{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JOAN   R ODLE","gend":1,"add":"PO BOX 58","city":"DUNGANNON","state":"VA","zip":"24245-9998","dob":"1958-12-24","age":"","mstatus":"","insh":"20032869*01","cliId":"","pno":"276\/467-5869","cno":"276\/467-5869","email":"","ename":"","eno":"","pphy":"CASSEL, TODD A MD","ppno":"276\/467-2201","pcpadd":"17285 VETERANS MEMORIAL HWY","pcpcity":"DUNGANNON","pcpstate":"VA","pcpzip":24245,"pcpcounty":"","pcpid":110741,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"SOUTHWEST","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"276\/467-2673","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R39.81","R15.9","Z99.3","L22.","N39.3","I10.","J43.9","E78.5","F51.05","R73.03","F32.89","Z12.39","Z12.4","Z11.59","K21.0","J30.2","M54.2","Z72.0","Z12.11","R42.","N93.9","H66.002"],"date":["2021-10-24","2021-10-24","2021-10-24","2021-10-24","2021-10-24","2020-09-01","2020-09-01","2020-09-01","2020-09-01","2020-09-01","2020-09-01","2020-09-01","2020-09-01","2020-09-01","2020-09-01","2020-09-01","2020-09-01","2020-04-27","2020-04-27","2021-06-06","2021-06-06","2021-06-06"],"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":[["","45802065078","LORATADINE ","10MG","30","Select","Select",""],["","00186037020","SYMBICORT ","160-4.5","10","Select","Select",""],["","00597007541","SPIRIVA ","HANDIHLR","30","Select","Select",""],["","69543013450","METHOCARBAM ","500MG","120","Select","Select",""],["","68001030900","BUPROPION ","100MG","60","Select","Select",""],["","65862020190","LOSARTAN ","25MG","30","Select","Select",""],["","68001028106","DICLOFENAC ","75MG DR","60","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","59762015701","ATORVASTATIN ","40MG","30","Select","Select",""],["","00228282011","HYDROCHLOROT ","12.5MG","90","Select","Select",""],["","67877057301","BENZONATATE ","100MG","25","Select","Select",""],["","47335090388","QUETIAPINE ","50MG","30","Select","Select",""],["","68001039708","FAMOTIDINE ","20MG","60","Select","Select",""],["","59746017506","PREDNISONE ","20MG","19","Select","Select",""],["","65862064163","AZITHROMYCIN ","250MG","6","Select","Select",""],["","00310737020","BUDES\/FORMOT ","160-4.5","10","Select","Select",""],["","00536342408","CALCIUM ","","30","Select","Select",""],["","68462039701","OMEPRAZOLE ","40MG","30","Select","Select",""],["","63824000832","MUCINEX ","600MG ER","8","Select","Select",""],["","00378967193","IPRATROPIUM\/ ","ALBUTER","360","Select","Select",""],["","39423011048","FLORAJEN ","ACIDOPHI","30","Select","Select",""],["","68462015713","ONDANSETRON ","4MG ODT","20","Select","Select",""],["","60432053716","NYSTATIN ","100000","112","Select","Select",""],["","65862050320","AMOX\/K ","875-125","20","Select","Select",""],["","45802049860","GUAIFENESIN ","600MG ER","10","Select","Select",""],["","65162044210","MECLIZINE ","25MG","30","Select","Select",""],["","00591034701","HYDROCHLOROT","12.5MG","30","Select","Select",""],["","65862020190","LOSARTAN","25MG","30","Select","Select",""],["","68001028106","DICLOFENAC","75MG DR","60","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","59762015701","ATORVASTATIN","40MG","30","Select","Select",""],["","68001030900","BUPROPION","100MG","60","Select","Select",""],["","00597007541","SPIRIVA","HANDIHLR","30","Select","Select",""],["","69543013450","METHOCARBAM","500MG","120","Select","Select",""],["","45802065078","LORATADINE","10MG","30","Select","Select",""],["","68001039708","FAMOTIDINE","20MG","60","Select","Select",""],["","00186037020","SYMBICORT","160-4.5","10","Select","Select",""],["","00310737020","BUDES\/FORMOT","160-4.5","10","Select","Select",""],["","67877057301","BENZONATATE","100MG","25","Select","Select",""],["","59746017506","PREDNISONE","20MG","19","Select","Select",""],["","47335090388","QUETIAPINE","50MG","90","Select","Select",""],["","00536342408","CALCIUM","","30","Select","Select",""],["","50111078751","AZITHROMYCIN","250MG","6","Select","Select",""],["","68382050010","OMEPRAZOLE","40MG","30","Select","Select",""],["","00378967193","IPRATROPIUM\/","ALBUTER","360","Select","Select",""],["","39423011048","FLORAJEN","ACIDOPHI","30","Select","Select",""],["","68462015713","ONDANSETRON","4MG ODT","20","Select","Select",""],["","45802049860","GUAIFENESIN","600MG ER","10","Select","Select",""],["","60432053716","NYSTATIN","100000","112","Select","Select",""],["","65862050320","AMOX\/K","875-125","20","Select","Select",""],["","63824000832","MUCINEX","600MG ER","10","Select","Select",""],["","65162044210","MECLIZINE","25MG","30","Select","Select",""],["","80681013900","CALCIUM\/D3 ","TAB 600-10","30","Select","Select",""],["","00536589588","NICOTINE ","DIS 14MG\/24H","28","Select","Select",""],["","57237001760","DULOXETINE ","CAP 20MG","60","Select","Select",""],["","43598032675","CIPRO\/DEXA ","SUS 0.3-0.1%","8","Select","Select",""],["","68180096301","ALBUTEROL ","AER HFA","8","Select","Select",""],["","00135019502","NICODERM ","DIS 14MG\/24H","28","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":""}]}]}