{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SHARON   S COLLINGSWORTH","gend":1,"add":"PO BOX 52","city":"BLACKWATER","state":"VA","zip":"24221-9998","dob":"1961-05-28","age":"","mstatus":"","insh":"20047327*01","cliId":"","pno":"276\/346-2715","cno":"276\/346-2715","email":"","ename":"","eno":"","pphy":"VANZEE, WAYNE","ppno":"276\/383-4428","pcpadd":"241 MONARCH RD","pcpcity":"SAINT CHARLES","pcpstate":"VA","pcpzip":24282,"pcpcounty":"","pcpid":143432,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"SOUTHWEST","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"276\/383-4927","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N39.0","Z00.8","Z13.9","Z13.89","Z71.89","E03.8","K75.81","E78.2","M15.0","R10.11","F33.0","K21.9","F41.1","R60.9","H25.813","Z13.818","G43.909"],"date":["2021-03-17","2021-06-09","2021-06-09","2021-06-09","2021-06-09","2021-06-09","2021-06-09","2020-03-10","2021-06-09","2020-03-10","2020-03-10","2021-06-09","2021-06-09","2020-05-19","2021-02-25","2020-01-20","2021-06-09"],"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":[["","68645049254","PANTOPRAZOLE ","40MG","30","Select","Select",""],["","16714043901","NITROFURANTN ","100MG","20","Select","Select",""],["","00781518292","LEVOTHYROXIN ","75MCG","30","Select","Select",""],["","68645056854","ATORVASTATIN ","40MG","30","Select","Select",""],["","68382005105","MELOXICAM ","15MG","30","Select","Select",""],["","29300011616","TOPIRAMATE ","50MG","60","Select","Select",""],["","68645057154","CITALOPRAM ","40MG","15","Select","Select",""],["","00008084402","PROTONIX ","","90","Select","Select",""],["","72305007530","EUTHYROX ","75MCG","30","Select","Select",""],["","31604002621","VITAMIN ","5000UNIT","90","Select","Select",""],["","49035061295","","","90","Select","Select",""],["","49035061247","ALLERGY ","10MG","90","Select","Select",""],["","16714089802","LORATADINE ","10MG","90","Select","Select",""],["","00781518292","LEVOTHYROXIN","75MCG","30","Select","Select",""],["","68382005105","MELOXICAM","15MG","30","Select","Select",""],["","16714043901","NITROFURANTN","100MG","20","Select","Select",""],["","68645049254","PANTOPRAZOLE","40MG","30","Select","Select",""],["","68645056854","ATORVASTATIN","40MG","30","Select","Select",""],["","69097012312","TOPIRAMATE","50MG","60","Select","Select",""],["","68645057154","CITALOPRAM","40MG","15","Select","Select",""],["","00008084402","PROTONIX","","30","Select","Select",""],["","31604002621","VITAMIN","5000UNIT","90","Select","Select",""],["","16714089802","LORATADINE","10MG","90","Select","Select",""],["","42571012290","LEVOCETIRIZI","5MG","30","Select","Select",""],["","49035061247","ALLERGY","10MG","90","Select","Select",""],["","72305007530","EUTHYROX","75MCG","30","Select","Select",""],["","42571012290","LEVOCETIRIZI ","TAB 5MG","30","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":""}]}]}