{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DONALD   HARRELL BRANKLEY","gend":0,"add":"121 JOHNSON ROAD","city":"CLARKSVILLE","state":"VA","zip":"23927-9998","dob":"1961-04-18","age":"","mstatus":"","insh":"1998763*01","cliId":"","pno":"434\/374-5124","cno":"434\/374-5124","email":"","ename":"","eno":"","pphy":"HIVELY, JEFFREY W MD","ppno":"434\/374-5344","pcpadd":"115 COLLEGE ST","pcpcity":"CLARKSVILLE","pcpstate":"VA","pcpzip":23927,"pcpcounty":"","pcpid":105511,"pcpname":"","plan":"OHP","program":"ACA","lob":"Individual","region":"CENTRAL","aligned":"","ano":"434\/374-5124","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/374-4814","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I72.3","E66.01","K59.1","R10.84","M48.062","S80.02XA","M17.12","M54.16","M17.0","M17.11","M48.061","R10.12","Z98.890","L40.0","S32.2XXA","M54.41","M48.00","I10.","F17.210","M79.651","R10.9","I71.4","Z12.11","D12.0","D12.2","D12.5","K64.8","K20.90","R10.13","M71.38","M19.90","E78.00","L40.9","Z79.899","Z98.84","Z82.61","Z82.49","Z82.3","Z83.3","N28.1","E78.5","Z87.39","Z90.49","E78.2","M25.775","Z11.59","I25.10","J84.10","K44.9","K40.90","M47.816","M47.817","H25.093","E88.81","H33.311","H33.301","R19.8","Z20.828","M25.551","J32.9","R09.81","R05.","R09.82","B96.89","K63.5","Z12.5","Z86.010","K57.90","M54.5","H31.001","H25.13","Z23.","Z20.822","H43.811"],"date":["2021-03-02","2020-08-27","2020-08-27","2020-08-27","2020-08-27","2021-01-18","2021-05-18","2021-02-15","2021-11-08","2021-05-18","2020-05-06","2020-08-12","2020-08-12","2021-09-15","2020-02-12","2020-03-10","2020-03-10","2021-04-28","2020-08-12","2020-03-10","2020-09-28","2021-03-24","2020-10-14","2020-10-14","2021-06-11","2021-06-11","2021-06-11","2021-04-22","2020-10-14","2020-05-06","2020-05-06","2020-05-06","2020-05-06","2021-04-28","2021-03-02","2020-05-06","2020-05-06","2020-05-06","2020-05-06","2021-03-02","2020-08-12","2020-08-12","2020-08-12","2021-04-28","2020-08-14","2020-09-28","2021-03-02","2021-03-02","2021-03-02","2021-03-02","2020-03-12","2020-03-12","2020-09-02","2021-10-25","2020-09-03","2020-09-02","2020-09-28","2020-12-19","2020-03-07","2020-10-05","2020-10-05","2020-10-05","2020-10-05","2020-10-05","2020-10-14","2021-04-28","2021-06-11","2021-06-11","2020-02-18","2021-10-25","2021-11-08","2020-11-11","2021-08-20","2021-11-08"],"priorHcc":["","","","","","","","",null,"","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",null,"","","","","","","","","","","","","","","",null,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":[["","00074055402","HUMIRA","40\/0.4ML","2","Select","Select",""],["","42858010201","OXYCOD\/APAP","5-325MG","20","Select","Select",""],["","00093720298","PRAVASTATIN","40MG","30","Select","Select",""],["","67877032105","IBUPROFEN","800MG","90","Select","Select",""],["","59746000103","METHYLPRED","4MG","21","Select","Select",""],["","69547035302","NARCAN","","2","Select","Select",""],["","68180051801","LISINOP\/HCTZ","10-12.5","30","Select","Select",""],["","00093310905","AMOXICILLIN","500MG","-21","Select","Select",""],["","69097084507","CYCLOBENZAPR","5MG","90","Select","Select",""],["","43386009019","GAVILYTE-G","","4000","Select","Select",""],["","50428166363","BISACODYL","5MG EC","2","Select","Select",""],["","69842000101","BUDESONIDE","32MCG","8","Select","Select",""],["","00378064110","PREDNISONE","10MG","40","Select","Select",""],["","66993087761","CALCIPOTRIEN","0.01%","60","Select","Select",""],["","43386006019","GAVILYTE-C","","4000","Select","Select",""],["","80777027310","MODERNA","COVID-19","0","Select","Select",""],["","59651000305","OMEPRAZOLE","40MG","60","Select","Select",""],["","69097015907","MELOXICAM","15MG","30","Select","Select",""],["","65862050320","AMOX\/K","875-125","20","Select","Select",""],["","65162068090","PROMETHAZINE","DM","120","Select","Select",""],["","00074055402","HUMIRA ","40\/0.4ML","-2","Select","Select",""],["","67877032105","IBUPROFEN ","800MG","90","Select","Select",""],["","00378064110","PREDNISONE ","10MG","40","Select","Select",""],["","68180051801","LISINOP\/HCTZ ","10-12.5","30","Select","Select",""],["","69097084507","CYCLOBENZAPR ","5MG","20","Select","Select",""],["","00093720298","PRAVASTATIN ","40MG","90","Select","Select",""],["","42858010201","OXYCOD\/APAP ","5-325MG","20","Select","Select",""],["","59746000103","METHYLPRED ","4MG","21","Select","Select",""],["","69547035302","NARCAN ","","2","Select","Select",""],["","00093310905","AMOXICILLIN ","500MG","21","Select","Select",""],["","66993087761","CALCIPOTRIEN ","0.01%","60","Select","Select",""],["","50428166363","BISACODYL ","5MG EC","2","Select","Select",""],["","43386009019","GAVILYTE-G ","","4000","Select","Select",""],["","59651000305","OMEPRAZOLE ","40MG","60","Select","Select",""],["","69842000101","BUDESONIDE ","32MCG","8","Select","Select",""],["","69097015907","MELOXICAM ","15MG","30","Select","Select",""],["","80777027310","MODERNA ","COVID-19","0","Select","Select",""],["","43386006019","GAVILYTE-C ","","4000","Select","Select",""],["","65862050320","AMOX\/K ","875-125","20","Select","Select",""],["","65162068090","PROMETHAZINE ","DM","120","Select","Select",""],["","49281042150","FLUZONE","2021-22","0","Select","Select",""],["","49281042150","FLUZONE ","INJ 2021-22","0","Select","Select",""],["","58160082311","SHINGRIX ","INJ 50\/0.5ML","1","Select","Select",""],["","59267100002","PFIZER ","INJ 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":[[["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","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":""}]}]}