{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JAULINDA REED","gend":1,"add":"511 N MECKLENBURG AVE APT 6","city":"SOUTH HILL","state":"VA","zip":"23970-9998","dob":"1966-04-17","age":"","mstatus":"","insh":"20033832*01","cliId":"","pno":"434\/774-0517","cno":"434\/774-0517","email":"","ename":"","eno":"","pphy":"ACKERMAN, CHRISTOPHER J MD","ppno":"434\/848-0771","pcpadd":"203 SHARP ST","pcpcity":"LAWRENCEVILLE","pcpstate":"VA","pcpzip":23868,"pcpcounty":"","pcpid":104888,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"434\/604-4034","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/848-3814","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R13.10","Z11.59","M96.1","G89.29","I10.","M06.9","M54.2","M54.5","Z79.899","M40.36","M54.89","R00.1","R94.31","Z51.81","S32.009K","Z98.890","J44.9","R51.9","M96.0","J45.909","R56.9","I11.9","K21.9","B19.20","Z23.","K29.70","NO DATA","M79.671","Z98.1","M79.641","M54.12","M72.2","L85.1","M79.673","M77.40","Z89.419","Z89.429"],"date":["2020-12-01","2020-12-15","2021-06-28","2021-06-25","2021-06-25","2021-06-25","2021-06-25","2021-06-30","2021-06-25","2021-07-22","2021-06-30","2020-08-28","2020-08-28","2021-03-25","2021-06-17","2021-06-30","2021-06-08","2021-03-16","2021-06-28","2021-06-25","2021-06-25","2021-06-08","2020-09-24","2020-09-24","2020-09-24","2020-10-01","2020-10-01","2020-10-12","2021-03-19","2020-10-30","2020-10-30","2020-10-12","2021-04-26","2021-04-26","2021-04-26","2021-04-26","2021-04-26"],"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":[["","00781107710","ALPRAZOLAM ","0.5MG","90","Select","Select",""],["","68382011314","RISPERIDONE ","0.5MG","30","Select","Select",""],["","23155019401","NIFEDIPINE ","10MG","90","Select","Select",""],["","65862019401","FLUOXETINE ","40MG","30","Select","Select",""],["","61442010301","DICLOFENAC ","75MG DR","60","Select","Select",""],["","65162021211","PHENYTOIN ","100MG","120","Select","Select",""],["","50111043302","TRAZODONE ","50MG","30","Select","Select",""],["","59310057922","PROAIR ","","26","Select","Select",""],["","13107005999","APAP\/CODEINE ","300-30MG","10","Select","Select",""],["","53746010901","HYDROCO\/APAP ","5-325MG","42","Select","Select",""],["","57664037718","TRAMADOL ","50MG","14","Select","Select",""],["","68180015001","FAMOTIDINE ","40MG\/5ML","150","Select","Select",""],["","70010004401","BUT\/APAP\/CAF ","","30","Select","Select",""],["","10702001801","OXYCODONE ","5MG","60","Select","Select",""],["","47781022901","OXYCOD\/APAP ","7.5-325","28","Select","Select",""],["","13668009405","PRAMIPEXOLE ","1MG","30","Select","Select",""],["","00781223410","OMEPRAZOLE ","40MG","30","Select","Select",""],["","23155050101","HYDROXYZ ","25MG","20","Select","Select",""],["","69097094312","GABAPENTIN ","300MG","60","Select","Select",""],["","00781261305","AMOXICILLIN ","500MG","15","Select","Select",""],["","67877024201","QUETIAPINE ","25MG","90","Select","Select",""],["","68180096301","ALBUTEROL ","HFA","26","Select","Select",""],["","69097084615","CYCLOBENZAPR ","10MG","30","Select","Select",""],["","69547035302","NARCAN ","","2","Select","Select",""],["","68382011314","RISPERIDONE","0.5MG","30","Select","Select",""],["","00781107710","ALPRAZOLAM","0.5MG","90","Select","Select",""],["","65862019401","FLUOXETINE","40MG","30","Select","Select",""],["","50111043302","TRAZODONE","50MG","30","Select","Select",""],["","23155019401","NIFEDIPINE","10MG","90","Select","Select",""],["","51672406901","PHENYTOIN","125\/5ML","237","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","23155050101","HYDROXYZ","25MG","20","Select","Select",""],["","00527409537","BUT\/APAP\/CAF","","30","Select","Select",""],["","00781223410","OMEPRAZOLE","40MG","30","Select","Select",""],["","57664037718","TRAMADOL","50MG","7","Select","Select",""],["","61442010301","DICLOFENAC","75MG DR","60","Select","Select",""],["","69097094312","GABAPENTIN","300MG","60","Select","Select",""],["","53746010901","HYDROCO\/APAP","5-325MG","42","Select","Select",""],["","67877024201","QUETIAPINE","25MG","90","Select","Select",""],["","61442012210","FAMOTIDINE","40MG","90","Select","Select",""],["","13107005999","APAP\/CODEINE","300-30MG","14","Select","Select",""],["","10702001801","OXYCODONE","5MG","60","Select","Select",""],["","47781022901","OXYCOD\/APAP","7.5-325","42","Select","Select",""],["","68180096301","ALBUTEROL","HFA","26","Select","Select",""],["","69547035302","NARCAN","","2","Select","Select",""],["","69097084615","CYCLOBENZAPR","10MG","30","Select","Select",""],["","13668009405","PRAMIPEXOLE","1MG","30","Select","Select",""],["","00781261305","AMOXICILLIN","500MG","15","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":""}]}]}