{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DEBBIE   S HUDDLESTON","gend":1,"add":"4124 BETHEL CHURCH ROAD","city":"GREEN BAY","state":"VA","zip":"23942-9998","dob":"1974-09-29","age":"","mstatus":"","insh":"20029498*01","cliId":"","pno":"434\/390-8638","cno":"434\/390-8638","email":"","ename":"","eno":"","pphy":"POWERS, LINDA P MD","ppno":"434\/584-2025","pcpadd":"514 W ATLANTIC ST","pcpcity":"SOUTH HILL","pcpstate":"VA","pcpzip":23970,"pcpcounty":"","pcpid":210251,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","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":["R05.","J02.9","E11.65","E11.40","R11.2","E86.0","Z23.","R87.610","Z01.419","Z30.46","Z97.5","Z30.017","Z20.822"],"date":["2020-01-24","2020-01-24","2020-07-14","2020-07-14","2020-07-14","2020-07-14","2021-03-09","2021-04-23","2021-03-31","2021-03-31","2021-04-15","2021-05-04","2021-09-28"],"priorHcc":["","","","","","","","","","","","",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":[["","00088221905","LANTUS ","100\/ML","9","Select","Select",""],["","08290320122","BD  PEN NEEDL","32GX4MM","100","Select","Select",""],["","00002879959","HUMALOG ","100\/ML","6","Select","Select",""],["","38396030576","CVS ","30G","100","Select","Select",""],["","45802026937","PERMETHRIN ","5%","60","Select","Select",""],["","68180016013","AZITHROMYCIN ","250MG","6","Select","Select",""],["","00378064110","PREDNISONE ","10MG","10","Select","Select",""],["","00169633910","NOVOLOG ","FLEXPEN","6","Select","Select",""],["","69097082112","GEMFIBROZIL ","600MG","60","Select","Select",""],["","69097081312","GABAPENTIN ","100MG","90","Select","Select",""],["","68382076010","METFORMIN ","1000MG","60","Select","Select",""],["","00591217101","HYDROCO\/APAP ","2.5-325","5","Select","Select",""],["","68180051201","LISINOPRIL ","2.5MG","30","Select","Select",""],["","59779001922","ALLERGY ","25MG","10","Select","Select",""],["","45802026937","PERMETHRIN","5%","60","Select","Select",""],["","00088221905","LANTUS","100\/ML","9","Select","Select",""],["","38396030576","CVS","30G","100","Select","Select",""],["","00002879959","HUMALOG","100\/ML","6","Select","Select",""],["","08290320122","BD PEN NEEDL","32GX4MM","100","Select","Select",""],["","68180016013","AZITHROMYCIN","250MG","6","Select","Select",""],["","00378064110","PREDNISONE","10MG","10","Select","Select",""],["","00169633910","NOVOLOG","FLEXPEN","6","Select","Select",""],["","68382076010","METFORMIN","1000MG","60","Select","Select",""],["","69097082112","GEMFIBROZIL","600MG","60","Select","Select",""],["","69097081312","GABAPENTIN","100MG","90","Select","Select",""],["","68180051201","LISINOPRIL","2.5MG","30","Select","Select",""],["","59779001922","ALLERGY","25MG","10","Select","Select",""],["","00591217101","HYDROCO\/APAP","2.5-325","5","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":""}]}]}