{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"NICOLETTE CORY","gend":1,"add":"1410 ORCHARD DR","city":"SALEM","state":"VA","zip":"24153-9998","dob":"1989-10-21","age":"","mstatus":"","insh":"20025815*01","cliId":"","pno":"336\/520-4882","cno":"336\/520-4882","email":"","ename":"","eno":"","pphy":"GLONTZ, GARY E MD","ppno":"540\/444-2010","pcpadd":"2155 APPERSON DRIVE","pcpcity":"SALEM","pcpstate":"VA","pcpzip":24153,"pcpcounty":"","pcpid":136562,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"ROANOKE ALLEGHANY","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"540\/444-2019","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F33.0","F88.","F42.2","I12.9","E55.9","E21.3","N18.1","K86.1","Z94.0","K86.2","R11.0","R53.83","R10.13","R10.10","K86.89","Q61.3","F32.3","G89.29","R10.9","Z79.899","Z48.298","F32.9","Q61.9","K76.89","J35.1","Q87.0","R13.10","J03.90","R05.","Q45.2","Q44.5","K83.9","J02.9","Z71.89","N28.89","K29.70","R10.11","Z76.89","Z13.220","K85.90","J06.9","R79.89"],"date":["2021-11-17","2021-03-25","2021-03-25","2020-01-13","2020-01-13","2020-01-13","2020-01-13","2021-08-19","2021-08-19","2020-09-29","2020-12-08","2020-05-14","2021-02-15","2020-07-29","2020-07-29","2020-12-08","2020-12-10","2020-04-28","2020-11-18","2021-04-21","2021-04-21","2021-04-21","2020-10-05","2020-09-29","2020-10-07","2020-10-07","2020-10-07","2020-08-31","2020-10-26","2021-03-15","2021-03-15","2021-03-15","2020-08-18","2021-04-21","2020-08-26","2020-08-26","2020-08-26","2020-11-18","2020-11-18","2021-02-15","2020-10-26","2021-10-01"],"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":[["","16729004201","TACROLIMUS ","1MG","120","Select","Select",""],["","50111064801","FLUOXETINE ","20MG","30","Select","Select",""],["","60505296507","MYCOPHENOLIC ","180MG DR","240","Select","Select",""],["","62175061743","PANTOPRAZOLE ","40MG","30","Select","Select",""],["","69452015120","VITAMIN ","50000UNT","4","Select","Select",""],["","68462010530","ONDANSETRON ","4MG","8","Select","Select",""],["","00078038566","MYFORTIC ","180MG","240","Select","Select",""],["","65862001501","AMOXICILLIN ","875MG","14","Select","Select",""],["","59267100002","PFIZER ","COVID-19","0","Select","Select",""],["","49281072010","FLUBLOK ","2020-21","0","Select","Select",""],["","00469061773","PROGRAF ","1MG","120","Select","Select",""],["","70710122501","AMITRIPTYLIN ","10MG","90","Select","Select",""],["","00603020922","MAG ","400MG","60","Select","Select",""],["","52569013918","MAGNESIUM ","400MG","60","Select","Select",""],["","00143992801","CIPROFLOXACN ","500MG","14","Select","Select",""],["","64980052810","SODIUM ","650MG","180","Select","Select",""],["","58526000542","D ","2000UNIT","90","Select","Select",""],["","50111064801","FLUOXETINE","20MG","30","Select","Select",""],["","16729004201","TACROLIMUS","1MG","120","Select","Select",""],["","60505296507","MYCOPHENOLIC","180MG DR","240","Select","Select",""],["","62175061743","PANTOPRAZOLE","40MG","30","Select","Select",""],["","69452015120","VITAMIN","50000UNT","4","Select","Select",""],["","68462010530","ONDANSETRON","4MG","8","Select","Select",""],["","00093310905","AMOXICILLIN","500MG","21","Select","Select",""],["","49281072010","FLUBLOK","2020-21","0","Select","Select",""],["","00078038566","MYFORTIC","180MG","240","Select","Select",""],["","70710122501","AMITRIPTYLIN","10MG","90","Select","Select",""],["","59267100002","PFIZER","COVID-19","0","Select","Select",""],["","00469061773","PROGRAF","1MG","120","Select","Select",""],["","64980052810","SODIUM","650MG","180","Select","Select",""],["","00143992801","CIPROFLOXACN","500MG","14","Select","Select",""],["","00603020922","MAG","400MG","60","Select","Select",""],["","52569013918","MAGNESIUM","400MG","60","Select","Select",""],["","58526000542","D","2000UNIT","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":[[["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":""}]}]}