{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BRIAN LEMON","gend":0,"add":"2006 E MAIN ST APT 2","city":"SALEM","state":"VA","zip":"24153-9998","dob":"1968-04-24","age":"","mstatus":"","insh":"2032700*01","cliId":"","pno":"540\/519-1029","cno":"540\/519-1029","email":"","ename":"","eno":"","pphy":"DAVIS, MICHAEL ALAN DO","ppno":"540\/381-1882","pcpadd":"10 HICKOK ST STE 101","pcpcity":"CHRISTIANSBURG","pcpstate":"VA","pcpzip":24073,"pcpcounty":"","pcpid":165286,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"ROANOKE ALLEGHANY","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"540\/381-1866","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E10.65","E89.0","F90.9","E03.9","Z12.11","N17.9","E10.10","Z20.828","E86.0","D72.829","E05.00","E86.1","F17.210","K76.0","F41.9","D64.9","I10.","Z79.890","Z79.4","Z91.018","NO DATA","G93.41","R57.1","D68.59","E46.","Z68.1","F17.200","I48.91","E83.39","E83.51","T68.XXXA","G70.00","E11.65","E78.2","R40.4","R40.20","R09.02","I95.9","E87.2","E87.5","R40.0","Z78.9","S01.00XA","S51.002A","S51.001A","E11.622","L01.00","S01.501A","L08.9","S51.001D","S01.00XD","E11.10","R41.82","R06.89","E11.9","Z91.14","E11.40","L60.0","E10.42","B35.1","R07.9","E16.1","E16.2","I48.0","Z20.822","R11.2","D72.825","D75.89","E03.8","F43.9","L98.499","Z91.19","Z83.3","Z80.1","I49.9","R07.89","L97.229","L97.529","G47.419","J01.00","A41.9","R65.21","I49.1","E11.621","L97.411","E78.5","J69.0","E05.90","Z87.891","R11.0","R00.0","R11.11","R53.81"],"date":["2021-09-04","2021-01-04","2021-02-12","2021-09-04","2020-04-15","2021-09-02","2021-09-04","2020-12-15","2021-05-18","2021-09-02","2021-09-02","2020-06-07","2020-06-07","2021-07-06","2021-07-06","2021-09-04","2021-09-02","2021-06-22","2021-06-22","2021-06-22","2021-09-02","2021-05-17","2021-05-17","2020-12-15","2020-12-16","2020-12-15","2021-09-02","2021-06-22","2020-12-15","2020-12-17","2020-12-15","2020-12-15","2021-09-01","2021-01-04","2021-05-16","2021-05-16","2021-09-01","2021-02-12","2021-07-08","2021-05-16","2021-05-16","2021-06-23","2021-05-26","2021-05-26","2021-05-26","2021-05-26","2020-04-16","2020-11-10","2021-05-04","2021-06-10","2021-06-10","2021-07-07","2020-12-14","2021-07-06","2021-09-02","2021-09-02","2021-09-02","2020-04-30","2020-04-30","2020-04-30","2021-06-22","2020-12-14","2020-12-14","2021-02-12","2021-09-01","2021-09-02","2021-05-16","2021-05-16","2021-05-16","2021-05-16","2021-07-06","2021-06-22","2021-05-16","2021-05-16","2021-06-22","2021-06-22","2021-07-06","2021-07-06","2021-07-06","2020-08-17","2021-02-12","2021-02-12","2021-05-16","2021-05-18","2021-05-18","2021-07-07","2021-06-22","2021-06-22","2021-06-22","2021-06-22","2021-09-01","2021-09-01","2021-09-01"],"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":[["","00555097302","AMPHET\/DEXTR ","20MG","60","Select","Select",""],["","57599000200","FREESTYLE    MIS READER","READER","1","Select","Select",""],["","57599000101","FREESTYLE    KIT SENSOR","SENSOR","1","Select","Select",""],["","68645055054","LISINOPRIL ","2.5MG","30","Select","Select",""],["","00168020260","CLINDAMYCIN ","1%","60","Select","Select",""],["","00472040015","CLOBETASOL ","0.05%","15","Select","Select",""],["","00472024260","PERMETHRIN ","5%","60","Select","Select",""],["","00169633910","NOVOLOG ","FLEXPEN","12","Select","Select",""],["","00002803101","GLUCAGON ","1MG","1","Select","Select",""],["","00781518892","LEVOTHYROXIN ","175MCG","30","Select","Select",""],["","73070010315","INSULIN ","FLEXPEN","30","Select","Select",""],["","00088221905","LANTUS ","100\/ML","6","Select","Select",""],["","68180012202","CEPHALEXIN ","500MG","30","Select","Select",""],["","08396902700","RELION ","31GX5\/16","300","Select","Select",""],["","53885024450","ONETOUCH ","ULTRA BL","150","Select","Select",""],["","45802011222","MUPIROCIN ","2%","22","Select","Select",""],["","00054327099","FLUTICASONE ","50MCG","16","Select","Select",""],["","55111015330","ONDANSETRON ","4MG","20","Select","Select",""],["","68645056854","ATORVASTATIN ","40MG","30","Select","Select",""],["","57844013001","ADDERALL ","30MG","60","Select","Select",""],["","72305017530","EUTHYROX ","175MCG","30","Select","Select",""],["","59676058015","JANSSEN ","COVID-19","0","Select","Select",""],["","65162027250","SMZ\/TMP ","800-160","20","Select","Select",""],["","70010010810","GABAPENTIN ","100MG","30","Select","Select",""],["","08290320119","BD  PEN NEEDL","31GX5MM","100","Select","Select",""],["","00143924920","AMOX\/K ","875-125","13","Select","Select",""],["","00093220401","METOCLOPRAM ","5MG","40","Select","Select",""],["","00555097302","AMPHET\/DEXTR","20MG","60","Select","Select",""],["","57599000200","FREESTYLE MIS READER","READER","1","Select","Select",""],["","68645055054","LISINOPRIL","2.5MG","30","Select","Select",""],["","00168020260","CLINDAMYCIN","1%","60","Select","Select",""],["","57599000101","FREESTYLE KIT SENSOR","SENSOR","1","Select","Select",""],["","00472040015","CLOBETASOL","0.05%","15","Select","Select",""],["","00472024260","PERMETHRIN","5%","60","Select","Select",""],["","00781518892","LEVOTHYROXIN","175MCG","30","Select","Select",""],["","00088221905","LANTUS","100\/ML","6","Select","Select",""],["","00169633910","NOVOLOG","FLEXPEN","12","Select","Select",""],["","68462018022","MUPIROCIN","2%","22","Select","Select",""],["","53885024450","ONETOUCH","ULTRA BL","150","Select","Select",""],["","00054327099","FLUTICASONE","50MCG","16","Select","Select",""],["","00002803101","GLUCAGON","1MG","1","Select","Select",""],["","68180012202","CEPHALEXIN","500MG","30","Select","Select",""],["","68645056854","ATORVASTATIN","40MG","30","Select","Select",""],["","72305017530","EUTHYROX","175MCG","30","Select","Select",""],["","73070010315","INSULIN","FLEXPEN","30","Select","Select",""],["","08396902700","RELION","31GX5\/16","300","Select","Select",""],["","65162027250","SMZ\/TMP","800-160","20","Select","Select",""],["","57844013001","ADDERALL","30MG","60","Select","Select",""],["","55111015330","ONDANSETRON","4MG","30","Select","Select",""],["","70010010810","GABAPENTIN","100MG","30","Select","Select",""],["","59676058015","JANSSEN","COVID-19","0","Select","Select",""],["","08290320119","BD PEN NEEDL","31GX5MM","100","Select","Select",""],["","00143924920","AMOX\/K","875-125","13","Select","Select",""],["","00093220401","METOCLOPRAM","5MG","40","Select","Select",""],["","08396900218","PEN  NEEDLES  ","MIS 31GX8MM","100","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","",""],["N\/A","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":""}]}]}