{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LISA   R GRIFFITH","gend":1,"add":"128 GAY AVE","city":"LEBANON","state":"VA","zip":"24266-9998","dob":"1973-10-07","age":"","mstatus":"","insh":"20028299*01","cliId":"","pno":"276\/701-8916","cno":"276\/701-8916","email":"","ename":"","eno":"","pphy":"SUAAVA, ROSE G DO","ppno":"276\/883-5939","pcpadd":"348 OVERLOOK DR","pcpcity":"LEBANON","pcpstate":"VA","pcpzip":24266,"pcpcounty":"","pcpid":171020,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"SOUTHWEST","aligned":"","ano":"276\/254-9241","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"276\/415-9162","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H60.503","Z12.31","R00.0","F41.1","E11.9","J44.9","F41.9","NO DATA","E53.8","R11.0","G62.9","M51.36","E55.9","R53.83","D50.9","F32.9","H65.01","H60.8X2","H61.21","K85.90","E87.6","N17.9","D69.6","R73.9","R41.82","E72.20","I10.","Z09.","G43.009","S42.022A","J80.","N17.0","I95.9","R57.9","E86.1","V54.19","S16.1XXS","Z79.899","K08.89","R07.9","F17.210","G40.909","R53.1","E13.10","R06.02","Z99.81","M25.512","Z87.891","M54.9","A41.9","R65.21","J96.01","J18.9","E87.0","Z20.828","J44.0","E11.00","K52.9","I12.9","N18.9","J96.00","W19.XXXD","S42.025D","S16.1XXA","Z79.4","S49.92XA","S42.032A","E08.10","E86.0","Z99.11","Z93.1","V28.0XXA"],"date":["2020-02-27","2020-02-27","2020-08-29","2021-11-11","2021-08-23","2021-06-22","2021-04-27","2020-11-13","2020-11-13","2021-06-11","2020-11-13","2021-04-27","2020-11-13","2020-11-13","2021-04-27","2021-04-27","2020-02-16","2020-03-09","2020-03-09","2020-08-30","2020-09-01","2020-08-30","2020-08-30","2020-08-30","2020-09-01","2020-09-01","2021-06-22","2020-09-09","2021-01-27","2021-07-04","2020-08-26","2020-08-30","2020-08-30","2020-08-30","2020-08-30","2021-06-22","2021-06-22","2021-06-22","2021-05-07","2021-06-11","2020-01-28","2020-01-28","2020-08-24","2020-08-24","2020-08-24","2020-08-24","2021-06-09","2021-06-11","2021-06-11","2020-08-25","2020-08-25","2020-08-29","2020-08-25","2020-08-29","2020-08-25","2020-08-25","2020-09-01","2020-08-25","2020-08-25","2020-08-25","2020-09-01","2021-06-11","2021-06-22","2021-06-22","2021-04-27","2021-06-30","2021-06-30","2020-08-24","2020-08-24","2020-08-29","2020-08-29","2021-06-06"],"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":[["","29300011405","LAMOTRIGINE","200MG","60","Select","Select",""],["","57237009960","CEFDINIR ","300MG","20","Select","Select",""],["","70069000510","CYANOCOBALAM ","1000MCG","1","Select","Select",""],["","00069047103","CHANTIX ","0.5& 1MG","53","Select","Select",""],["","69315011610","FUROSEMIDE ","20MG","30","Select","Select",""],["","29300011416","LAMOTRIGINE ","200MG","60","Select","Select",""],["","43547035411","LISINOPRIL ","20MG","30","Select","Select",""],["","65862019201","FLUOXETINE ","10MG","30","Select","Select",""],["","27241009706","DULOXETINE ","20MG","60","Select","Select",""],["","71093011205","GABAPENTIN ","800MG","120","Select","Select",""],["","29300012510","MELOXICAM ","15MG","30","Select","Select",""],["","45802059465","LEVOCETIRIZI ","5MG","30","Select","Select",""],["","42571016201","AMOX\/K ","875-125","20","Select","Select",""],["","61314064511","NEO\/POLY\/HC ","1% OTIC","10","Select","Select",""],["","59746017310","PREDNISONE ","10MG","21","Select","Select",""],["","68382018105","BUSPIRONE ","10MG","90","Select","Select",""],["","10702000201","PROMETHAZINE ","12.5MG","15","Select","Select",""],["","63868000230","NATURA-LAX ","3350 NF","510","Select","Select",""],["","00591406030","DESVENLAFAX ","25MG ER","30","Select","Select",""],["","59746011506","PROCHLORPER ","10MG","30","Select","Select",""],["","53885001110","ONETOUCH ","PLUS 30G","100","Select","Select",""],["","42858011830","LIDOCAINE ","5%","60","Select","Select",""],["","00093506001","HYDROXYZ ","10MG","26","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","00093083205","CLONAZEPAM ","0.5MG","20","Select","Select",""],["","59267100001","PFIZER ","COVID-19","0","Select","Select",""],["","00005197105","PREVNAR ","","0","Select","Select",""],["","57599000200","FREESTYLE    MIS READER","READER","1","Select","Select",""],["","27808003501","HYDROCO\/APAP ","5-325MG","9","Select","Select",""],["","00002879959","HUMALOG ","100\/ML","30","Select","Select",""],["","00193731221","CONTOUR ","NEXT","100","Select","Select",""],["","91237000177","EASY ","32GX5\/32","100","Select","Select",""],["","00088221905","LANTUS ","100\/ML","15","Select","Select",""],["","57599000101","FREESTYLE    KIT SENSOR","SENSOR","2","Select","Select",""],["","00904759180","FEROSUL ","325MG","180","Select","Select",""],["","51224002070","METFORMIN ","500MG","180","Select","Select",""],["","69097045805","FENOFIBRATE ","145MG","6","Select","Select",""],["","51991070510","ALPRAZOLAM ","0.5MG","75","Select","Select",""],["","49281042050","FLUZONE ","2020-21","0","Select","Select",""],["","00378668910","PANTOPRAZOLE ","40MG","43","Select","Select",""],["","00093317431","ALBUTEROL ","HFA","8","Select","Select",""],["","00904759180","FERROUS ","325MG","180","Select","Select",""],["","00193730850","","","100","Select","Select",""],["","56151146304","TRUE ","GLUCOSE","100","Select","Select",""],["","71351001250","LACTOBACILLU ","","14","Select","Select",""],["","55111029236","SUMATRIPTAN ","50MG","10","Select","Select",""],["","69452015120","VITAMIN ","50000UNT","12","Select","Select",""],["","43386048024","ORPHENADRINE ","100MG ER","20","Select","Select",""],["","45802011222","MUPIROCIN ","2%","22","Select","Select",""],["","60432026415","FLUTICASONE ","50MCG","16","Select","Select",""],["","76385012350","METHOCARBAM ","500MG","20","Select","Select",""],["","00113030603","CLEARLAX ","","510","Select","Select",""],["","69547035302","NARCAN ","","2","Select","Select",""],["","42571025101","CLINDAMYCIN ","150MG","28","Select","Select",""],["","29300012510","MELOXICAM","15MG","30","Select","Select",""],["","69315011610","FUROSEMIDE","20MG","30","Select","Select",""],["","43547035411","LISINOPRIL","20MG","90","Select","Select",""],["","70069000510","CYANOCOBALAM","1000MCG","1","Select","Select",""],["","71093011205","GABAPENTIN","800MG","120","Select","Select",""],["","65862019201","FLUOXETINE","10MG","30","Select","Select",""],["","00069047103","CHANTIX","0.5& 1MG","53","Select","Select",""],["","27241009706","DULOXETINE","20MG","60","Select","Select",""],["","57237009960","CEFDINIR","300MG","20","Select","Select",""],["","45802059465","LEVOCETIRIZI","5MG","30","Select","Select",""],["","59746017310","PREDNISONE","10MG","21","Select","Select",""],["","61314064511","NEO\/POLY\/HC","1% OTIC","10","Select","Select",""],["","42571016201","AMOX\/K","875-125","20","Select","Select",""],["","68382018105","BUSPIRONE","10MG","90","Select","Select",""],["","00591406030","DESVENLAFAX","25MG ER","30","Select","Select",""],["","53885024510","ONETOUCH","ULTRA","100","Select","Select",""],["","91237000177","EASY","32GX5\/32","100","Select","Select",""],["","00193731221","CONTOUR","NEXT","100","Select","Select",""],["","00088221905","LANTUS","100\/ML","30","Select","Select",""],["","71351001250","LACTOBACILLU","","14","Select","Select",""],["","10702000201","PROMETHAZINE","12.5MG","15","Select","Select",""],["","00378668910","PANTOPRAZOLE","40MG","43","Select","Select",""],["","63868000230","NATURA-LAX","3350 NF","510","Select","Select",""],["","56151146304","TRUE","GLUCOSE","100","Select","Select",""],["","59746011506","PROCHLORPER","10MG","90","Select","Select",""],["","51224002070","METFORMIN","500MG","168","Select","Select",""],["","00904759180","FERROUS","325MG","180","Select","Select",""],["","00002879959","HUMALOG","100\/ML","30","Select","Select",""],["","00093506001","HYDROXYZ","10MG","60","Select","Select",""],["","00005197105","PREVNAR","","0","Select","Select",""],["","42858011830","LIDOCAINE","5%","30","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","69452015120","VITAMIN","50000UNT","8","Select","Select",""],["","66993001968","ALBUTEROL","HFA","18","Select","Select",""],["","51991070510","ALPRAZOLAM","0.5MG","60","Select","Select",""],["","00093083205","CLONAZEPAM","0.5MG","20","Select","Select",""],["","59267100001","PFIZER","COVID-19","0","Select","Select",""],["","57599000200","FREESTYLE MIS READER","READER","1","Select","Select",""],["","57599000101","FREESTYLE KIT SENSOR","SENSOR","2","Select","Select",""],["","45802011222","MUPIROCIN","2%","22","Select","Select",""],["","60432026415","FLUTICASONE","50MCG","16","Select","Select",""],["","00904759180","FEROSUL","325MG","180","Select","Select",""],["","00113030603","CLEARLAX","","510","Select","Select",""],["","27808003501","HYDROCO\/APAP","5-325MG","9","Select","Select",""],["","43386048024","ORPHENADRINE","100MG ER","20","Select","Select",""],["","69547035302","NARCAN","","2","Select","Select",""],["","76385012350","METHOCARBAM","500MG","20","Select","Select",""],["","42571025101","CLINDAMYCIN","150MG","28","Select","Select",""],["","69097045805","FENOFIBRATE","145MG","6","Select","Select",""],["","49281042050","FLUZONE","2020-21","0","Select","Select",""],["","55111029236","SUMATRIPTAN","50MG","10","Select","Select",""],["","00002822259","INSULIN ","INJ 100\/ML","30","Select","Select",""],["","90166043154","PEN  NEEDLES  ","MIS 32GX4MM","360","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","",""],["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":""}]}]}