{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"RANDY   M KING","gend":0,"add":"181 MELROSE DR","city":"BASSETT","state":"VA","zip":"24055-9998","dob":"1966-05-07","age":"","mstatus":"","insh":"20054714*01","cliId":"","pno":"276\/226-3690","cno":"276\/226-3690","email":"","ename":"","eno":"","pphy":"SUBUHI, TABASSUM MD","ppno":"540\/365-4469","pcpadd":"180 FERRUM MOUNTAIN ROAD","pcpcity":"FERRUM","pcpstate":"VA","pcpzip":24088,"pcpcounty":"","pcpid":140573,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"ROANOKE ALLEGHANY","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"540\/365-4272","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M10.00","M54.41","R29.3","R53.1","R26.89","M54.5","E11.8","M47.26","R22.9","F17.210","Z79.899","E11.65","R52.","M54.89","I42.9","I21.4","I34.0","I88.0","I10.","I50.22","Z72.0","M25.561","M25.562","G89.29","I42.8","M51.36","M51.26","R26.9","Z91.81","I11.0","E79.0","Z79.4","R09.02","I51.7","G44.89","R51.9","E86.0"],"date":["2021-08-31","2020-07-02","2020-07-02","2020-07-02","2020-07-02","2020-05-21","2020-07-07","2020-07-07","2020-07-07","2020-07-07","2020-09-30","2020-05-21","2021-07-18","2020-05-21","2021-08-25","2021-08-25","2021-08-25","2020-09-15","2020-03-09","2020-05-28","2020-03-09","2020-03-09","2020-08-06","2020-03-09","2020-01-24","2020-08-07","2020-08-07","2020-08-07","2020-08-07","2020-05-28","2020-05-28","2020-05-28","2020-08-06","2021-08-16","2021-07-18","2021-07-18","2021-07-18"],"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":[["","16729017317","AMITRIPTYLIN ","50MG","30","Select","Select",""],["","68382009505","CARVEDILOL ","25MG","60","Select","Select",""],["","68645058459","METFORMIN ","1000MG","60","Select","Select",""],["","00078065920","ENTRESTO ","24-26MG","60","Select","Select",""],["","53885027150","ONETOUCH ","VERIO","50","Select","Select",""],["","68462022555","MOMETASONE ","0.10%","90","Select","Select",""],["","00169633910","NOVOLOG ","FLEXPEN","3","Select","Select",""],["","16714004211","ALLOPURINOL ","300MG","30","Select","Select",""],["","43547040211","FUROSEMIDE ","40MG","30","Select","Select",""],["","59746021601","SPIRONOLACT ","25MG","30","Select","Select",""],["","55111018015","TIZANIDINE ","4MG","20","Select","Select",""],["","50383070016","FLUTICASONE ","50MCG","16","Select","Select",""],["","42858010301","OXYCOD\/APAP ","7.5-325","10","Select","Select",""],["","08290320119","BD  PEN NEEDL","31GX5MM","200","Select","Select",""],["","68180098003","LISINOPRIL ","10MG","30","Select","Select",""],["","00169643810","LEVEMIR ","FLEXTOUC","9","Select","Select",""],["","08463520350","INFINITY ","BLD GLUC","400","Select","Select",""],["","68645056354","IBUPROFEN ","800MG","30","Select","Select",""],["","60913000601","ALCOHOL ","","300","Select","Select",""],["","73070010315","INSULIN ","FLEXPEN","6","Select","Select",""],["","60913000101","AQUALANCE ","30G","400","Select","Select",""],["","57513000629","PEN  NEEDLES  ","31GX8MM","300","Select","Select",""],["","60913000301","LANCING ","","1","Select","Select",""],["","65702040710","ACCU-CHEK ","AVIVA PL","300","Select","Select",""],["","59267100001","PFIZER ","COVID-19","0","Select","Select",""],["","68462022555","MOMETASONE","0.10%","90","Select","Select",""],["","68645054659","METFORMIN","1000MG","60","Select","Select",""],["","53885027150","ONETOUCH","VERIO","50","Select","Select",""],["","43547040211","FUROSEMIDE","40MG","30","Select","Select",""],["","16729017317","AMITRIPTYLIN","50MG","30","Select","Select",""],["","00078065920","ENTRESTO","24-26MG","60","Select","Select",""],["","16714004211","ALLOPURINOL","300MG","30","Select","Select",""],["","59746021601","SPIRONOLACT","25MG","30","Select","Select",""],["","00169633910","NOVOLOG","FLEXPEN","3","Select","Select",""],["","68382009505","CARVEDILOL","25MG","60","Select","Select",""],["","68180098003","LISINOPRIL","10MG","30","Select","Select",""],["","55111018015","TIZANIDINE","4MG","20","Select","Select",""],["","68645056354","IBUPROFEN","800MG","30","Select","Select",""],["","73070010315","INSULIN","FLEXPEN","6","Select","Select",""],["","00169643810","LEVEMIR","FLEXTOUC","12","Select","Select",""],["","50383070016","FLUTICASONE","50MCG","16","Select","Select",""],["","42858010301","OXYCOD\/APAP","7.5-325","10","Select","Select",""],["","08290320119","BD PEN NEEDL","31GX5MM","200","Select","Select",""],["","60913000301","LANCING","","1","Select","Select",""],["","60913000601","ALCOHOL","","700","Select","Select",""],["","08463510301","INFINITY","SYSTEM","1","Select","Select",""],["","57513000629","PEN NEEDLES","31GX8MM","300","Select","Select",""],["","60913000101","AQUALANCE","30G","400","Select","Select",""],["","65702040710","ACCU-CHEK","AVIVA PL","300","Select","Select",""],["","59267100001","PFIZER","COVID-19","0","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":""}]}]}