{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JOHN   H STILTNER JR","gend":0,"add":"245 EASTRIDGE RD APT 105","city":"BRISTOL","state":"VA","zip":"24201-9998","dob":"1976-02-26","age":"","mstatus":"","insh":"20035670*01","cliId":"","pno":"276\/494-3154","cno":"276\/494-3154","email":"","ename":"","eno":"","pphy":"MOORE, JASON BRENT MD","ppno":"423\/989-4050","pcpadd":"208 MEDICAL PARK BLVD","pcpcity":"BRISTOL","pcpstate":"TN","pcpzip":37620,"pcpcounty":"","pcpid":169503,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"SOUTHWEST","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"423\/990-3044","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I25.10","E78.2","E11.65","J06.9","M54.5","M25.561","W19.XXXA","T14.8XXA","E11.49","I10.","E78.5","J44.9","G43.909","K75.81","E66.9","E55.9","R60.9","J98.8","R05.","R11.0","R11.14","G62.9","N47.6","J01.90","R68.89","R19.7","E11.40","Z87.891","R50.9","M54.41","S80.01XA","Q74.1","Z95.5","E11.618","R07.89","R11.2","Z79.4","R68.83","R52.","R73.09","R06.2","B35.6","R30.0","E11.9","H02.831","H02.834","L03.314","R10.84"],"date":["2021-05-24","2020-10-27","2021-09-16","2020-05-28","2020-10-14","2021-02-18","2020-09-02","2020-09-02","2021-05-24","2021-05-24","2021-05-24","2021-05-24","2021-05-24","2021-05-24","2021-05-24","2021-05-24","2021-05-24","2020-02-05","2021-03-13","2021-08-02","2020-02-05","2020-08-08","2021-08-11","2020-11-18","2021-03-13","2020-03-11","2020-08-19","2020-08-19","2020-05-28","2020-09-09","2020-09-25","2020-09-25","2020-10-27","2021-03-13","2021-03-13","2021-03-13","2021-09-16","2021-03-13","2021-03-13","2021-03-13","2021-03-13","2021-08-11","2021-08-11","2021-07-29","2021-07-29","2021-07-29","2021-09-16","2021-08-02"],"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":[["","00378967130","IPRATROPIUM\/","ALBUTER","30","Select","Select",""],["","70377002911","ATORVASTATIN ","40MG","90","Select","Select",""],["","57664050658","METOPROL ","25MG","60","Select","Select",""],["","00088222033","LANTUS ","100\/ML","10","Select","Select",""],["","57664049983","MIRTAZAPINE ","15MG","30","Select","Select",""],["","68382076010","METFORMIN ","1000MG","60","Select","Select",""],["","66993001968","ALBUTEROL ","HFA","54","Select","Select",""],["","68180036009","FENOFIBRATE ","48MG","30","Select","Select",""],["","08290328440","INSULIN ","0.3\/31G","100","Select","Select",""],["","52565000814","LIDOCAINE ","5%","35","Select","Select",""],["","00378967130","IPRATROPIUM\/ ","ALBUTER","90","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","00310737020","BUDES\/FORMOT ","160-4.5","10","Select","Select",""],["","00173068220","VENTOLIN ","","18","Select","Select",""],["","59779060016","CVS ","81MG EC","30","Select","Select",""],["","53489011905","DOXYCYCL ","100MG","20","Select","Select",""],["","00186037020","SYMBICORT ","160-4.5","10","Select","Select",""],["","51672415403","CALCIPOTRIEN ","0.01%","240","Select","Select",""],["","62332042631","BENZONATATE ","100MG","20","Select","Select",""],["","68462050535","FLUOCINONIDE ","0.10%","120","Select","Select",""],["","60505025203","TIZANIDINE ","4MG","60","Select","Select",""],["","59310030480","QVAR ","80MCG","11","Select","Select",""],["","70512003350","HALOBETASOL ","0.05%","100","Select","Select",""],["","00168084401","DICLOFENAC ","3%","100","Select","Select",""],["","68134020116","NAPROXEN ","125\/5ML","1000","Select","Select",""],["","60505317007","OMEGA-3-ACID ","1GM","120","Select","Select",""],["","71800000960","DIFLORASONE ","0.05%","120","Select","Select",""],["","55111032001","GLIMEPIRIDE ","1MG","90","Select","Select",""],["","00002771459","HUMALOG ","100\/ML","6","Select","Select",""],["","51991074790","DULOXETINE ","30MG","30","Select","Select",""],["","69097012303","TOPIRAMATE ","50MG","30","Select","Select",""],["","08290320119","BD  