{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ELIZABETH HAYNES","gend":1,"add":"7712 COPLE HWY","city":"HAGUE","state":"VA","zip":"22469-9998","dob":"1974-12-11","age":"","mstatus":"","insh":"20028935*01","cliId":"","pno":"804\/214-8713","cno":"","email":"","ename":"","eno":"","pphy":"WALKER, ANDREW F MD","ppno":"804\/493-9999","pcpadd":"18849 KINGS HGHWY","pcpcity":"MONTROSS","pcpstate":"VA","pcpzip":22520,"pcpcounty":"","pcpid":"","pcpname":"CENTRAL VIRGINIA HEALTH SERVICES INC","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F43.12","T16.1XXA","R06.02","R07.9","J02.9","L28.0","R21.","Z20.828","I10.","F41.9","F31.62","K21.9","E55.9","Z71.89","K59.00","F31.9","J45.909","M25.512","Z71.3","A08.4","M75.102","R35.0","K21.0","F31.70","J45.20","L30.9","R94.31","J02.0","R10.10","R11.2","R10.13","K60.2","R30.0","Z01.419","N89.8","B34.9","E86.0","R19.7","R53.1","R05.","J30.9"],"date":["2021-07-19","2021-03-03","2021-09-07","2020-04-23","2020-08-26","2020-08-26","2020-08-26","2020-08-26","2021-09-14","2021-09-14","2021-09-14","2021-09-14","2021-09-14","2021-09-14","2021-09-14","2021-09-14","2021-09-14","2019-04-03","2019-05-23","2019-03-19","2019-02-06","2019-05-23","2019-05-23","2019-05-23","2019-05-23","2019-05-23","2019-03-18","2019-03-23","2019-03-23","2019-03-23","2019-04-15","2019-04-25","2019-04-03","2019-02-25","2019-02-25","2019-03-18","2019-03-18","2019-03-18","2019-03-18","2019-04-03","2019-04-03"],"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":[["","00378003210","METOPROL","TAB 50MG","60","Select","Select",""],["","","STOOL","CAP 100MG","","Select","Select",""],["","","AUG","OIN 0.0005","","Select","Select",""],["","68462013701","OXCARBAZEPIN","TAB 150MG","60","Select","Select",""],["","","WAL-TUSSIN","SYP 100\/5ML","","Select","Select",""],["","60505009400","DOXAZOSIN","TAB 2MG","30","Select","Select",""],["","00781635587","MOMETASONE","SPR 50MCG","17","Select","Select",""],["","69452015120","VITAMIN","CAP 50000UNT","3","Select","Select",""],["","68462015713","ONDANSETRON","TAB 4MG ODT","30","Select","Select",""],["","00591352530","LIDOCAINE","PAD 0.05","30","Select","Select",""],["","","ANTACID","SUS ANTI-GAS","","Select","Select",""],["","","MILK","SUS 1200\/15","","Select","Select",""],["","68382018201","BUSPIRONE","TAB 15MG","30","Select","Select",""],["","","SALINE","SPR 0.0065","","Select","Select",""],["","00115201101","ORPHENADRINE","TAB 100MG ER","60","Select","Select",""],["","00172572860","FAMOTIDINE","TAB 20MG","60","Select","Select",""],["","00536118583","ALMACONE","SUS ","710","Select","Select",""],["","13668033005","TRAZODONE","TAB 50MG","30","Select","Select",""],["","68180072103","AMLODIPINE","TAB 10MG","30","Select","Select",""],["","","GUAIFENESIN","LIQ 100\/5ML","","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","00378668977","PANTOPRAZOLE","TAB 40MG","90","Select","Select",""],["","16729018317","HYDROCHLOROT","TAB 25MG","30","Select","Select",""],["","11822316450","LORATADINE","TAB 10MG","30","Select","Select",""],["","64380086107","POT  CHLORIDE","TAB 10MEQ ER","30","Select","Select",""],["","","MONTELUKAST","TAB 10MG","","Select","Select",""],["","00904671960","ACETAMINOPHE","TAB 