{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TOSHA   R COMBS","gend":1,"add":"412 S CHURCH ST","city":"MARION","state":"VA","zip":"24354-9998","dob":"1992-03-22","age":"","mstatus":"","insh":"20025678*01","cliId":"","pno":"276\/783-4741","cno":"276\/783-4741","email":"","ename":"","eno":"","pphy":"CLAMPITT, ROBERT VAN MD","ppno":"276\/783-7167","pcpadd":"STE 200 1020 TERRACE DR","pcpcity":"MARION","pcpstate":"VA","pcpzip":24354,"pcpcounty":"","pcpid":151902,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"SOUTHWEST","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F31.81","S60.222A","W22.8XXA","R11.2","N30.01","R06.09","S60.221A","S90.31XA","X50.1XXA","M25.562","L25.9","S93.402A","S20.212A","W10.9XXA","S63.91XA","X58.XXXA","S53.401A","S63.501A","W17.89XA","M79.605","I10.","N92.6","E66.9","S50.11XA","S66.811A","W01.0XXA","M62.838","S63.502A","R06.00","S90.32XA","S93.401A","S60.051A","S92.414A","W20.8XXA","M25.531","M79.642","R20.2","M79.674","M79.641","I47.1","N94.6","S93.412A","W18.42XA","R00.0","R06.83","S93.602A","R43.9","Z20.822","Z20.828","F41.9","F31.9","Z79.899","M25.571","R07.9","Z87.891"],"date":["2021-09-01","2020-01-06","2021-04-26","2021-03-05","2021-03-05","2021-04-12","2021-04-26","2021-06-07","2021-07-31","2021-07-10","2020-11-02","2021-07-31","2021-01-01","2021-01-01","2021-05-17","2021-05-17","2021-06-23","2021-11-06","2021-06-23","2021-01-25","2021-03-08","2021-01-25","2021-01-25","2021-03-29","2020-02-06","2021-11-06","2020-07-08","2020-12-05","2021-04-12","2021-04-13","2020-06-15","2020-09-05","2020-10-04","2021-02-17","2021-11-06","2021-07-07","2021-07-07","2020-10-09","2021-06-29","2020-01-28","2020-03-08","2020-05-08","2020-05-08","2021-03-08","2021-03-08","2021-07-31","2021-08-11","2021-10-07","2021-08-11","2021-08-11","2021-08-11","2021-08-11","2021-08-30","2021-10-07","2021-11-06"],"priorHcc":["","","","","","","","","","","","","","","","","",null,"","","","","","","",null,"","","","","","","","",null,"","","","","","","","","","","","",null,"","","","","",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":[["","69097084905","ESCITALOPRAM ","20MG","30","Select","Select",""],["","00185041501","BUPROPION ","150MG SR","30","Select","Select",""],["","50111043401","TRAZODONE ","100MG","60","Select","Select",""],["","57664047758","METOPROL ","50MG","60","Select","Select",""],["","63304071990","DILTIAZEM ","180MG ER","30","Select","Select",""],["","00093506201","HYDROXYZ ","50MG","60","Select","Select",""],["","68180032002","BUPROPN ","300MG XL","30","Select","Select",""],["","57237007730","ONDANSETRON ","4MG ODT","10","Select","Select",""],["","52817033010","CYCLOBENZAPR ","5MG","10","Select","Select",""],["","42858011830","LIDOCAINE ","5%","30","Select","Select",""],["","68180012202","CEPHALEXIN ","500MG","15","Select","Select",""],["","51224002218","AZITHROMYCIN ","250MG","6","Select","Select",""],["","57237009960","CEFDINIR ","300MG","20","Select","Select",""],["","50228043605","NAPROXEN ","500MG","30","Select","Select",""],["","64380080807","IBUPROFEN ","600MG","14","Select","Select",""],["","50111043401","TRAZODONE","100MG","60","Select","Select",""],["","43547028910","BUPROPION","150MG SR","30","Select","Select",""],["","00093506201","HYDROXYZ","50MG","60","Select","Select",""],["","69097084905","ESCITALOPRAM","20MG","30","Select","Select",""],["","57664047758","METOPROL","50MG","180","Select","Select",""],["","63304071990","DILTIAZEM","180MG ER","90","Select","Select",""],["","68180032002","BUPROPN","300MG XL","30","Select","Select",""],["","52817033010","CYCLOBENZAPR","5MG","10","Select","Select",""],["","42858011830","LIDOCAINE","5%","30","Select","Select",""],["","57237007730","ONDANSETRON","4MG ODT","10","Select","Select",""],["","68180012202","CEPHALEXIN","500MG","15","Select","Select",""],["","50228043605","NAPROXEN","500MG","30","Select","Select",""],["","51224002218","AZITHROMYCIN","250MG","6","Select","Select",""],["","57237009960","CEFDINIR","300MG","20","Select","Select",""],["","64380080807","IBUPROFEN","600MG","14","Select","Select",""],["","59148007280","ABILIFY","400MG","1","Select","Select",""],["","59148007280","ABILIFY ","INJ 400MG","1","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":[[["No","Select","","","","","Select","",""],["No","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":""}]}]}