{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ANGELA CORDLE","gend":1,"add":"PO BOX 447","city":"DORAN","state":"VA","zip":"24612-9998","dob":"1972-09-22","pno":"276\/701-5593","cno":"276\/701-5593","email":"","pphy":"WESS, KEVIN L DO","ppno":"","pcpadd":"495 EAST MAIN ST","pcpcity":"LEBANON","pcpstate":"VA","pcpzip":24266,"pcpcounty":"","pcpid":123215,"pcpname":"","insh":"20046694*01","cliId":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"SOUTHWEST","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"276\/889-5505","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R18.8","K74.60","J06.9","R05.","R79.1","R53.1","Z29.9","K85.90","N39.0","D61.818","K76.6","R11.2","E86.0","G40.909","N83.9","I10.","E87.6","E83.42","D69.6","K29.80","B18.2","Z11.59","J32.0","J31.0","R09.82","R51.9","R07.9","I95.9","K92.2","T83.511A","M79.89","K75.81","K72.10","R10.13","N17.9","K56.7","J44.9","Z20.822","R19.5","I86.4","K31.89","K65.2","I85.10","Z68.42","K92.1","R10.9","E66.01","F31.9","G89.29","K14.0","R51.","D64.9","R06.02","K74.69","T83.518A","D69.59","K64.9","Z86.59","I85.00","R14.0","I49.3","A41.9","K81.0","K29.71","K70.31","R73.9","R60.0","D10.1","J01.81","Z01.419","Z12.72","Z87.42","Z00.00","F31.89","K72.00","K22.8","Z01.818","D12.3","R33.9","K72.90","E72.20","J02.9","R09.81","L03.90","M54.9","I85.01","Z86.19","Z76.82","Z79.51","Z79.899","R16.1","R11.10","F19.10","R07.2","I49.8","K64.1","I36.1","R71.0","D68.9","D53.9","D72.819","N83.8","J01.90","E55.9","E61.2","R56.9","Z01.810","G43.909","R10.84","L03.311","Z68.41","D62.","D69.1","K31.84","R00.0","R94.31","I82.612","D68.4","E44.0","E87.1","D63.8","K29.81","Z68.43","Z90.710","Z88.8","F43.22","E87.8","K62.5"],"date":["2021-11-04","2021-11-04","2020-03-24","2020-03-24","2020-03-24","2021-02-12","2020-03-24","2021-06-24","2021-03-13","2021-08-07","2021-06-09","2020-07-15","2020-07-15","2021-06-09","2020-07-16","2021-06-24","2020-07-15","2020-07-15","2021-11-04","2021-02-12","2021-08-07","2020-07-15","2021-01-20","2021-01-20","2021-01-20","2021-02-10","2021-06-21","2021-02-01","2021-03-05","2021-03-13","2021-03-29","2021-08-07","2021-08-13","2021-08-13","2021-10-28","2021-08-13","2021-02-12","2021-03-06","2021-03-13","2021-06-09","2021-03-17","2021-06-09","2021-08-07","2021-08-07","2021-06-11","2021-06-09","2021-06-09","2021-06-09","2021-08-07","2021-06-09","2020-01-06","2021-10-28","2020-11-27","2021-03-06","2021-03-06","2021-08-07","2021-03-06","2021-03-06","2021-03-09","2021-11-04","2020-03-20","2021-02-27","2021-02-11","2021-02-11","2021-02-11","2021-02-27","2021-07-02","2021-07-14","2021-07-14","2020-02-13","2020-02-13","2020-02-13","2020-03-19","2020-04-06","2021-08-07","2020-02-21","2020-03-20","2020-08-06","2020-11-27","2021-02-27","2021-02-12","2021-01-18","2021-01-18","2021-02-01","2021-02-01","2021-03-15","2021-03-15","2020-02-21","2020-02-21","2020-02-21","2020-03-20","2020-07-15","2021-01-26","2021-02-01","2021-02-11","2021-03-02","2021-03-15","2020-07-16","2020-07-16","2020-07-16","2020-07-16","2020-07-30","2020-10-08","2020-10-08","2020-10-08","2020-10-08","2020-11-02","2021-02-08","2021-02-12","2021-02-27","2021-02-27","2021-02-27","2021-08-07","2021-02-27","2021-02-28","2021-02-28","2021-03-12","2021-08-07","2021-08-07","2021-08-07","2021-08-07","2021-02-12","2021-02-12","2021-02-12","2021-02-12","2021-02-12","2021-02-12","2021-10-28"],"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":[["","65862052405","GABAPENTIN ","TAB 800MG","90","Select","Select",""],["","69097012303","TOPIRAMATE ","TAB 50MG","60","Select","Select",""],["","00378021610","FUROSEMIDE ","TAB 40MG","30","Select","Select",""],["","53746051401","SPIRONOLACT ","TAB 50MG","30","Select","Select",""],["","49281041950","FLUZONE ","INJ 2019-20","0","Select","Select",""],["","00121057716","LACTULOSE ","SOL 10GM\/15","946","Select","Select",""],["","00131247835","VIMPAT ","TAB 100MG","60","Select","Select",""],["","68180071160","CEFDINIR ","CAP 300MG","20","Select","Select",""],["","76385011150","CARVEDILOL ","TAB 6.25MG","90","Select","Select",""],["","75834002001","VITAMIN ","CAP 50000UNT","12","Select","Select",""],["","65862050320","AMOX\/K ","TAB 875-125","20","Select","Select",""],["","50742061510","METOPROL ","TAB 25MG ER","30","Select","Select",""],["","53489011905","DOXYCYCL ","CAP 100MG","20","Select","Select",""],["","31604002576","MAGNESIUM ","CAP 400MG","60","Select","Select",""],["","68180030360","CEFUROXIME ","TAB 500MG","20","Select","Select",""],["","10006073038","MAG ","TAB 400MG","60","Select","Select",""],["","43386009019","GAVILYTE-G ","SOL ","4000","Select","Select",""],["","53746010901","HYDROCO\/APAP ","TAB 5-325MG","10","Select","Select",""],["","65862069201","PHENYTOIN ","CAP 100MG","90","Select","Select",""],["","65649030302","XIFAXAN ","TAB 550MG","60","Select","Select",""],["","65162070684","AZELASTINE ","SPR 0.0015","30","Select","Select",""],["","63304069301","CLINDAMYCIN ","CAP 300MG","40","Select","Select",""],["","69097014260","ALBUTEROL ","AER HFA","7","Select","Select",""],["","59310057922","PROAIR ","AER ","8","Select","Select",""],["","62175061743","PANTOPRAZOLE ","TAB 40MG","60","Select","Select",""],["","43547030203","ARIPIPRAZOLE ","TAB 2MG","30","Select","Select",""],["","13668000905","CITALOPRAM ","TAB 10MG","30","Select","Select",""],["","57237001401","TAMSULOSIN ","CAP 0.4MG","90","Select","Select",""],["","75826011510","PHENAZOPYRID ","TAB 200MG","10","Select","Select",""],["","65162052110","PROMETHAZINE ","TAB 25MG","40","Select","Select",""],["","00093221001","SUCRALFATE ","TAB 1GM","120","Select","Select",""],["","00054327099","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","00603533715","PREDNISONE ","PAK 5MG","21","Select","Select",""],["","23155022901","ACYCLOVIR ","CAP 200MG","200","Select","Select",""],["","10702001801","OXYCODONE ","TAB 5MG","12","Select","Select",""],["","60432053760","NYSTATIN ","SUS 100000","60","Select","Select",""],["","68180012202","CEPHALEXIN ","CAP 500MG","28","Select","Select",""],["","51672126705","TRIAMCINOLON ","PST DEN 0.1%","5","Select","Select",""],["","0",""," ","260","Select","Select",""],["","69547035302","NARCAN ","SPR ","2","Select","Select",""],["","00115165903","PROPRANOLOL ","TAB 10MG","270","Select","Select",""],["","59779066916","HEMORRHOIDAL ","OIN CVS","57","Select","Select",""],["","00143992801","CIPROFLOXACN ","TAB 500MG","14","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","",""],["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":""}]}]}