{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ANITA  L HUGHES","gend":1,"add":"83 CARR CREEK ROAD","city":"LEBANON","state":"VA","zip":"24266-9998","dob":"1967-07-31","age":"","mstatus":"","insh":"20029534*01","cliId":"","pno":"276\/206-9547","cno":"276\/206-9547","email":"","ename":"","eno":"","pphy":"YOUSUF, SAMINA MD","ppno":"276\/889-0433","pcpadd":"142 HIGHLANDS DR","pcpcity":"LEBANON","pcpstate":"VA","pcpzip":24266,"pcpcounty":"","pcpid":169125,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"SOUTHWEST","aligned":"","ano":"276\/345-2298","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"423\/431-1457","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I10.","M54.5","F41.1","J45.998","G43.109","Z13.83","B02.9","Z90.710","F33.0","J20.9","F17.210","R05.","E78.5","M54.2","M48.02","Z79.899","E78.2","K21.9"],"date":["2021-02-10","2021-06-04","2021-06-04","2020-10-16","2020-10-16","2021-06-04","2020-04-16","2021-06-04","2021-06-04","2021-02-10","2021-02-10","2021-02-10","2021-02-10","2020-09-18","2021-06-04","2020-11-06","2020-12-04","2020-12-04"],"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":[["","00143974001","PREDNISONE ","5MG","30","Select","Select",""],["","57237004001","PENICILLN ","250MG","20","Select","Select",""],["","42858000401","OXYCODONE ","20MG","90","Select","Select",""],["","16729011917","MONTELUKAST ","10MG","30","Select","Select",""],["","69315011610","FUROSEMIDE ","20MG","30","Select","Select",""],["","42571025201","CLINDAMYCIN ","300MG","20","Select","Select",""],["","65862060012","RIZATRIPTAN ","10MG","9","Select","Select",""],["","69230030401","ALLERGY ","10MG","30","Select","Select",""],["","67877051210","ATORVASTATIN ","20MG","30","Select","Select",""],["","43547035311","LISINOPRIL ","10MG","30","Select","Select",""],["","69547035302","NARCAN ","","2","Select","Select",""],["","00186037020","SYMBICORT ","160-4.5","10","Select","Select",""],["","59762372004","ALPRAZOLAM ","0.5MG","14","Select","Select",""],["","55111018010","TIZANIDINE ","4MG","90","Select","Select",""],["","31722077801","ACYCLOVIR ","800MG","20","Select","Select",""],["","29300012410","MELOXICAM ","7.5MG","60","Select","Select",""],["","70069000510","CYANOCOBALAM ","1000MCG","2","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","68180079902","POT  CHLORIDE","10MEQ ER","30","Select","Select",""],["","55111015905","OMEPRAZOLE ","40MG","30","Select","Select",""],["","58602044594","","","30","Select","Select",""],["","64980041209","PREGABALIN ","75MG","60","Select","Select",""],["","00310737020","BUDES\/FORMOT ","160-4.5","10","Select","Select",""],["","59762444002","METHYLPRED ","4MG","21","Select","Select",""],["","45802026937","PERMETHRIN ","5%","60","Select","Select",""],["","39328002430","LIDOCAINE ","4%","60","Select","Select",""],["","42806064801","DIPHENHYDRAM ","25MG","40","Select","Select",""],["","33342002332","LEVOFLOXACIN ","750MG","10","Select","Select",""],["","00487950160","ALBUTEROL ","0.08%","360","Select","Select",""],["","00536589688","NICOTINE ","21MG\/24H","28","Select","Select",""],["","68462019255","MOMETASONE ","0.10%","60","Select","Select",""],["","42571012290","LEVOCETIRIZI ","5MG","30","Select","Select",""],["","69452017173","AZITHROMYCIN ","250MG","6","Select","Select",""],["","53489014605","SMZ\/TMP ","800-160","20","Select","Select",""],["","68308015260","NYSTATIN ","100000","60","Select","Select",""],["","00832046560","NYAMYC ","100000","60","Select","Select",""],["","00069046903","CHANTIX ","1MG","56","Select","Select",""],["","59267100001","PFIZER ","COVID-19","0","Select","Select",""],["","00904546080","OYST ","500MG","60","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","",""],["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":""}]}]}