{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DANA   L SOURS","gend":1,"add":"1610 CLEARVIEW ROAD","city":"LURAY","state":"VA","zip":"22835-9998","dob":"1982-06-18","age":"","mstatus":"","insh":"1057617*01","cliId":"","pno":"540\/773-5566","cno":"","email":"","ename":"","eno":"","pphy":"DALE, JAMES G DO","ppno":"540\/743-2887","pcpadd":"135 MEMORIAL DRIVE","pcpcity":"LURAY","pcpstate":"VA","pcpzip":22835,"pcpcounty":"","pcpid":"","pcpname":"PAGE MEMORIAL HOSPITAL INC","plan":"OHP","program":"MEDICAID","lob":"M4","region":"NORTHERN & WINCHESTER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"540\/743-1288","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F11.20","M79.604","G89.4","M96.1","N75.0","F43.10","Z12.11","K63.5","K63.89","Z80.0","R11.2","K29.00","R10.33","F31.63","F41.1","D12.3","E53.8","R41.89","G40.109","R41.3","R52.","R06.9","R09.02","N76.4","N93.9","D72.829","E05.00","M54.2","L40.9","S82.154S","Z76.89","G47.00","Z13.220","M54.40","N39.0","R31.9","F41.9","Z20.822","Z09.","R07.9","E03.9","F31.9","J45.909","F11.23","R50.9","N90.89","B37.3","L98.9","N89.8","R10.84","E86.0","R11.0","K21.0","M25.462","L28.1","L81.0","Z87.891","Z88.5","Z88.8","Z88.0","R13.10","R14.0","H93.12","K31.89","M25.571","L02.416","R91.8","L65.9","R61.","R79.89","R06.02","R07.1","E89.0","E65.","Z91.19","N91.2","T18.128A","L03.115","F17.210","X50.0XXA","Z51.81","Z79.899","R91.1","R06.00","R06.2","K29.90","K22.8","V58.89","M76.71","X50.0XXD"],"date":["2020-05-18","2021-01-07","2021-01-07","2021-01-07","2021-02-26","2021-03-29","2021-04-29","2021-04-29","2021-04-29","2021-04-29","2021-03-15","2020-07-04","2020-07-04","2021-03-14","2021-03-14","2021-04-29","2020-09-03","2020-11-13","2020-09-03","2020-11-05","2021-03-15","2021-02-24","2021-02-24","2021-06-10","2021-03-01","2021-06-10","2021-11-04","2021-06-10","2021-06-10","2021-06-10","2021-06-10","2021-06-10","2021-06-10","2020-08-25","2021-03-09","2021-03-09","2021-03-09","2021-03-09","2021-04-23","2021-07-08","2021-11-04","2020-07-04","2020-07-04","2020-07-05","2021-03-05","2021-03-07","2021-03-07","2021-02-08","2021-02-08","2021-03-15","2021-03-15","2021-03-15","2020-01-03","2021-11-04","2020-03-09","2020-03-09","2021-02-18","2021-02-18","2021-02-18","2021-02-18","2019-12-10","2019-12-10","2019-11-25","2019-12-10","2019-04-25","2019-06-07","2019-07-01","2019-06-07","2019-06-07","2019-06-07","2019-06-10","2019-06-10","2019-07-01","2019-07-01","2019-07-01","2019-08-13","2019-05-03","2019-04-25","2019-07-19","2019-04-25","2019-05-24","2019-05-24","2019-07-19","2019-07-19","2019-07-19","2019-12-10","2019-12-10","2019-05-16","2019-05-16","2019-05-16"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}}]},{"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":[]},{"a":[]},{"a":{"indx":[false,false],"comment":["",""],"score":["",""]}},{"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":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","16714045301","QUETIAPINE","TAB 50MG","30","Select","Select",""],["","57237007810","ONDANSETRON","TAB 8MG ODT","20","Select","Select",""],["","16714008210","HYDROXYZ","TAB 25MG","90","Select","Select",""],["","67877012405","SILVER","CRE 0.01","50","Select","Select",""],["","65862085901","FAMOTIDINE","TAB 20MG","30","Select","Select",""],["","13668008630","OLANZAPINE","TAB 5MG ODT","14","Select","Select",""],["","","METHADONE","TAB 10MG","","Select","Select",""],["","58406045504","ENBREL","INJ 25\/0.5ML","2","Select","Select",""],["","00781518592","LEVOTHYROXIN","TAB 112MCG","30","Select","Select",""],["","60505024801","MIRTAZAPINE","TAB 30MG","90","Select","Select",""],["","55111014512","FLUCONAZOLE","TAB 150MG","1","Select","Select",""],["","00143314250","DOXYCYCL","CAP 100MG","14","Select","Select",""],["","65862053650","LEVOFLOXACIN","TAB 250MG","7","Select","Select",""],["","42858010250","OXYCOD\/APAP","TAB 5-325MG","16","Select","Select",""],["","16571020150","DICLOFENAC","TAB 75MG DR","20","Select","Select",""],["","68462029855","CLOTRIM\/BETA","CRE DIPROP","45","Select","Select",""],["","67877014601","TEMAZEPAM","CAP 15MG","14","Select","Select",""],["","","CLINDAMYCIN","CAP 150MG","","Select","Select",""],["","00378312501","DOXEPIN","CAP 25MG","14","Select","Select",""],["","","EUTHYROX","TAB 112MCG","","Select","Select",""],["","67877021905","CEPHALEXIN","CAP 500MG","21","Select","Select",""],["","50111033402","METRONIDAZOL","TAB 500MG","21","Select","Select",""],["","69238112001","OXAPROZIN","TAB 600MG","20","Select","Select",""],["","13668000801","ZOLPIDEM","TAB 10MG","30","Select","Select",""],["","","TRIAMCINOLON","OIN 0.005","","Select","Select",""],["","","NARCAN","SPR ","","Select","Select",""],["","","VITAMIN","CAP 50000UNT","","Select","Select",""],["","","POT  CHLORIDE","TAB 10MEQ ER","","Select","Select",""],["","29300011101","LAMOTRIGINE","TAB 25MG","60","Select","Select",""],["","23155022701","ACYCLOVIR","TAB 400MG","21","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","20","Select","Select",""],["","00093532862","JUNEL","TAB 44581","56","Select","Select",""],["","68645049254","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","Select","Select",""],["","68645053959","METFORMIN","TAB 500MG","60","Select","Select",""],["","00555901658","SPRINTEC","TAB 28 DAY","28","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""]]}},{"a":[]},{"a":[]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":[]}]},{"t":"Mini-Cog","q":[{"a":[]},{"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":"","a13":""}]}]}