{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"VERTA   P STEVENS","gend":1,"add":"APT 5 PO BOX 2471","city":"GRUNDY","state":"VA","zip":"24614-9998","dob":"1968-05-22","age":"","mstatus":"","insh":"20035624*01","cliId":"","pno":"276\/312-0146","cno":"276\/312-0146","email":"","ename":"","eno":"","pphy":"OWENS, DIA P MD","ppno":"276\/597-7081","pcpadd":"1721 LOVERS GAP ROAD","pcpcity":"VANSANT","pcpstate":"VA","pcpzip":24656,"pcpcounty":"","pcpid":177840,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"SOUTHWEST","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"276\/546-9709","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I10.","J20.0","M54.12","L02.212","R10.30","R11.0","M25.511","J20.9","N39.0","N30.01","D17.22","L02.413","L03.113","M79.621","M25.569","R51.","M79.605","L03.90","M25.561","N89.8","E87.1","K29.00","R10.13","R10.84","M19.011","Z00.8","Z13.9","Z23.","Z71.89","Z13.89","L03.312","M79.672","L84.","L98.9","G44.219","Z20.822"],"date":["2020-03-30","2020-03-30","2020-10-06","2020-01-06","2020-01-06","2020-01-06","2020-01-10","2020-03-30","2020-03-30","2020-03-30","2020-03-30","2020-01-10","2020-01-10","2020-01-10","2020-02-06","2020-01-10","2020-01-10","2020-01-10","2020-02-06","2020-02-06","2020-02-06","2020-01-11","2020-01-11","2020-03-30","2021-05-27","2020-01-16","2020-01-16","2020-01-16","2020-01-16","2020-01-16","2020-01-16","2020-03-19","2020-03-19","2020-03-19","2021-09-26","2021-09-26"],"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":[["","62175013643","OMEPRAZOLE ","40MG","30","Select","Select",""],["","53746046505","IBUPROFEN ","600MG","30","Select","Select",""],["","65862018601","CLINDAMYCIN ","300MG","30","Select","Select",""],["","00172208380","HYDROCHLOROT ","25MG","30","Select","Select",""],["","68462019005","NAPROXEN ","500MG","60","Select","Select",""],["","00904576960","ARTHRTS ","650MG","60","Select","Select",""],["","00093031401","KETOROLAC ","10MG","15","Select","Select",""],["","00603533832","PREDNISONE ","10MG","28","Select","Select",""],["","57237010199","METOPROL ","50MG","60","Select","Select",""],["","37205016210","HYDROCORT ","1%","30","Select","Select",""],["","68084077725","ACETAMIN ","650MG","60","Select","Select",""],["","00186074331","PRILOSEC ","40MG","30","Select","Select",""],["","45802006436","TRIAMCINOLON ","0.10%","80","Select","Select",""],["","68001000100","NITROFURANTN ","100MG","14","Select","Select",""],["","68180016006","AZITHROMYCIN ","250MG","4","Select","Select",""],["","67877022405","GABAPENTIN ","400MG","20","Select","Select",""],["","49281072010","FLUBLOK ","2020-21","0","Select","Select",""],["","00045083824","TYLENOL ","650MG","60","Select","Select",""],["","47335038283","DULOXETINE ","30MG","30","Select","Select",""],["","79854005024","VITAMIN ","1000UNIT","30","Select","Select",""],["","59267100001","PFIZER ","COVID-19","0","Select","Select",""],["","00168025815","CLOTRIM\/BETA ","DIPROP","45","Select","Select",""],["","00781506101","AMOXICILLIN ","875MG","20","Select","Select",""],["","65162027250","SMZ\/TMP ","800-160","14","Select","Select",""],["","00172208380","HYDROCHLOROT","25MG","30","Select","Select",""],["","65162027250","SMZ\/TMP","800-160","14","Select","Select",""],["","59762332801","CLINDAMYCIN","150MG","60","Select","Select",""],["","00904576960","ARTHRTS","650MG","60","Select","Select",""],["","53746046505","IBUPROFEN","600MG","30","Select","Select",""],["","62175013643","OMEPRAZOLE","40MG","30","Select","Select",""],["","68462019005","NAPROXEN","500MG","60","Select","Select",""],["","57237010199","METOPROL","50MG","60","Select","Select",""],["","00603533832","PREDNISONE","10MG","28","Select","Select",""],["","00186074331","PRILOSEC","40MG","30","Select","Select",""],["","45802006436","TRIAMCINOLON","0.10%","80","Select","Select",""],["","68084077725","ACETAMIN","650MG","60","Select","Select",""],["","37205016210","HYDROCORT","1%","30","Select","Select",""],["","68001000100","NITROFURANTN","100MG","14","Select","Select",""],["","68180016006","AZITHROMYCIN","250MG","4","Select","Select",""],["","49281072010","FLUBLOK","2020-21","0","Select","Select",""],["","00045083824","TYLENOL","650MG","60","Select","Select",""],["","59267100001","PFIZER","COVID-19","0","Select","Select",""],["","00168025815","CLOTRIM\/BETA","DIPROP","45","Select","Select",""],["","79854005024","VITAMIN","1000UNIT","30","Select","Select",""],["","47335038283","DULOXETINE","30MG","30","Select","Select",""],["","00781506101","AMOXICILLIN","875MG","20","Select","Select",""],["","00093031401","KETOROLAC","10MG","15","Select","Select",""],["","67877022405","GABAPENTIN","400MG","20","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":""}]}]}