{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JOHN   A MORRIS","gend":0,"add":"101 GRACE ST","city":"CLARKSVILLE","state":"VA","zip":"23927-9998","dob":"1966-11-03","age":"","mstatus":"","insh":"20032445*01","cliId":"","pno":"434\/374-4000","cno":"434\/374-4000","email":"","ename":"","eno":"","pphy":"SUSLICK, RANDALL H MD","ppno":"434\/372-5141","pcpadd":"946 N MAIN ST","pcpcity":"CHASE CITY","pcpstate":"VA","pcpzip":23924,"pcpcounty":"","pcpid":105512,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/372-8910","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F10.239","F11.20","B18.2","F41.9","F32.9","G89.29","F14.10","F12.10","F17.210","F10.20","F11.10","T17.920A","T18.128A","K22.2","K44.9","Z11.59","J40.","R06.2","U07.1","R50.81","R09.02","I10.","F14.20","F10.10","Z90.49","Z96.643","Z96.652","Z82.49","Z80.9","R11.0","R74.8","Z86.19","Z86.010","F17.200","R73.03","E78.5","T40.1X1A","F10.929","Z20.822","H25.13","H35.3131","H52.4","E66.9","F11.29","G47.00","G25.81"],"date":["2020-04-09","2021-11-06","2020-04-09","2020-04-09","2020-04-09","2020-04-09","2020-04-11","2020-04-09","2020-05-21","2021-04-07","2020-05-21","2020-11-18","2020-11-18","2020-11-18","2020-11-18","2020-11-18","2021-01-14","2021-01-14","2021-02-04","2021-02-04","2021-03-09","2021-03-09","2020-05-28","2020-05-21","2020-05-21","2020-05-21","2020-05-21","2020-05-21","2020-05-21","2020-05-21","2020-01-07","2020-07-24","2020-01-07","2020-01-07","2021-02-03","2021-02-03","2021-03-09","2021-03-09","2021-03-09","2021-07-26","2021-07-26","2021-07-26","2020-07-24","2020-07-24","2020-07-24","2020-07-24"],"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":[["","00093031401","KETOROLAC ","10MG","14","Select","Select",""],["","65162021210","PHENYTOIN ","100MG","4","Select","Select",""],["","65862042005","SMZ\/TMP ","800-160","20","Select","Select",""],["","00228253910","CARB\/LEVO ","25-100MG","90","Select","Select",""],["","00093005401","BUSPIRONE ","10MG","28","Select","Select",""],["","65862018730","ONDANSETRON ","4MG","1","Select","Select",""],["","43547026810","ROPINIROLE ","0.25MG","90","Select","Select",""],["","00555015902","CHLORDIAZEP ","25MG","33","Select","Select",""],["","29300013901","DIVALPROEX ","250MG DR","3","Select","Select",""],["","29300012510","MELOXICAM ","15MG","30","Select","Select",""],["","00093720756","MIRTAZAPINE ","30MG","30","Select","Select",""],["","70010077005","METHOCARBAM ","750MG","60","Select","Select",""],["","13668033005","TRAZODONE ","50MG","30","Select","Select",""],["","00115165801","NABUMETONE ","750MG","60","Select","Select",""],["","66689000816","NYSTATIN ","100000","224","Select","Select",""],["","00603240728","BACLOFEN ","20MG","90","Select","Select",""],["","00186037020","SYMBICORT ","160-4.5","10","Select","Select",""],["","00310737020","BUDES\/FORMOT ","160-4.5","10","Select","Select",""],["","80777027398","MODERNA ","COVID-19","0","Select","Select",""],["","29300034905","ALLOPURINOL ","100MG","30","Select","Select",""],["","65162021210","PHENYTOIN","100MG","120","Select","Select",""],["","65862042005","SMZ\/TMP","800-160","20","Select","Select",""],["","00228253910","CARB\/LEVO","25-100MG","90","Select","Select",""],["","00093031401","KETOROLAC","10MG","14","Select","Select",""],["","00093005401","BUSPIRONE","10MG","28","Select","Select",""],["","00555015902","CHLORDIAZEP","25MG","33","Select","Select",""],["","13668033005","TRAZODONE","50MG","30","Select","Select",""],["","65862018730","ONDANSETRON","4MG","1","Select","Select",""],["","00093720756","MIRTAZAPINE","30MG","30","Select","Select",""],["","61442012710","MELOXICAM","15MG","30","Select","Select",""],["","43547026810","ROPINIROLE","0.25MG","90","Select","Select",""],["","62756079713","DIVALPROEX","250MG DR","28","Select","Select",""],["","80777027398","MODERNA","COVID-19","0","Select","Select",""],["","00591367101","NABUMETONE","750MG","60","Select","Select",""],["","00603240728","BACLOFEN","20MG","90","Select","Select",""],["","00186037020","SYMBICORT","160-4.5","10","Select","Select",""],["","66689000816","NYSTATIN","100000","224","Select","Select",""],["","29300034905","ALLOPURINOL","100MG","30","Select","Select",""],["","00310737020","BUDES\/FORMOT","160-4.5","10","Select","Select",""],["","70010077005","METHOCARBAM","750MG","60","Select","Select",""],["","80681009800","VITAMIN ","TAB 100MG","30","Select","Select",""],["","59310057922","PROAIR ","AER ","8","Select","Select",""],["","68180096301","ALBUTEROL ","AER HFA","8","Select","Select",""],["","00904759160","FEROSUL ","TAB 325MG","30","Select","Select",""],["","59746017506","PREDNISONE ","TAB 20MG","30","Select","Select",""],["","65862055990","PANTOPRAZOLE ","TAB 20MG","60","Select","Select",""],["","69315012701","FOLIC ","TAB 1000MCG","30","Select","Select",""],["","69784050001","EC-NAPROXEN ","TAB 500MG","60","Select","Select",""],["","00173089310","TRELEGY ","AER ELLIPTA","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":""}]}]}