{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"REGINALD   J BROOKS","gend":0,"add":"PO BOX 482","city":"STANLEY","state":"VA","zip":"22851-9998","dob":"1970-12-23","age":"","mstatus":"","insh":"20024461*01","cliId":"","pno":"540\/742-8566","cno":"540\/742-8566","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":["F32.9","F41.1","B02.9","I10.","F17.210","E11.42","G47.30","E66.01","Z68.38","Z88.0","Z88.6","Z88.2","Z91.013","Z79.4","R39.14","E11.9","N31.9","M77.12","V58.89","R45.4","F31.62","F33.1","R09.81","R06.7","M25.512","G89.29","J40.","R06.02","M25.522","S56.519A","S22.41XA","W01.198A","F41.9","V54.19","F99.","N52.9","Z73.0","E11.65","F43.9","G47.33","F31.4","V62.85","V62.84","F39.","F17.200","G56.01","Z00.8","Z03.818","G47.00","Z01.818","G25.81","J06.9","R11.2","R45.86","M25.50","Z76.89","J20.9","Z68.41","Z87.891","J32.9","F43.21","Z99.89","F31.75","K21.9","M19.012","R06.2","R53.82","Z91.14","J01.00","F31.32","M79.672","Z01.810","Z01.812","Z20.822","R94.31","S56.512A","J45.909","F41.8","F51.01","Z79.899","M75.52"],"date":["2020-09-17","2021-09-22","2020-08-12","2021-08-06","2020-08-06","2021-07-05","2021-07-05","2021-07-05","2020-08-06","2021-07-05","2021-07-05","2021-07-05","2021-07-05","2021-03-03","2021-09-01","2021-09-01","2021-09-01","2021-03-09","2021-08-30","2021-09-22","2021-02-24","2021-09-22","2021-05-12","2021-07-05","2021-06-14","2021-05-12","2021-07-08","2021-07-03","2021-08-30","2021-08-06","2020-02-19","2020-02-19","2020-11-25","2020-02-21","2020-09-17","2020-04-24","2020-08-12","2021-08-06","2020-08-12","2020-09-25","2021-09-22","2021-01-18","2021-01-18","2020-11-15","2020-11-15","2020-02-13","2021-01-13","2021-01-13","2021-05-21","2021-08-06","2020-05-26","2020-06-05","2020-06-05","2020-11-03","2020-12-22","2020-11-10","2021-07-05","2021-07-05","2021-07-05","2020-01-02","2020-09-09","2020-09-09","2020-12-22","2020-12-22","2021-03-09","2021-07-08","2020-06-04","2020-06-04","2020-06-04","2020-07-16","2021-01-21","2021-08-06","2021-08-06","2021-08-06","2021-08-06","2021-08-10","2021-08-10","2021-08-10","2021-09-22","2021-09-22","2021-08-30"],"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":[["","53746010901","HYDROCO\/APAP ","5-325MG","42","Select","Select",""],["","53885004601","ONETOUCH ","ULTRA 2","1","Select","Select",""],["","53489011905","DOXYCYCL ","100MG","20","Select","Select",""],["","68180051303","LISINOPRIL ","5MG","30","Select","Select",""],["","51991074890","DULOXETINE ","60MG","60","Select","Select",""],["","00093742698","MONTELUKAST ","10MG","30","Select","Select",""],["","55111015810","OMEPRAZOLE ","20MG","30","Select","Select",""],["","00536589688","NICOTINE ","21MG\/24H","28","Select","Select",""],["","08290320119","BD  PEN NEEDL","31GX5MM","100","Select","Select",""],["","00002143380","TRULICITY ","0.75\/0.5","2","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","69547035302","NARCAN ","","2","Select","Select",""],["","65862039010","ONDANSETRON ","4MG ODT","30","Select","Select",""],["","68180016013","AZITHROMYCIN ","250MG","6","Select","Select",""],["","00093816201","QUETIAPINE ","100MG","30","Select","Select",""],["","10702001150","HYDROXYZ ","25MG","60","Select","Select",""],["","10370010150","BUPROPN ","150MG XL","30","Select","Select",""],["","68382025501","OXYBUTYNIN ","5MG ER","30","Select","Select",""],["","65862068890","SILDENAFIL ","20MG","50","Select","Select",""],["","43547027010","ROPINIROLE ","1MG","30","Select","Select",""],["","55111053401","DIVALPROEX ","500MG ER","30","Select","Select",""],["","00088221905","LANTUS ","100\/ML","15","Select","Select",""],["","57664049983","MIRTAZAPINE ","15MG","30","Select","Select",""],["","67877022310","GABAPENTIN ","300MG","90","Select","Select",""],["","43547030403","ARIPIPRAZOLE ","10MG","30","Select","Select",""],["","00228207610","TEMAZEPAM ","15MG","30","Select","Select",""],["","42858010201","OXYCOD\/APAP ","5-325MG","21","Select","Select",""],["","59746000103","METHYLPRED ","4MG","21","Select","Select",""],["","00169750111","NOVOLOG ","100\/ML","10","Select","Select",""],["","16729020201","BUSPIRONE ","10MG","60","Select","Select",""],["","00228202950","ALPRAZOLAM ","0.5MG","90","Select","Select",""],["","00115166003","PROPRANOLOL ","20MG","90","Select","Select",""],["","16714069703","VALACYCLOVIR ","1GM","21","Select","Select",""],["","10147095203","PALIPERIDONE ","ER 3MG","30","Select","Select",""],["","13668000805","ZOLPIDEM ","10MG","30","Select","Select",""],["","68382003416","VENLAFAXINE ","37.5 ER","45","Select","Select",""],["","16714070001","LAMOTRIGINE ","25MG","14","Select","Select",""],["","00591354060","BUPROPION ","100MG SR","30","Select","Select",""],["","08290324909","INSULIN ","0.3\/31G","100","Select","Select",""],["","68180071160","CEFDINIR ","300MG","20","Select","Select",""],["","00054327099","FLUTICASONE ","50MCG","16","Select","Select",""],["","41100080884","CORICIDIN ","HBP","355","Select","Select",""],["","00378699252","ALBUTEROL ","1.25MG\/3","150","Select","Select",""],["","68462033290","PRAMIPEXOLE ","0.5MG","60","Select","Select",""],["","59779044874","CVS ","21MG\/24H","28","Select","Select",""],["","68462033290","PRAMIPEXOLE","0.5MG","60","Select","Select",""],["","68180051303","LISINOPRIL","5MG","30","Select","Select",""],["","51991074790","DULOXETINE","30MG","60","Select","Select",""],["","00169750111","NOVOLOG","100\/ML","10","Select","Select",""],["","00093742698","MONTELUKAST","10MG","30","Select","Select",""],["","53885004601","ONETOUCH","ULTRA 2","1","Select","Select",""],["","55111015810","OMEPRAZOLE","20MG","30","Select","Select",""],["","00406012305","HYDROCO\/APAP","5-325MG","40","Select","Select",""],["","59779044874","CVS","21MG\/24H","28","Select","Select",""],["","00536589688","NICOTINE","21MG\/24H","28","Select","Select",""],["","08290320119","BD PEN NEEDL","31GX5MM","100","Select","Select",""],["","00002143380","TRULICITY","0.75\/0.5","2","Select","Select",""],["","69547035302","NARCAN","","2","Select","Select",""],["","68180016013","AZITHROMYCIN","250MG","6","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","10702001150","HYDROXYZ","25MG","120","Select","Select",""],["","65862068890","SILDENAFIL","20MG","50","Select","Select",""],["","53489011905","DOXYCYCL","100MG","20","Select","Select",""],["","65862039010","ONDANSETRON","4MG ODT","30","Select","Select",""],["","43547027010","ROPINIROLE","1MG","30","Select","Select",""],["","00093816201","QUETIAPINE","100MG","30","Select","Select",""],["","00088221905","LANTUS","100\/ML","15","Select","Select",""],["","68382025501","OXYBUTYNIN","5MG ER","30","Select","Select",""],["","57664049983","MIRTAZAPINE","15MG","30","Select","Select",""],["","00228202950","ALPRAZOLAM","0.5MG","90","Select","Select",""],["","16714069703","VALACYCLOVIR","1GM","21","Select","Select",""],["","10370010150","BUPROPN","150MG XL","30","Select","Select",""],["","69097094312","GABAPENTIN","300MG","30","Select","Select",""],["","10147095203","PALIPERIDONE","ER 3MG","30","Select","Select",""],["","16714070001","LAMOTRIGINE","25MG","14","Select","Select",""],["","16714078401","ARIPIPRAZOLE","5MG","14","Select","Select",""],["","55111053401","DIVALPROEX","500MG ER","30","Select","Select",""],["","13668000805","ZOLPIDEM","10MG","30","Select","Select",""],["","00228207610","TEMAZEPAM","15MG","30","Select","Select",""],["","08290324909","INSULIN","0.3\/31G","100","Select","Select",""],["","43547028810","BUPROPION","100MG SR","30","Select","Select",""],["","68382003416","VENLAFAXINE","37.5 ER","45","Select","Select",""],["","16729020201","BUSPIRONE","10MG","60","Select","Select",""],["","00115166003","PROPRANOLOL","20MG","90","Select","Select",""],["","42858010201","OXYCOD\/APAP","5-325MG","21","Select","Select",""],["","59746000103","METHYLPRED","4MG","21","Select","Select",""],["","00378699252","ALBUTEROL","1.25MG\/3","150","Select","Select",""],["","41100080884","CORICIDIN","HBP","355","Select","Select",""],["","00054327099","FLUTICASONE","50MCG","16","Select","Select",""],["","45802006003","BACITRACIN","500\/GM","28","Select","Select",""],["","58657050016","CODEINE\/GG","10-100\/5","236","Select","Select",""],["","00143992801","CIPROFLOXACN","500MG","14","Select","Select",""],["","68180071160","CEFDINIR","300MG","20","Select","Select",""],["","45802006003","BACITRACIN ","OIN 500\/GM","28","Select","Select",""],["","58657050016","CODEINE\/GG ","SOL 10-100\/5","236","Select","Select",""],["","00143992801","CIPROFLOXACN ","TAB 500MG","14","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":""}]}]}