{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"POLLY   M RYDER","gend":1,"add":"1606 W CAROLINA AVE APT 43","city":"CREWE","state":"VA","zip":"23930-9998","dob":"1994-03-16","age":"","mstatus":"","insh":"8605823*01","cliId":"","pno":"434\/294-1226","cno":"434\/294-1226","email":"","ename":"","eno":"","pphy":"ADAMS, DAVID MD","ppno":"434\/857-3600","pcpadd":"414 PARK AVE","pcpcity":"DANVILLE","pcpstate":"VA","pcpzip":24541,"pcpcounty":"","pcpid":182209,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/857-3601","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M51.16","S39.012A","R10.11","M54.5","M51.36","M54.16","S63.501A","S80.11XA","S50.811A","S10.91XA","R30.0","R11.0","N39.0","K21.9","R10.9","R19.7","R13.10","J02.9","H66.91","R20.0","V43.52XA","NO DATA","M47.816","R50.9","R51.9","R11.2","J06.9","Y93.89","U07.1","R11.10","S20.211A","R07.81"],"date":["2020-02-18","2021-05-20","2020-09-05","2020-11-05","2020-11-05","2020-03-04","2020-12-04","2020-12-04","2020-12-04","2020-12-04","2020-07-09","2020-07-09","2020-10-22","2020-11-02","2020-11-02","2020-11-02","2021-05-13","2021-05-13","2021-04-28","2020-09-24","2020-09-24","2021-08-19","2021-08-19","2020-10-22","2021-08-15","2020-10-22","2020-01-20","2021-05-20","2021-08-15","2021-08-15","2021-09-29","2021-09-29"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",null,null]}},{"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":[["","67877057305","BENZONATATE ","100MG","15","Select","Select",""],["","00093317431","ALBUTEROL ","HFA","8","Select","Select",""],["","55111018010","TIZANIDINE ","4MG","90","Select","Select",""],["","61442010310","DICLOFENAC ","75MG DR","60","Select","Select",""],["","57237007710","ONDANSETRON ","4MG ODT","15","Select","Select",""],["","42937070210","PHENAZOPYRID ","200MG","4","Select","Select",""],["","67877021905","CEPHALEXIN ","500MG","30","Select","Select",""],["","00143122701","DICYCLOMINE ","20MG","15","Select","Select",""],["","65162019050","NAPROXEN ","500MG","30","Select","Select",""],["","10702000709","CYCLOBENZAPR ","10MG","30","Select","Select",""],["","59746000103","METHYLPRED ","4MG","21","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","00093031401","KETOROLAC ","10MG","20","Select","Select",""],["","00085113201","PROVENTIL ","HFA","7","Select","Select",""],["","50383077504","LIDOCAINE ","2% VISC","100","Select","Select",""],["","00143993905","AMOXICILLIN ","500MG","30","Select","Select",""],["","63304069301","CLINDAMYCIN ","300MG","14","Select","Select",""],["","68180016013","AZITHROMYCIN ","250MG","6","Select","Select",""],["","00254100752","ALBUTEROL","HFA","7","Select","Select",""],["","55111018010","TIZANIDINE","4MG","90","Select","Select",""],["","61442010310","DICLOFENAC","75MG DR","60","Select","Select",""],["","68462015713","ONDANSETRON","4MG ODT","20","Select","Select",""],["","67877021905","CEPHALEXIN","500MG","30","Select","Select",""],["","10702000709","CYCLOBENZAPR","10MG","30","Select","Select",""],["","00591079401","DICYCLOMINE","10MG","90","Select","Select",""],["","59746000103","METHYLPRED","4MG","21","Select","Select",""],["","00093031401","KETOROLAC","10MG","20","Select","Select",""],["","00143993905","AMOXICILLIN","500MG","30","Select","Select",""],["","63304069301","CLINDAMYCIN","300MG","14","Select","Select",""],["","00085113201","PROVENTIL","HFA","7","Select","Select",""],["","50383077504","LIDOCAINE","2% VISC","100","Select","Select",""],["","68180016013","AZITHROMYCIN","250MG","6","Select","Select",""],["","49483060450","IBUPROFEN","800MG","15","Select","Select",""],["","67877057305","BENZONATATE","100MG","15","Select","Select",""],["","42937070210","PHENAZOPYRID","200MG","4","Select","Select",""],["","65162019050","NAPROXEN","500MG","30","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","49483060450","IBUPROFEN ","TAB 800MG","15","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","",""],["No","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":""}]}]}