325MG","100","Select","Select",""],["","","BUDESONIDE","SUS 32MCG","","Select","Select",""],["","11822046713","PAIN","TAB 325MG","100","Select","Select",""],["","49884068905","METOCLOPRAM","TAB 10MG","90","Select","Select",""],["","45802006436","TRIAMCINOLON","CRE 0.001","80","Select","Select",""],["","68462019005","NAPROXEN","TAB 500MG","60","Select","Select",""],["","52817033200","CYCLOBENZAPR","TAB 10MG","20","Select","Select",""],["","10135012310","ACETAMIN","TAB 325MG","360","Select","Select",""],["","45802086803","POLYETH","POW 3350 NF","510","Select","Select",""],["","54838011780","SILTUSSIN","SYP 100\/5ML","473","Select","Select",""],["","62559043130","HYDROCORTISO","CRE 0.025","30","Select","Select",""],["","00168008031","HYDROCORT","CRE 0.025","30","Select","Select",""],["","11523723403","MIRALAX","POW 3350 NF","238","Select","Select",""],["","00045049660","TYLENOL","TAB 325MG","120","Select","Select",""],["","57896062912","GERI-LANTA","SUS ","710","Select","Select",""],["","59267100001","PFIZER","INJ COVID-19","0","Select","Select",""],["","00904699860","DOCUSATE","CAP 100MG","60","Select","Select",""],["","11917015116","COMFORT","SUS ANTI-GAS","710","Select","Select",""],["","","AMOX\/K","TAB 875-125","","Select","Select",""],["","","BUT\/APAP\/CAF","TAB ","","Select","Select",""],["","","MUCUS&CHST","LIQ 100\/5ML","","Select","Select",""],["","62332025050","DOXYCYC","CAP 100MG","14","Select","Select",""],["","","PREDNISONE","TAB 20MG","","Select","Select",""],["","65862001705","AMOXICILLIN","CAP 500MG","30","Select","Select",""],["","","CEPACOL","LOZ 10-2.1MG","","Select","Select",""],["","65862001905","CEPHALEXIN","CAP 500MG","14","Select","Select",""],["","","DOK","CAP 100MG","","Select","Select",""],["","","MINTOX","SUS MINT","","Select","Select",""],["","11822039940","RA","SUS 400\/5ML","710","Select","Select",""],["","51672126901","BETAMETH","CRE 0.001","30","Select","Select",""],["","68462039710","OMEPRAZOLE","CAP 40MG","30","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","00225052848","AYR","GEL NASAL","22","Select","Select",""],["","68382031910","TRAMADOL","TAB 50MG","12","Select","Select",""],["","00713050324","ANUCORT-HC","SUP 25MG","12","Select","Select",""],["","62037099901","POT  CL MICRO","TAB 20MEQ ER","30","Select","Select",""],["","58160084252","BOOSTRIX","INJ ","0","Select","Select",""],["","54766083504","MICORT-HC","CRE 0.025","30","Select","Select",""],["","47781030301","NITROFURANTN","CAP 100MG","14","Select","Select",""],["","00713067115","KETOCONAZOLE","CRE 0.02","30","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","Select","Select",""],["","69315030230","PROCTO-MED","CRE HC 2.5%","30","Select","Select",""],["","65649041112","ANUSOL-HC","SUP 25MG","12","Select","Select",""],["","64980032430","PROCTOZONE","CRE -HC 2.5%","30","Select","Select",""],["","57237004105","PENICILLN","TAB 500MG","30","Select","Select",""],["","00406048410","APAP\/CODEINE","TAB 300-30MG","12","Select","Select",""],["","00378210001","LOPERAMIDE","CAP 2MG","30","Select","Select",""],["","70461031903","FLUCLVX","INJ 2019-20","0","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":""}]}]}