{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CHARLOTTE BROWN","gend":1,"add":"39 CRESTVIEW RD # 107","city":"LAWRENCEVILLE","state":"VA","zip":"23868-9998","dob":"1966-11-27","age":"","mstatus":"","insh":"20065906*01","cliId":"","pno":"434\/532-8013","cno":"434\/532-8013","email":"","ename":"","eno":"","pphy":"ACKERMAN, CHRISTOPHER J MD","ppno":"434\/848-0771","pcpadd":"203 SHARP ST","pcpcity":"LAWRENCEVILLE","pcpstate":"VA","pcpzip":23868,"pcpcounty":"","pcpid":104888,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"434\/604-0259","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/848-3814","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["NO DATA","E11.22","N18.6","Z91.14","R11.2","R41.82","R09.02","R00.0","E11.00","E11.3399","G60.3","E78.00","F32.89","I15.2","J41.0","N17.9","E87.2","E13.10","E11.10","E11.42","I12.9","N18.4","I63.9","G62.9","E56.8","F41.8","Z79.899","Z79.84","I10.","E11.9","M25.511","G93.41","E66.9","F32.9","E78.5","J44.9","Z20.822","E11.40","M21.379","F17.210","K82.9","A41.9","R25.1","R53.1","M62.81","Z74.09","E87.1","E83.52","E86.1","E87.5","Z51.81","E71.32","Z91.19"],"date":["2021-08-09","2021-08-09","2021-05-24","2021-05-24","2021-05-24","2021-05-27","2021-05-24","2021-05-24","2021-08-09","2021-04-08","2021-04-08","2021-06-06","2021-04-08","2021-04-08","2021-04-08","2021-06-06","2021-05-27","2021-06-06","2021-06-16","2021-08-09","2021-08-09","2021-08-09","2021-06-09","2020-05-21","2020-05-21","2020-05-21","2021-06-06","2020-05-21","2020-10-27","2021-09-02","2020-10-27","2021-05-24","2021-06-06","2021-06-06","2021-06-06","2021-05-24","2021-06-06","2021-05-24","2021-05-24","2021-06-06","2021-05-24","2021-05-26","2021-06-05","2021-06-06","2021-06-10","2021-06-10","2021-06-06","2021-06-06","2021-06-06","2021-06-06","2021-06-06","2021-06-06","2021-06-06"],"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":[["","00591086201","LISINOP\/HCTZ ","20-25MG","30","Select","Select",""],["","65862019105","CYCLOBENZAPR ","10MG","30","Select","Select",""],["","00093075210","ATENOLOL ","50MG","60","Select","Select",""],["","00172572860","FAMOTIDINE ","20MG","60","Select","Select",""],["","11822547890","VITAMIN ","2000UNIT","30","Select","Select",""],["","43547028910","BUPROPION ","150MG SR","30","Select","Select",""],["","51224022060","METFORMIN ","1000MG","60","Select","Select",""],["","16714089803","LORATADINE ","10MG","30","Select","Select",""],["","60505014200","GLIPIZIDE ","10MG","60","Select","Select",""],["","00006011231","JANUVIA ","50MG","30","Select","Select",""],["","69097045805","FENOFIBRATE ","145MG","30","Select","Select",""],["","31722077701","ACYCLOVIR ","400MG","60","Select","Select",""],["","16714066101","GABAPENTIN ","100MG","90","Select","Select",""],["","00002821501","HUMULIN ","U-100","10","Select","Select",""],["","08290328431","INSULIN ","0.3\/30G","120","Select","Select",""],["","00093077198","PRAVASTATIN ","10MG","90","Select","Select",""],["","65162044110","MECLIZINE ","12.5MG","90","Select","Select",""],["","60432026415","FLUTICASONE ","50MCG","16","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","00093317431","ALBUTEROL ","HFA","8","Select","Select",""],["","16571066401","METRONIDAZOL ","500MG","16","Select","Select",""],["","08290320109","BD  PEN NEEDL","31GX8MM","50","Select","Select",""],["","11822033670","RA ","100MG","30","Select","Select",""],["","00093075210","ATENOLOL","50MG","60","Select","Select",""],["","00006011231","JANUVIA","50MG","30","Select","Select",""],["","00591086201","LISINOP\/HCTZ","20-25MG","30","Select","Select",""],["","65862019105","CYCLOBENZAPR","10MG","30","Select","Select",""],["","31722077701","ACYCLOVIR","400MG","60","Select","Select",""],["","11822547890","VITAMIN","2000UNIT","30","Select","Select",""],["","16714089803","LORATADINE","10MG","30","Select","Select",""],["","43547028910","BUPROPION","150MG SR","30","Select","Select",""],["","69097045805","FENOFIBRATE","145MG","30","Select","Select",""],["","60505014200","GLIPIZIDE","10MG","60","Select","Select",""],["","42806031505","METFORMIN","1000MG","60","Select","Select",""],["","16714066101","GABAPENTIN","100MG","90","Select","Select",""],["","00172572860","FAMOTIDINE","20MG","60","Select","Select",""],["","60432026415","FLUTICASONE","50MCG","16","Select","Select",""],["","65162044110","MECLIZINE","12.5MG","90","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","00093317431","ALBUTEROL","HFA","8","Select","Select",""],["","00002821501","HUMULIN","U-100","10","Select","Select",""],["","00093077198","PRAVASTATIN","10MG","90","Select","Select",""],["","08290328431","INSULIN","0.3\/30G","120","Select","Select",""],["","16571066401","METRONIDAZOL","500MG","16","Select","Select",""],["","08290320109","BD PEN NEEDL","31GX8MM","50","Select","Select",""],["","11822033670","RA","100MG","30","Select","Select",""],["","65162046650","IBUPROFEN ","TAB 800MG","21","Select","Select",""],["","51660052653","ALLERGY ","TAB 10MG","30","Select","Select",""],["","00093310953","AMOXICILLIN ","CAP 500MG","21","Select","Select",""],["","68180031909","BUPROPN ","TAB 150MG XL","28","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":""}]}]}