{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DANYEL   M PARRISH","gend":1,"add":"1537 CLOVER RD APT 16","city":"LA CROSSE","state":"VA","zip":"23950-9998","dob":"1973-10-07","age":"","mstatus":"","insh":"20033144*01","cliId":"","pno":"434\/755-1414","cno":"434\/755-1414","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":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F11.20","R60.0","G89.21","F41.9","F11.10","R65.10","M79.604","M79.605","E87.6","E83.42","F31.9","E03.9","F19.10","N28.89","N32.89","K56.41","F14.10","M54.31","F17.210","M54.5","V54.17","V58.89","V89.2XXD","D57.3","L90.5","R29.3","R26.89","M25.561","M62.81","R20.8","Z98.1","R22.43","F11.24","R07.89","M79.89","R41.82","A41.9","E05.90","R60.9","G62.9","K59.00","G82.20","F11.21","R25.2","R26.0","G89.29","R07.81","R20.0","R06.00","R42.","R41.89","R23.8","R50.9","R00.0","M54.16","M54.9"],"date":["2021-11-26","2020-08-10","2020-08-31","2020-08-31","2020-08-31","2020-04-06","2020-04-06","2020-04-06","2020-04-06","2020-04-06","2020-08-10","2020-08-10","2020-04-06","2020-04-06","2020-04-06","2020-04-06","2020-08-31","2020-08-30","2020-08-30","2020-08-10","2020-08-10","2020-08-10","2020-08-10","2020-08-10","2020-08-10","2020-08-10","2020-08-10","2020-08-10","2020-08-10","2020-08-10","2020-08-10","2020-01-20","2020-07-14","2020-01-15","2020-01-15","2020-04-04","2020-04-04","2020-04-04","2020-01-29","2020-01-29","2020-01-29","2020-11-01","2020-08-02","2021-02-10","2021-02-10","2021-02-10","2020-01-14","2020-01-14","2020-01-14","2020-01-14","2020-01-14","2020-01-14","2020-04-05","2020-04-05","2021-01-04","2020-07-05"],"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":[["","12496120803","SUBOXONE","8-2MG","45","Select","Select",""],["","12496120803","SUBOXONE ","8-2MG","45","Select","Select",""],["","00781723864","BUPREN\/NALOX ","8-2MG","15","Select","Select",""],["","00093816401","QUETIAPINE ","300MG","60","Select","Select",""],["","50428231183","MAG ","CHERRY","296","Select","Select",""],["","65862052305","GABAPENTIN ","600MG","90","Select","Select",""],["","52817031910","BACLOFEN ","5MG","90","Select","Select",""],["","71093014105","METHOCARBAM ","750MG","42","Select","Select",""],["","00603188016","LIDOCAINE ","5%","30","Select","Select",""],["","63481068447","VOLTAREN ","1%","100","Select","Select",""],["","57237004701","DIVALPROEX ","250MG DR","60","Select","Select",""],["","13668033005","TRAZODONE ","50MG","7","Select","Select",""],["","65162083366","DICLOFENAC ","1%","100","Select","Select",""],["","65862018730","ONDANSETRON ","4MG","1","Select","Select",""],["","50111033401","METRONIDAZOL ","500MG","14","Select","Select",""],["","55111015810","OMEPRAZOLE ","20MG","60","Select","Select",""],["","70710113908","FLUCONAZOLE ","150MG","2","Select","Select",""],["","42571017701","PIROXICAM ","20MG","30","Select","Select",""],["","51991074790","DULOXETINE ","30MG","60","Select","Select",""],["","65862037401","ESCITALOPRAM ","10MG","30","Select","Select",""],["","00093031401","KETOROLAC ","10MG","20","Select","Select",""],["","49483060350","IBUPROFEN ","600MG","9","Select","Select",""],["","69097084507","CYCLOBENZAPR ","5MG","60","Select","Select",""],["","16729020301","BUSPIRONE ","15MG","60","Select","Select",""],["","16729020301","BUSPIRONE","15MG","60","Select","Select",""],["","00603188016","LIDOCAINE","5%","30","Select","Select",""],["","00781723864","BUPREN\/NALOX","8-2MG","15","Select","Select",""],["","65862052305","GABAPENTIN","600MG","90","Select","Select",""],["","52817031910","BACLOFEN","5MG","90","Select","Select",""],["","50428231183","MAG","CHERRY","296","Select","Select",""],["","00093816401","QUETIAPINE","300MG","60","Select","Select",""],["","71093014105","METHOCARBAM","750MG","42","Select","Select",""],["","55111015810","OMEPRAZOLE","20MG","60","Select","Select",""],["","70710113908","FLUCONAZOLE","150MG","2","Select","Select",""],["","63481068447","VOLTAREN","1%","100","Select","Select",""],["","65162083366","DICLOFENAC","1%","100","Select","Select",""],["","57237004701","DIVALPROEX","250MG DR","60","Select","Select",""],["","13668033005","TRAZODONE","50MG","7","Select","Select",""],["","00093031401","KETOROLAC","10MG","20","Select","Select",""],["","65862037401","ESCITALOPRAM","10MG","30","Select","Select",""],["","42571017701","PIROXICAM","20MG","30","Select","Select",""],["","51991074790","DULOXETINE","30MG","60","Select","Select",""],["","65862018730","ONDANSETRON","4MG","14","Select","Select",""],["","69097084507","CYCLOBENZAPR","5MG","60","Select","Select",""],["","50111033401","METRONIDAZOL","500MG","14","Select","Select",""],["","49483060350","IBUPROFEN","600MG","9","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","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["No","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":""}]}]}