{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CALVIN POTTER","gend":0,"add":"60 WILLOW SPRINGS RD APT B6","city":"LEXINGTON","state":"VA","zip":"24450-9998","dob":"1960-11-06","age":"","mstatus":"","insh":"20033538*01","cliId":"","pno":"540\/319-8338","cno":"540\/319-8338","email":"","ename":"","eno":"","pphy":"SAILER, JAY MD","ppno":"540\/258-1700","pcpadd":"730 MCCULLOCH STREET","pcpcity":"GLASGOW","pcpstate":"VA","pcpzip":24555,"pcpcounty":"","pcpid":163352,"pcpname":"Hospitalist Carilion Stonewall Jackson Hospital","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"ROANOKE ALLEGHANY","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E87.5","I10.","Z09.","N18.3","M1A.3720","L30.4","R09.89","R09.82","I83.012","R05.","R04.2","M1A.0720","J39.2","G47.33","M25.511","M75.51","K21.9","I25.89","E11.9","Z79.4","E78.00","Z79.82","E08.00","R29.898","R54.","I87.2","L03.115","L97.211","NO DATA","E78.5","M25.50","M79.604","G62.9","M25.561","M25.562","G89.29","M54.2","M10.9","M54.5","E66.01","Z68.43","R10.10","J30.9","M79.671","S81.802A","X58.XXXA","M79.672","I95.1","N17.9","E66.9","M17.0","I12.9","E11.22","Z23.","M54.42","R60.9","R09.81","F45.8","K21.0","R42.","M62.81","I25.9","R53.81","R19.5","T50.0X5A","E08.40","N28.89","S50.312A","S29.9XXA","V03.00XA","E11.65","E11.21","R07.81","M79.89","M25.522","N28.1","N18.9","Z79.02","Z79.899"],"date":["2021-09-14","2021-09-27","2020-04-01","2020-09-01","2020-04-27","2020-04-01","2020-10-12","2021-04-20","2020-02-25","2020-09-10","2020-09-21","2020-09-21","2020-09-30","2021-10-06","2021-09-09","2021-06-10","2020-10-20","2021-09-11","2021-09-11","2021-10-06","2021-09-11","2021-09-11","2021-10-06","2020-03-26","2020-03-26","2021-10-06","2020-06-03","2021-10-06","2021-10-06","2021-09-27","2020-06-26","2021-01-28","2021-07-07","2021-07-07","2021-07-07","2021-07-07","2020-06-26","2020-06-26","2021-09-11","2021-09-27","2021-09-27","2020-08-06","2021-04-20","2021-01-25","2021-05-25","2021-05-25","2020-01-16","2020-03-27","2020-03-27","2020-03-28","2020-07-08","2020-04-27","2020-04-27","2021-10-06","2020-09-01","2020-09-01","2020-10-10","2020-10-10","2020-01-16","2020-03-25","2020-03-25","2020-03-27","2020-03-27","2020-03-27","2020-03-27","2021-09-09","2021-09-15","2021-09-14","2021-09-14","2021-09-14","2021-09-27","2021-09-27","2021-09-11","2021-09-11","2021-09-11","2021-10-04","2021-10-04","2021-09-11","2021-09-11"],"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":[["","00002882427","HUMULIN ","U-500","12","Select","Select",""],["","00228212750","CLONIDINE ","0.1MG","60","Select","Select",""],["","62175013643","OMEPRAZOLE ","40MG","30","Select","Select",""],["","08496331001","KROGER ","33G","100","Select","Select",""],["","00378581577","VALSARTAN ","320MG","30","Select","Select",""],["","65862000899","METFORMIN ","500MG","60","Select","Select",""],["","68382066105","SPIRONOLACT ","50MG","60","Select","Select",""],["","90166083152","PEN  NEEDLES  ","31GX8MM","100","Select","Select",""],["","69097012715","AMLODIPINE ","5MG","30","Select","Select",""],["","68462019005","NAPROXEN ","500MG","60","Select","Select",""],["","55111046905","METOPROL ","200MG ER","30","Select","Select",""],["","00002143380","TRULICITY ","0.75\/0.5","4","Select","Select",""],["","60505132305","PRAVASTATIN ","80MG","30","Select","Select",""],["","52817033200","CYCLOBENZAPR ","10MG","30","Select","Select",""],["","00591554310","ALLOPURINOL ","100MG","30","Select","Select",""],["","51672128902","NYSTATIN ","100000","30","Select","Select",""],["","53885027150","ONETOUCH ","VERIO","100","Select","Select",""],["","50111043303","TRAZODONE ","50MG","30","Select","Select",""],["","62332042671","BENZONATATE ","100MG","15","Select","Select",""],["","69315011610","FUROSEMIDE ","20MG","60","Select","Select",""],["","00591544310","PREDNISONE ","20MG","3","Select","Select",""],["","63481068447","VOLTAREN ","1%","100","Select","Select",""],["","21922000909","DICLOFENAC ","1%","300","Select","Select",""],["","00143301801","COLCHICINE ","0.6MG","30","Select","Select",""],["","68462026190","ROSUVASTATIN ","5MG","15","Select","Select",""],["","16729011917","MONTELUKAST ","10MG","30","Select","Select",""],["","67877021905","CEPHALEXIN ","500MG","30","Select","Select",""],["","60505082901","FLUTICASONE ","50MCG","16","Select","Select",""],["","80777027399","MODERNA ","COVID-19","0","Select","Select",""],["","59746000103","METHYLPRED ","4MG","21","Select","Select",""],["","08496331001","EASY ","LANC\/33G","300","Select","Select",""],["","00832046530","NYAMYC ","100000","90","Select","Select",""],["","45802091987","CETIRIZINE ","10MG","30","Select","Select",""],["","65862056099","PANTOPRAZOLE ","40MG","30","Select","Select",""],["","00054004641","IPRATROPIUM ","0.06%","15","Select","Select",""],["","65862085901","FAMOTIDINE ","20MG","60","Select","Select",""],["","57664037708","TRAMADOL ","50MG","12","Select","Select",""],["","70000004701","ALL ","10MG","30","Select","Select",""],["","67877022210","GABAPENTIN ","100MG","90","Select","Select",""],["","64764011901","COLCRYS ","0.6MG","30","Select","Select",""],["","00169406012","VICTOZA ","18MG\/3ML","6","Select","Select",""],["","42571016242","AMOX\/K ","875-125","20","Select","Select",""],["","00169413212","OZEMPIC ","2\/1.5ML","2","Select","Select",""],["","00168025846","CLOTRIM\/BETA ","DIPROP","45","Select","Select",""],["","00172409680","BACLOFEN ","10MG","30","Select","Select",""],["","00228212750","CLONIDINE","0.1MG","60","Select","Select",""],["","00378581577","VALSARTAN","320MG","30","Select","Select",""],["","00002882427","HUMULIN","U-500","12","Select","Select",""],["","65862000899","METFORMIN","500MG","60","Select","Select",""],["","62175013643","OMEPRAZOLE","40MG","30","Select","Select",""],["","08496331001","KROGER","33G","100","Select","Select",""],["","60505132305","PRAVASTATIN","80MG","30","Select","Select",""],["","90166083152","PEN NEEDLES","31GX8MM","100","Select","Select",""],["","52817033200","CYCLOBENZAPR","10MG","30","Select","Select",""],["","53885027150","ONETOUCH","VERIO","100","Select","Select",""],["","00172409680","BACLOFEN","10MG","30","Select","Select",""],["","68382066105","SPIRONOLACT","50MG","60","Select","Select",""],["","68462019005","NAPROXEN","500MG","60","Select","Select",""],["","69097012715","AMLODIPINE","5MG","30","Select","Select",""],["","55111046905","METOPROL","200MG ER","30","Select","Select",""],["","00002143380","TRULICITY","0.75\/0.5","2","Select","Select",""],["","62332042671","BENZONATATE","100MG","15","Select","Select",""],["","00591544310","PREDNISONE","20MG","9","Select","Select",""],["","00591554310","ALLOPURINOL","100MG","30","Select","Select",""],["","51672128902","NYSTATIN","100000","30","Select","Select",""],["","69315011610","FUROSEMIDE","20MG","60","Select","Select",""],["","00143301801","COLCHICINE","0.6MG","30","Select","Select",""],["","50111043303","TRAZODONE","50MG","30","Select","Select",""],["","60505082901","FLUTICASONE","50MCG","16","Select","Select",""],["","16729011917","MONTELUKAST","10MG","30","Select","Select",""],["","67877021905","CEPHALEXIN","500MG","30","Select","Select",""],["","00832046530","NYAMYC","100000","90","Select","Select",""],["","68462026190","ROSUVASTATIN","5MG","7","Select","Select",""],["","65862056099","PANTOPRAZOLE","40MG","30","Select","Select",""],["","21922000909","DICLOFENAC","1%","100","Select","Select",""],["","63481068447","VOLTAREN","1%","100","Select","Select",""],["","08496331001","EASY","LANC\/33G","300","Select","Select",""],["","65862085901","FAMOTIDINE","20MG","60","Select","Select",""],["","45802091987","CETIRIZINE","10MG","30","Select","Select",""],["","00054004641","IPRATROPIUM","0.06%","15","Select","Select",""],["","59746000103","METHYLPRED","4MG","21","Select","Select",""],["","70000004701","ALL","10MG","30","Select","Select",""],["","64764011901","COLCRYS","0.6MG","30","Select","Select",""],["","80777027399","MODERNA","COVID-19","0","Select","Select",""],["","00169413212","OZEMPIC","2\/1.5ML","2","Select","Select",""],["","00168025846","CLOTRIM\/BETA","DIPROP","45","Select","Select",""],["","13107003105","MIRTAZAPINE","15MG","30","Select","Select",""],["","00169406012","VICTOZA","18MG\/3ML","6","Select","Select",""],["","51672131200","MUPIROCIN","2%","22","Select","Select",""],["","57664037708","TRAMADOL","50MG","12","Select","Select",""],["","67877022210","GABAPENTIN","100MG","90","Select","Select",""],["","42571016242","AMOX\/K","875-125","20","Select","Select",""],["","00904698640","MUCUS","600MG ER","30","Select","Select",""],["","51672131200","MUPIROCIN ","OIN 0.02","22","Select","Select",""],["","13107003105","MIRTAZAPINE ","TAB 15MG","30","Select","Select",""],["","00904698640","MUCUS ","TAB 600MG ER","30","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":""}]}]}