{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DAMARIS REYES-MULERO","gend":1,"add":"46 HURST LN","city":"COLLINSVILLE","state":"VA","zip":"24078-9998","dob":"1970-05-31","age":"","mstatus":"","insh":"20033899*01","cliId":"","pno":"276\/356-2499","cno":"276\/356-2499","email":"","ename":"","eno":"","pphy":"","ppno":"","pcpadd":"","pcpcity":"","pcpstate":"","pcpzip":"","pcpcounty":"","pcpid":"","pcpname":"","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":["E10.9","E10.65","E10.59","I11.0","I25.118","I50.32","Z95.5","Z12.4","N92.1","E66.9","Z11.51","Z20.828","E10.10","B20.","I10.","E03.9","E11.43","NO DATA","Z01.810","E10.42","E86.0","N39.0","R07.9","Z23.","K31.84","Z79.4","J45.30","K29.60","I25.10","E10.29","B37.3","F41.8","E10.319","E10.21","Z20.822","E10.43","E10.40","Z96.41","I25.2","Z86.718","Z86.711","R00.0","I45.10","R10.84","K59.00","M25.532","R87.610","R87.810","R10.0","M79.604","M79.605","G89.29","E10.3293","H25.13","H40.059","H52.203","E11.69","R94.31","R60.0","I20.9","K76.0","E88.81","K21.9","R11.2","E78.2","E11.9","H40.053","H11.001","H25.12","K31.89","H25.11","S05.01XA"],"date":["2021-08-25","2021-08-25","2021-08-25","2021-02-22","2021-03-08","2021-02-24","2021-08-05","2020-06-26","2020-06-26","2020-11-23","2020-06-26","2020-11-05","2021-02-24","2021-11-18","2021-02-24","2021-10-12","2021-02-24","2021-02-24","2021-10-14","2021-10-12","2020-11-05","2020-11-05","2020-11-05","2021-11-18","2021-10-14","2021-02-23","2020-11-03","2020-11-03","2021-10-14","2021-10-12","2020-11-03","2020-11-03","2021-02-22","2021-02-22","2021-02-22","2021-02-22","2021-02-22","2021-02-22","2021-02-22","2021-02-22","2021-02-22","2021-02-22","2021-02-22","2020-06-30","2020-06-30","2020-06-30","2020-10-30","2020-10-30","2020-06-30","2020-06-30","2020-06-30","2020-06-30","2020-08-18","2021-09-02","2020-08-18","2021-08-18","2020-11-23","2021-10-14","2020-11-05","2020-11-05","2021-03-12","2021-03-12","2021-10-14","2021-03-12","2021-08-05","2021-08-18","2021-08-18","2021-09-02","2021-09-28","2021-10-14","2021-10-18","2021-10-19"],"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":[["","69238147101","ERYTHROMYCIN ","250MG EC","90","Select","Select",""],["","59762453802","MEDROXYPR ","150MG\/ML","1","Select","Select",""],["","00173060202","FLOVENT ","100MCG","60","Select","Select",""],["","00378181301","LEVOTHYROXIN ","125MCG","60","Select","Select",""],["","61958190101","GENVOYA ","","30","Select","Select",""],["","73070010011","INSULIN ","100\/ML","70","Select","Select",""],["","68645059090","CLOPIDOGREL ","75MG","30","Select","Select",""],["","55111015930","OMEPRAZOLE ","40MG","60","Select","Select",""],["","50228017805","GABAPENTIN ","800MG","120","Select","Select",""],["","68645049554","ATORVASTATIN ","80MG","30","Select","Select",""],["","68382009405","CARVEDILOL ","12.5MG","60","Select","Select",""],["","00002751001","HUMALOG ","100\/ML","50","Select","Select",""],["","43547040350","FUROSEMIDE ","80MG","60","Select","Select",""],["","72305012530","EUTHYROX ","125MCG","180","Select","Select",""],["","00186091612","PULMICORT ","180MCG","1","Select","Select",""],["","59310030240","QVAR ","40MCG","11","Select","Select",""],["","68382080601","TRAZODONE ","100MG","60","Select","Select",""],["","00527058601","DICYCLOMINE ","10MG","360","Select","Select",""],["","69315090401","LORAZEPAM ","0.5MG","180","Select","Select",""],["","00054327099","FLUTICASONE ","50MCG","16","Select","Select",""],["","43598043611","NITROGLYCERN ","0.4MG","25","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","00378911293","NITROGLYCER ","0.4MG\/HR","30","Select","Select",""],["","68645057054","CITALOPRAM ","20MG","30","Select","Select",""],["","80777027398","MODERNA ","COVID-19","0","Select","Select",""],["","16729017217","AMITRIPTYLIN ","25MG","90","Select","Select",""],["","42858000101","OXYCODONE ","5MG","30","Select","Select",""],["","00597007541","SPIRIVA ","HANDIHLR","90","Select","Select",""],["","66993001968","ALBUTEROL ","HFA","18","Select","Select",""],["","16714069211","FLUCONAZOLE ","150MG","14","Select","Select",""],["","10702000709","CYCLOBENZAPR ","10MG","30","Select","Select",""],["","61958250101","BIKTARVY ","","30","Select","Select",""],["","00088221905","LANTUS ","100\/ML","15","Select","Select",""],["","55111015330","ONDANSETRON ","4MG","20","Select","Select",""],["","68645049554","ATORVASTATIN","80MG","30","Select","Select",""],["","00173060202","FLOVENT","100MCG","60","Select","Select",""],["","69238147101","ERYTHROMYCIN","250MG EC","90","Select","Select",""],["","61958190101","GENVOYA","","30","Select","Select",""],["","00378181301","LEVOTHYROXIN","125MCG","60","Select","Select",""],["","59762453802","MEDROXYPR","150MG\/ML","1","Select","Select",""],["","00002751001","HUMALOG","100\/ML","50","Select","Select",""],["","73070010011","INSULIN","100\/ML","70","Select","Select",""],["","50228017805","GABAPENTIN","800MG","120","Select","Select",""],["","68382009405","CARVEDILOL","12.5MG","60","Select","Select",""],["","68382080601","TRAZODONE","100MG","60","Select","Select",""],["","68645059090","CLOPIDOGREL","75MG","30","Select","Select",""],["","55111015930","OMEPRAZOLE","40MG","60","Select","Select",""],["","69315090401","LORAZEPAM","0.5MG","180","Select","Select",""],["","00378911293","NITROGLYCER","0.4MG\/HR","30","Select","Select",""],["","00054327099","FLUTICASONE","50MCG","16","Select","Select",""],["","43598043611","NITROGLYCERN","0.4MG","25","Select","Select",""],["","72305012530","EUTHYROX","125MCG","180","Select","Select",""],["","00378023205","FUROSEMIDE","80MG","60","Select","Select",""],["","59310030240","QVAR","40MCG","11","Select","Select",""],["","00186091612","PULMICORT","180MCG","1","Select","Select",""],["","16729017217","AMITRIPTYLIN","25MG","90","Select","Select",""],["","00527058601","DICYCLOMINE","10MG","360","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","00597007541","SPIRIVA","HANDIHLR","90","Select","Select",""],["","66993001968","ALBUTEROL","HFA","18","Select","Select",""],["","16714069211","FLUCONAZOLE","150MG","14","Select","Select",""],["","42858000101","OXYCODONE","5MG","30","Select","Select",""],["","10702000709","CYCLOBENZAPR","10MG","30","Select","Select",""],["","00088221905","LANTUS","100\/ML","15","Select","Select",""],["","80777027398","MODERNA","COVID-19","0","Select","Select",""],["","61958250101","BIKTARVY","","30","Select","Select",""],["","55111015330","ONDANSETRON","4MG","20","Select","Select",""],["","69547035302","NARCAN","","2","Select","Select",""],["","60758011905","PREDNISOLONE","1% OP","5","Select","Select",""],["","17478071310","OFLOXACIN","0.3% OP","5","Select","Select",""],["","61314012605","KETOROLAC","0.50%","5","Select","Select",""],["","68645057054","CITALOPRAM","20MG","30","Select","Select",""],["","31722070090","LOSARTAN ","TAB 25MG","30","Select","Select",""],["","60758077305","KETOROLAC ","SOL 0.004","5","Select","Select",""],["","69547035302","NARCAN ","SPR ","2","Select","Select",""],["","60505464303","PRASUGREL ","TAB 10MG","36","Select","Select",""],["","60758011905","PREDNISOLONE ","SUS 1% OP","5","Select","Select",""],["","00116200116","CHLORHEX ","SOL 0.0012","473","Select","Select",""],["","00781261305","AMOXICILLIN ","CAP 500MG","21","Select","Select",""],["","17478071310","OFLOXACIN ","DRO 0.3% OP","5","Select","Select",""],["","45802010901","TRIAMCINOLON ","AER 55MCG\/AC","17","Select","Select",""],["","00173038879","BECONASE ","SUS 0.00042","25","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":""}]}]}