{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BARRY   J MILES","gend":0,"add":"715 TRENTS MILL ROAD","city":"CUMBERLAND","state":"VA","zip":"23040-9998","dob":"1963-08-18","age":"","mstatus":"","insh":"20032069*01","cliId":"","pno":"804\/492-5806","cno":"804\/492-5806","email":"","ename":"","eno":"","pphy":"CAMPANELLI, DAVID MD","ppno":"434\/581-3271","pcpadd":"RT 15 SOUTH","pcpcity":"NEW CANTON","pcpstate":"VA","pcpzip":23123,"pcpcounty":"","pcpid":105792,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"804\/517-8592","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/581-1105","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G47.33","H40.059","E11.9","H27.03","H55.00","H43.813","M79.642","Z23.","M25.532","M79.602"],"date":["2021-04-23","2020-09-22","2020-09-22","2020-09-22","2020-09-22","2020-09-22","2020-03-18","2021-06-01","2020-03-12","2020-03-12"],"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":[["","59310057922","PROAIR ","","8","Select","Select",""],["","68382075810","METFORMIN ","500MG","155","Select","Select",""],["","45802004611","GENTAMICIN ","0.10%","30","Select","Select",""],["","68180098103","LISINOPRIL ","20MG","34","Select","Select",""],["","00597015330","JARDIANCE ","25MG","30","Select","Select",""],["","00006027754","JANUVIA ","100MG","30","Select","Select",""],["","55111032001","GLIMEPIRIDE ","1MG","102","Select","Select",""],["","00093727398","PIOGLITAZONE ","45MG","30","Select","Select",""],["","43547038450","GABAPENTIN ","300MG","120","Select","Select",""],["","00603188016","LIDOCAINE ","5%","30","Select","Select",""],["","55111012290","ATORVASTATIN ","20MG","30","Select","Select",""],["","76204020025","ALBUTEROL ","0.08%","300","Select","Select",""],["","53885024450","ONETOUCH ","ULTRA BL","50","Select","Select",""],["","51991091390","FOLTANX ","","30","Select","Select",""],["","55111072510","MONTELUKAST ","10MG","30","Select","Select",""],["","24208046325","LATANOPROST ","0.01%","2","Select","Select",""],["","16729018201","HYDROCHLOROT ","12.5MG","30","Select","Select",""],["","65162089129","MOMETASONE ","50MCG","51","Select","Select",""],["","67877032005","IBUPROFEN ","600MG","180","Select","Select",""],["","00904404073","ASPIRIN ","81MG","90","Select","Select",""],["","00525804990","METANX ","","90","Select","Select",""],["","68462018135","CLOTRIMAZOLE ","1%","90","Select","Select",""],["","51672128202","TRIAMCINOLON ","0.10%","180","Select","Select",""],["","76439040390","METHYLFOL\/ME ","CBL\/P5P","30","Select","Select",""],["","60505025202","TIZANIDINE ","4MG","270","Select","Select",""],["","00054327099","FLUTICASONE ","50MCG","48","Select","Select",""],["","08463702930","LANCETS ","30G","100","Select","Select",""],["","51672210002","BUTENAFINE ","1%","30","Select","Select",""],["","70461032003","FLUCLVX ","2020-21","0","Select","Select",""],["","08463382001","LANCING ","","1","Select","Select",""],["","47884017540","EASYMAX ","NORMAL","1","Select","Select",""],["","00603188016","LIDOCAINE","5%","30","Select","Select",""],["","55111012290","ATORVASTATIN","20MG","30","Select","Select",""],["","76204020025","ALBUTEROL","0.08%","300","Select","Select",""],["","53885024450","ONETOUCH","ULTRA BL","50","Select","Select",""],["","68382075810","METFORMIN","500MG","155","Select","Select",""],["","55111032001","GLIMEPIRIDE","1MG","102","Select","Select",""],["","00597015330","JARDIANCE","25MG","30","Select","Select",""],["","00006027754","JANUVIA","100MG","30","Select","Select",""],["","45802004611","GENTAMICIN","0.10%","30","Select","Select",""],["","68180098103","LISINOPRIL","20MG","34","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","43547038450","GABAPENTIN","300MG","120","Select","Select",""],["","00093727398","PIOGLITAZONE","45MG","30","Select","Select",""],["","24208046325","LATANOPROST","0.01%","2","Select","Select",""],["","55111072510","MONTELUKAST","10MG","30","Select","Select",""],["","16729018201","HYDROCHLOROT","12.5MG","30","Select","Select",""],["","51991091390","FOLTANX","","30","Select","Select",""],["","00525804918","METANX","","90","Select","Select",""],["","00904404073","ASPIRIN","81MG","90","Select","Select",""],["","76439040390","METHYLFOL\/ME","CBL\/P5P","90","Select","Select",""],["","65162089129","MOMETASONE","50MCG","51","Select","Select",""],["","67877032005","IBUPROFEN","600MG","180","Select","Select",""],["","51672128202","TRIAMCINOLON","0.10%","180","Select","Select",""],["","68462018135","CLOTRIMAZOLE","1%","90","Select","Select",""],["","60505025202","TIZANIDINE","4MG","270","Select","Select",""],["","51672210002","BUTENAFINE","1%","30","Select","Select",""],["","70461032003","FLUCLVX","2020-21","0","Select","Select",""],["","00054327099","FLUTICASONE","50MCG","48","Select","Select",""],["","08463702930","LANCETS","30G","100","Select","Select",""],["","08463382001","LANCING","","1","Select","Select",""],["","47884017540","EASYMAX","NORMAL","1","Select","Select",""],["","49281063515","FLUZONE ","INJ 2021-22","0","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":""}]}]}