{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CONSTANCE ROSE","gend":1,"add":"11427 PINE CAMP ROAD","city":"COEBURN","state":"VA","zip":"24230-9998","dob":"1992-11-30","age":"","mstatus":"","insh":"2154965*01","cliId":"","pno":"276\/623-3833","cno":"276\/623-3833","email":"","ename":"","eno":"","pphy":"WHEATLEY, MICHAEL W MD","ppno":"276\/328-7071","pcpadd":"417 W MAIN ST","pcpcity":"WISE","pcpstate":"VA","pcpzip":24293,"pcpcounty":"","pcpid":171020,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"SOUTHWEST","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J06.9","Z72.0","G47.33","J45.20","F31.0","NO DATA","E03.0","F17.210","R11.2","Z33.1","R51.9","R20.2","G43.009","Z82.3","Z86.39","R00.0","R06.02","R50.9","O24.419","Z3A.32","Z39.1","Z34.82","Z34.83","O24.410","Z3A.35","Z32.01","N92.6","R35.0","R53.81","Z87.898","Z36.9","Z3A.08","N39.0","E03.9","Z86.79","Z30.41","R06.83","F41.9","R53.83","F32.9","F43.10","F60.5","O21.9","Z3A.11","O34.211","Z3A.38","Z37.0","O99.613","K80.20","Z3A.36","O98.32","O99.354","O13.4","O99.334","O99.344","O99.284","E78.5","O34.83","N83.209","G44.209","O99.52","T14.8XXA","L08.9","E66.01","Z68.38","O24.420","O98.52","A60.00","O99.824","B95.1","F31.9","R68.89","R07.89","J40.","N76.0","B96.89","Z13.32","R45.851","F41.0","V62.84","Z20.822","F31.5","N30.01","J45.909","I47.1","R06.2","J45.40","G43.909"],"date":["2020-02-14","2020-02-14","2020-11-11","2020-03-17","2021-07-07","2020-03-17","2020-03-17","2020-11-11","2020-04-20","2020-04-20","2021-03-24","2021-03-24","2021-04-01","2021-04-01","2021-04-01","2021-07-23","2020-02-14","2020-02-14","2020-09-30","2020-09-30","2020-10-06","2020-10-06","2020-10-06","2020-10-27","2020-10-19","2020-03-27","2020-03-27","2020-03-27","2020-03-27","2020-03-27","2020-03-27","2020-03-27","2021-07-20","2021-07-23","2021-07-20","2020-03-12","2020-03-12","2020-11-11","2020-03-12","2021-07-20","2021-08-18","2021-08-18","2020-04-19","2020-04-19","2020-11-11","2020-11-11","2020-11-11","2020-10-27","2020-10-27","2020-10-27","2020-11-11","2020-11-11","2020-11-11","2020-11-11","2020-11-11","2020-11-11","2020-11-11","2020-11-11","2020-11-11","2020-11-11","2020-11-11","2020-11-25","2020-11-25","2020-11-25","2020-11-25","2020-11-11","2020-11-11","2020-11-11","2020-11-11","2020-11-11","2021-08-18","2020-02-11","2020-02-11","2020-02-11","2021-03-01","2021-03-01","2021-03-01","2021-07-07","2021-07-07","2021-07-20","2021-07-20","2021-07-23","2021-07-23","2021-07-23","2021-07-23","2021-08-17","2021-08-17","2021-08-09"],"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":[["","00487950125","ALBUTEROL ","0.08%","75","Select","Select",""],["","51991031190","DESVENLAFAX ","50MG ER","30","Select","Select",""],["","45963014205","BUPROPN ","300MG XL","30","Select","Select",""],["","29300011610","TOPIRAMATE ","50MG","60","Select","Select",""],["","13668021830","ARIPIPRAZOLE ","10MG","30","Select","Select",""],["","00186037020","SYMBICORT ","160-4.5","10","Select","Select",""],["","27808003503","HYDROCO\/APAP ","5-325MG","16","Select","Select",""],["","68462067295","LEVONOR\/ETHI ","ESTRADIO","91","Select","Select",""],["","50111078751","AZITHROMYCIN ","250MG","6","Select","Select",""],["","16729011917","MONTELUKAST ","10MG","30","Select","Select",""],["","64380080707","IBUPROFEN ","800MG","30","Select","Select",""],["","60432060616","PROMETH\/COD ","6.25-10","200","Select","Select",""],["","00085113204","PROVENTIL ","HFA","7","Select","Select",""],["","59746000103","METHYLPRED ","4MG","21","Select","Select",""],["","00093100301","BUSPIRONE ","15MG","60","Select","Select",""],["","51224000160","BENZONATATE ","200MG","15","Select","Select",""],["","16714008310","HYDROXYZ ","50MG","60","Select","Select",""],["","50742061701","METOPROL ","100MG ER","30","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","57237007710","ONDANSETRON ","4MG ODT","90","Select","Select",""],["","51862027906","MICROGESTIN ","1.5\/30","21","Select","Select",""],["","66993068130","OLANZAPINE ","5MG","30","Select","Select",""],["","53885027210","ONETOUCH ","VERIO","100","Select","Select",""],["","00591315901","URSODIOL ","300MG","90","Select","Select",""],["","68382004101","PROMETHAZINE ","25MG","20","Select","Select",""],["","45802086866","POLYETH ","3350 NF","7","Select","Select",""],["","00168034646","TERCONAZOLE ","0.40%","45","Select","Select",""],["","00002143611","EMGALITY ","120MG\/ML","1","Select","Select",""],["","69097083412","SERTRALINE ","50MG","45","Select","Select",""],["","65862044930","VALACYCLOVIR ","1GM","30","Select","Select",""],["","00406051205","OXYCOD\/APAP ","5-325MG","12","Select","Select",""],["","00904645760","DOK ","100MG","60","Select","Select",""],["","67877021905","CEPHALEXIN ","500MG","28","Select","Select",""],["","61874011530","VRAYLAR ","1.5MG","30","Select","Select",""],["","50111033402","METRONIDAZOL ","500MG","14","Select","Select",""],["","69315090405","LORAZEPAM ","0.5MG","15","Select","Select",""],["","29300011101","LAMOTRIGINE ","25MG","60","Select","Select",""],["","65862069790","VENLAFAXINE ","150MG ER","30","Select","Select",""],["","00591352530","LIDOCAINE ","5%","30","Select","Select",""],["","43547040011","CYCLOBENZAPR ","10MG","20","Select","Select",""],["","68382080510","TRAZODONE ","50MG","30","Select","Select",""],["","42571025201","CLINDAMYCIN ","300MG","30","Select","Select",""],["","51672421701","DOXEPIN ","10MG","30","Select","Select",""],["","16729044717","LEVOTHYROXIN ","25MCG","30","Select","Select",""],["","68001042300","NITROFURANTN ","100MG","20","Select","Select",""],["","00023650110","UBRELVY ","100MG","10","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","",""],["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":""}]}]}