BUDES\/FORMOT ","160-4.5","10","Select","Select",""],["","52565000814","LIDOCAINE ","5%","35","Select","Select",""],["","00169633910","NOVOLOG ","FLEXPEN","15","Select","Select",""],["","00487950125","ALBUTEROL ","0.08%","75","Select","Select",""],["","62332042731","BENZONATATE ","200MG","20","Select","Select",""],["","08496310601","EASY ","31GX5\/16","500","Select","Select",""],["","68462050535","FLUOCINONIDE ","0.10%","120","Select","Select",""],["","00186037020","SYMBICORT ","160-4.5","10","Select","Select",""],["","68134020116","NAPROXEN ","125\/5ML","1000","Select","Select",""],["","51672415403","CALCIPOTRIEN ","0.01%","240","Select","Select",""],["","66685100101","AMOX\/K ","875-125","28","Select","Select",""],["","71800000960","DIFLORASONE ","0.05%","120","Select","Select",""],["","70512003350","HALOBETASOL ","0.05%","100","Select","Select",""],["","53885027210","ONETOUCH ","VERIO","400","Select","Select",""],["","00006022131","JANUVIA ","25MG","30","Select","Select",""],["","00085113204","PROVENTIL ","HFA","7","Select","Select",""],["","00169706515","GLUCAGEN ","HYPOKIT","2","Select","Select",""],["","00002882427","HUMULIN ","U-500","12","Select","Select",""],["","59267100003","PFIZER ","COVID-19","0","Select","Select",""],["","00143992801","CIPROFLOXACN ","500MG","20","Select","Select",""],["","57237001830","DULOXETINE ","30MG","60","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","00781261305","AMOXICILLIN ","500MG","30","Select","Select",""],["","00781808926","AZITHROMYCIN ","250MG","6","Select","Select",""],["","29300013010","HYDROCHLOROT","12.5MG","30","Select","Select",""],["","65862056090","PANTOPRAZOLE","40MG","30","Select","Select",""],["","69238131409","PREGABALIN","150MG","60","Select","Select",""],["","00378003210","METOPROL","50MG","30","Select","Select",""],["","65862020330","LOSARTAN","100MG","30","Select","Select",""],["","08214385034","UNIFINE","31GX3\/16","100","Select","Select",""],["","00093720110","PRAVASTATIN","20MG","30","Select","Select",""],["","00487950125","ALBUTEROL","0.08%","75","Select","Select",""],["","00186037020","SYMBICORT","160-4.5","10","Select","Select",""],["","00310737020","BUDES\/FORMOT","160-4.5","10","Select","Select",""],["","62332042731","BENZONATATE","200MG","20","Select","Select",""],["","71800000960","DIFLORASONE","0.05%","120","Select","Select",""],["","66685100101","AMOX\/K","875-125","28","Select","Select",""],["","69097012605","AMLODIPINE","2.5MG","30","Select","Select",""],["","00168084401","DICLOFENAC","3%","100","Select","Select",""],["","60505317007","OMEGA-3-ACID","1GM","120","Select","Select",""],["","68462050535","FLUOCINONIDE","0.10%","120","Select","Select",""],["","68134020116","NAPROXEN","125\/5ML","1000","Select","Select",""],["","51672415403","CALCIPOTRIEN","0.01%","240","Select","Select",""],["","70512003350","HALOBETASOL","0.05%","100","Select","Select",""],["","00169633910","NOVOLOG","FLEXPEN","45","Select","Select",""],["","08496310601","EASY","31GX5\/16","500","Select","Select",""],["","00143992801","CIPROFLOXACN","500MG","20","Select","Select",""],["","53885027210","ONETOUCH","VERIO","400","Select","Select",""],["","00002882427","HUMULIN","U-500","12","Select","Select",""],["","57237001830","DULOXETINE","30MG","60","Select","Select",""],["","00006022131","JANUVIA","25MG","30","Select","Select",""],["","00085113204","PROVENTIL","HFA","7","Select","Select",""],["","00169706515","GLUCAGEN","HYPOKIT","2","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","00781261305","AMOXICILLIN","500MG","30","Select","Select",""],["","00781808926","AZITHROMYCIN","250MG","6","Select","Select",""],["","59267100003","PFIZER","COVID-19","0","Select","Select",""],["","52565000814","LIDOCAINE","5%","35","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":""}]}]}