PEN NEEDL","31GX5MM","100","Select","Select",""],["","68180012202","CEPHALEXIN ","500MG","42","Select","Select",""],["","59651000305","OMEPRAZOLE ","40MG","30","Select","Select",""],["","43598043611","NITROGLYCERN ","0.4MG","25","Select","Select",""],["","00536123441","ASPIRIN ","81MG EC","90","Select","Select",""],["","00093310905","AMOXICILLIN ","500MG","30","Select","Select",""],["","00378064205","PREDNISONE ","20MG","10","Select","Select",""],["","80681013200","VITAMIN ","50MCG","90","Select","Select",""],["","58526000542","D ","2000UNIT","90","Select","Select",""],["","65862039010","ONDANSETRON ","4MG ODT","20","Select","Select",""],["","68462018135","CLOTRIMAZOLE ","1%","30","Select","Select",""],["","62559043001","HYDROCORT ","1%","28","Select","Select",""],["","70710113803","FLUCONAZOLE ","100MG","10","Select","Select",""],["","68180098003","LISINOPRIL ","10MG","90","Select","Select",""],["","00088222033","LANTUS","100\/ML","10","Select","Select",""],["","57664049983","MIRTAZAPINE","15MG","30","Select","Select",""],["","00186037020","SYMBICORT","160-4.5","10","Select","Select",""],["","68180036009","FENOFIBRATE","48MG","30","Select","Select",""],["","57664050658","METOPROL","25MG","60","Select","Select",""],["","70377002911","ATORVASTATIN","40MG","30","Select","Select",""],["","08290328440","INSULIN","0.3\/31G","100","Select","Select",""],["","59779060016","CVS","81MG EC","30","Select","Select",""],["","00310737020","BUDES\/FORMOT","160-4.5","10","Select","Select",""],["","66993001968","ALBUTEROL","HFA","18","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","68382076010","METFORMIN","1000MG","60","Select","Select",""],["","00173068220","VENTOLIN","","18","Select","Select",""],["","62332042631","BENZONATATE","100MG","20","Select","Select",""],["","68462050535","FLUOCINONIDE","0.10%","120","Select","Select",""],["","52565000814","LIDOCAINE","5%","35","Select","Select",""],["","51672415403","CALCIPOTRIEN","0.01%","240","Select","Select",""],["","70512003350","HALOBETASOL","0.05%","100","Select","Select",""],["","71800000960","DIFLORASONE","0.05%","120","Select","Select",""],["","00168084401","DICLOFENAC","3%","100","Select","Select",""],["","68134020116","NAPROXEN","125\/5ML","1000","Select","Select",""],["","60505317007","OMEGA-3-ACID","1GM","120","Select","Select",""],["","53489011905","DOXYCYCL","100MG","20","Select","Select",""],["","69097012303","TOPIRAMATE","50MG","30","Select","Select",""],["","60505025203","TIZANIDINE","4MG","60","Select","Select",""],["","59310030480","QVAR","80MCG","11","Select","Select",""],["","51991074790","DULOXETINE","30MG","30","Select","Select",""],["","43598043611","NITROGLYCERN","0.4MG","25","Select","Select",""],["","08290320119","BD PEN NEEDL","31GX5MM","100","Select","Select",""],["","55111032001","GLIMEPIRIDE","1MG","30","Select","Select",""],["","68180012202","CEPHALEXIN","500MG","42","Select","Select",""],["","00002771459","HUMALOG","100\/ML","6","Select","Select",""],["","00093310905","AMOXICILLIN","500MG","30","Select","Select",""],["","00378064205","PREDNISONE","20MG","10","Select","Select",""],["","00536123441","ASPIRIN","81MG EC","90","Select","Select",""],["","80681013200","VITAMIN","50MCG","90","Select","Select",""],["","58526000542","D","2000UNIT","90","Select","Select",""],["","65862039010","ONDANSETRON","4MG ODT","20","Select","Select",""],["","59651000305","OMEPRAZOLE","40MG","90","Select","Select",""],["","68180098003","LISINOPRIL","10MG","90","Select","Select",""],["","68462018135","CLOTRIMAZOLE","1%","30","Select","Select",""],["","62559043001","HYDROCORT","1%","28","Select","Select",""],["","70710113803","FLUCONAZOLE","100MG","10","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","",""],["No","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":""}]}]}