{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BETTY   J CARTER","gend":1,"add":"PO BOX 694","city":"KILMARNOCK","state":"VA","zip":22482,"dob":"1957-04-12","age":"","mstatus":"","insh":"20025063*01","cliId":"","pno":"804\/480-9064","cno":"804\/480-9064","email":"","ename":"","eno":"","pphy":"ASHWORTH, JOEL MD","ppno":"804\/435-2651","pcpadd":"402 NORTH MAIN STREET","pcpcity":"KILMARNOCK","pcpstate":"VA","pcpzip":22482,"pcpcounty":"","pcpid":200957,"pcpname":"BON SECOURS KILMARNOCK PRIMARY CARE","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/435-2303","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F33.1","N95.0","Z11.3","A59.00","A53.0","D32.0","Z20.828","D32.9","J11.1","R68.89","K76.89","R74.8","N93.9","Z12.39","G40.909","G62.9","F41.9","E11.21","E78.5","Z01.818","Z87.891","H61.22","J01.91","Q67.0","Z68.22","H35.3131","Z96.1","H04.123","F33.9","B02.9","J32.1","F32.9","R51.9","R11.10","E11.9","N30.90","Z51.81","R19.7","H61.23","G50.1","Z23.","Z68.21","M54.2","R30.0","S16.1XXA","M19.90","V49.40XA"],"date":["2021-09-27","2021-09-23","2020-05-04","2020-10-12","2020-07-13","2021-06-30","2020-09-29","2021-09-23","2020-01-15","2020-01-15","2020-10-28","2020-04-28","2020-06-03","2020-04-29","2021-09-23","2020-06-03","2021-07-20","2021-09-23","2021-03-25","2020-06-03","2020-06-03","2020-06-03","2020-08-27","2020-08-27","2021-09-23","2020-09-14","2020-09-14","2020-09-14","2020-03-18","2020-08-29","2020-08-29","2020-03-18","2020-11-04","2020-11-04","2020-01-22","2020-01-22","2020-01-22","2020-02-26","2020-02-26","2020-08-28","2021-09-23","2021-07-06","2021-07-27","2021-09-23","2021-07-20","2021-07-20","2021-07-20"],"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":[["","68180031902","BUPROPN ","150MG XL","30","Select","Select",""],["","53885065701","ONETOUCH ","VERIO","1","Select","Select",""],["","49884090761","MEGESTROL ","40MG\/ML","240","Select","Select",""],["","31722055190","LEVOCETIRIZI ","5MG","30","Select","Select",""],["","00603516621","PHENOBARB ","32.4MG","90","Select","Select",""],["","68462039610","OMEPRAZOLE ","20MG","30","Select","Select",""],["","00054327099","FLUTICASONE ","50MCG","16","Select","Select",""],["","00591354160","BUPROPION ","150MG SR","180","Select","Select",""],["","47781030301","NITROFURANTN ","100MG","14","Select","Select",""],["","00904539561","FERREX ","150MG","60","Select","Select",""],["","00555077902","MEDROXYPR ","10MG","14","Select","Select",""],["","00245531790","KLOR-CON ","10MEQ ER","30","Select","Select",""],["","00597007541","SPIRIVA ","HANDIHLR","30","Select","Select",""],["","68180067711","OSELTAMIVIR ","75MG","10","Select","Select",""],["","16714068302","SIMVASTATIN ","20MG","30","Select","Select",""],["","99073070805","FREESTYLE    MIS LITE","LITE","1","Select","Select",""],["","53885000048","","","1","Select","Select",""],["","65702040810","ACCU-CHEK ","AVIVA PL","100","Select","Select",""],["","65162021210","PHENYTOIN ","100MG","90","Select","Select",""],["","65862039010","ONDANSETRON ","4MG ODT","10","Select","Select",""],["","53489011905","DOXYCYCL ","100MG","14","Select","Select",""],["","33332041910","AFLURIA ","2019-20","0","Select","Select",""],["","50111033401","METRONIDAZOL ","500MG","4","Select","Select",""],["","00187137316","CERAVE ","","453","Select","Select",""],["","69784050001","EC-NAPROXEN ","500MG","30","Select","Select",""],["","69543042610","NAPROXEN ","500MG","30","Select","Select",""],["","60793070110","BICILLIN ","1200000","12","Select","Select",""],["","62037071001","POT  CL MICRO","10MEQ CR","30","Select","Select",""],["","65162074510","PROMETHAZINE ","12.5MG","15","Select","Select",""],["","00591565810","CYCLOBENZAPR ","10MG","15","Select","Select",""],["","65862050320","AMOX\/K ","875-125","10","Select","Select",""],["","65862052305","GABAPENTIN ","600MG","30","Select","Select",""],["","31722070530","VALACYCLOVIR ","1GM","21","Select","Select",""],["","53746010901","HYDROCO\/APAP ","5-325MG","15","Select","Select",""],["","00054418325","DEXAMETHASON ","2MG","20","Select","Select",""],["","56151146001","TRUE ","GLUCOSE","100","Select","Select",""],["","68180031902","BUPROPN","150MG XL","30","Select","Select",""],["","68180067711","OSELTAMIVIR","75MG","10","Select","Select",""],["","68462039610","OMEPRAZOLE","20MG","30","Select","Select",""],["","00603516621","PHENOBARB","32.4MG","90","Select","Select",""],["","47781030301","NITROFURANTN","100MG","14","Select","Select",""],["","00054327099","FLUTICASONE","50MCG","16","Select","Select",""],["","00781571001","POT CL MICRO","10MEQ ER","30","Select","Select",""],["","65162021210","PHENYTOIN","100MG","90","Select","Select",""],["","16714068302","SIMVASTATIN","20MG","30","Select","Select",""],["","56151146001","TRUE","GLUCOSE","100","Select","Select",""],["","53885027210","ONETOUCH","VERIO","100","Select","Select",""],["","31722055190","LEVOCETIRIZI","5MG","30","Select","Select",""],["","60432012608","MEGESTROL","40MG\/ML","240","Select","Select",""],["","00597007541","SPIRIVA","HANDIHLR","30","Select","Select",""],["","99073070805","FREESTYLE MIS LITE","LITE","1","Select","Select",""],["","00555077902","MEDROXYPR","10MG","14","Select","Select",""],["","00904539561","FERREX","150MG","60","Select","Select",""],["","00245531790","KLOR-CON","10MEQ ER","30","Select","Select",""],["","65702040810","ACCU-CHEK","AVIVA PL","100","Select","Select",""],["","65862039010","ONDANSETRON","4MG ODT","10","Select","Select",""],["","53489011905","DOXYCYCL","100MG","14","Select","Select",""],["","00591354160","BUPROPION","150MG SR","180","Select","Select",""],["","33332041910","AFLURIA","2019-20","0","Select","Select",""],["","50111033401","METRONIDAZOL","500MG","4","Select","Select",""],["","00187137316","CERAVE","","453","Select","Select",""],["","60793070110","BICILLIN","1200000","12","Select","Select",""],["","31722070530","VALACYCLOVIR","1GM","21","Select","Select",""],["","65862052305","GABAPENTIN","600MG","30","Select","Select",""],["","65862050320","AMOX\/K","875-125","10","Select","Select",""],["","65162074510","PROMETHAZINE","12.5MG","15","Select","Select",""],["","53746010901","HYDROCO\/APAP","5-325MG","15","Select","Select",""],["","69543042610","NAPROXEN","500MG","30","Select","Select",""],["","69784050001","EC-NAPROXEN","500MG","30","Select","Select",""],["","00591565810","CYCLOBENZAPR","10MG","15","Select","Select",""],["","00054418325","DEXAMETHASON","2MG","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","",""],["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":""}]}]}