{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LOIS   E HAZELWOOD","gend":1,"add":"913 LUNENBURG AVE","city":"VICTORIA","state":"VA","zip":"23974-9998","dob":"1959-05-05","age":"","mstatus":"","insh":"20028949*01","cliId":"","pno":"434\/298-8968","cno":"434\/298-8968","email":"","ename":"","eno":"","pphy":"ADAMS, DAVID MD","ppno":"434\/857-3600","pcpadd":"414 PARK AVE","pcpcity":"DANVILLE","pcpstate":"VA","pcpzip":24541,"pcpcounty":"","pcpid":182209,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/857-3601","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["L03.311","L02.211","B96.89","E11.65","E66.01","I10.","M17.0","E78.5","Z68.44","Z79.84","L60.0","B35.3","B35.1","E11.9","E83.42","K76.0","N20.0","D63.8","Z79.899","Z82.49","E83.31","D64.9","Z01.818","N85.00","E66.8","D25.0","R93.89","J01.00","Z98.890","M51.36","M54.31","E66.9","K65.1","Z74.3","T81.89XA","L03.319","K21.9","M25.551","M25.561","M54.5","R31.9","N39.0","H43.813","H35.033","H25.13","I87.8","S31.109A","R13.10","Z45.2","N95.0","Z20.822"],"date":["2020-03-06","2020-03-07","2020-03-07","2020-03-07","2020-03-07","2021-04-08","2020-03-07","2021-04-08","2021-01-12","2020-03-07","2021-10-13","2021-10-13","2021-10-13","2021-10-13","2020-03-13","2020-02-20","2020-03-13","2020-02-20","2020-02-20","2020-02-20","2020-03-06","2020-03-13","2021-04-08","2021-04-08","2021-04-08","2021-03-08","2021-03-08","2020-02-07","2020-03-04","2020-11-03","2020-11-03","2020-11-03","2020-03-26","2020-02-20","2020-03-06","2020-03-13","2020-12-17","2020-10-21","2020-10-21","2020-10-21","2021-01-12","2021-01-12","2021-04-14","2021-04-14","2021-04-14","2020-02-27","2020-02-27","2020-02-27","2020-03-26","2021-01-28","2021-09-01"],"priorHcc":["","","","","","","","","","",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":[["","23155010410","METFORMIN ","1000MG","60","Select","Select",""],["","62175013643","OMEPRAZOLE ","40MG","30","Select","Select",""],["","16571040250","CETIRIZINE ","10MG","30","Select","Select",""],["","00591046110","GLIPIZIDE ","10MG","60","Select","Select",""],["","00603020922","MAG ","400MG","30","Select","Select",""],["","00781261305","AMOXICILLIN ","500MG","21","Select","Select",""],["","68180098003","LISINOPRIL ","10MG","30","Select","Select",""],["","67877019890","AMLODIPINE ","5MG","30","Select","Select",""],["","60505257808","ATORVASTATIN ","10MG","30","Select","Select",""],["","69097084615","CYCLOBENZAPR ","10MG","21","Select","Select",""],["","67877021905","CEPHALEXIN ","500MG","28","Select","Select",""],["","00713067831","NYSTATIN ","100000","30","Select","Select",""],["","00378064210","PREDNISONE ","20MG","9","Select","Select",""],["","68462019005","NAPROXEN ","500MG","20","Select","Select",""],["","64380073706","VITAMIN ","50000UNT","12","Select","Select",""],["","00006011231","JANUVIA ","50MG","30","Select","Select",""],["","57237000511","FLUCONAZOLE ","150MG","2","Select","Select",""],["","16571041250","CIPROFLOXACN ","500MG","14","Select","Select",""],["","00591040505","LISINOPRIL","2.5MG","30","Select","Select",""],["","16571040250","CETIRIZINE","10MG","30","Select","Select",""],["","23155010410","METFORMIN","1000MG","60","Select","Select",""],["","62175013643","OMEPRAZOLE","40MG","30","Select","Select",""],["","00591046110","GLIPIZIDE","10MG","60","Select","Select",""],["","60505257808","ATORVASTATIN","10MG","30","Select","Select",""],["","00781261305","AMOXICILLIN","500MG","21","Select","Select",""],["","67877019890","AMLODIPINE","5MG","30","Select","Select",""],["","00603020922","MAG","400MG","30","Select","Select",""],["","69097084615","CYCLOBENZAPR","10MG","21","Select","Select",""],["","68462019005","NAPROXEN","500MG","20","Select","Select",""],["","67877021905","CEPHALEXIN","500MG","28","Select","Select",""],["","16571041250","CIPROFLOXACN","500MG","14","Select","Select",""],["","64380073706","VITAMIN","50000UNT","12","Select","Select",""],["","00006011231","JANUVIA","50MG","30","Select","Select",""],["","57237000511","FLUCONAZOLE","150MG","2","Select","Select",""],["","00713067831","NYSTATIN","100000","30","Select","Select",""],["","00378064210","PREDNISONE","20MG","9","Select","Select",""],["","37000002444","METAMUCIL ","POW 0.5812","44","Select","Select",""],["","00904699880","DOCUSATE ","CAP 100MG","30","Select","Select",""],["","11523726803","MIRALAX ","POW 3350 NF","30","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":""}]}]}