{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MARGARET   R OULDS","gend":1,"add":"816 CHURCH ST","city":"BLACKSTONE","state":"VA","zip":"23824-9998","dob":"1966-08-31","age":"","mstatus":"","insh":"20032958*01","cliId":"","pno":"434\/294-3170","cno":"","email":"","ename":"","eno":"","pphy":"EGGLESTON III, WILLIAM MD","ppno":"434\/292-7261","pcpadd":"213 NORTH MAIN ST","pcpcity":"BLACKSTONE","pcpstate":"VA","pcpzip":23824,"pcpcounty":"","pcpid":"","pcpname":"BLACKSTONE FAMILY PRACTICE CENTER","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/292-7965","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N39.46","I10.","R32.","D57.3","M25.561","J45.20","E55.9","M54.5","H44.001","R25.2","J45.40","Z68.28","M79.641","E78.00","Z68.27","M79.674","R41.840","S86.911A","M18.11","G56.01","J45.21","J40.","M77.8","R20.0","R20.2","F33.0","Z12.4","Z12.11","Z12.31","Z12.12","H53.8","H53.9","G43.811","G43.109","Z79.899","F32.1","R05.","R50.9","F41.9","F51.01","G56.03","R19.5","J45.909","M17.11","M25.50","G47.62","G43.709","M79.671","Z11.59"],"date":["2021-03-19","2021-12-01","2021-12-01","2021-12-01","2020-06-02","2020-05-14","2021-08-30","2021-03-01","2021-08-30","2021-08-30","2021-08-30","2021-10-04","2019-12-03","2019-12-05","2020-06-02","2021-06-25","2021-10-04","2019-04-10","2019-12-03","2019-12-03","2020-03-04","2020-03-04","2019-08-28","2019-08-28","2019-08-28","2019-10-30","2019-01-10","2020-12-03","2019-08-13","2019-01-10","2019-02-07","2019-02-07","2019-03-20","2019-03-20","2019-08-13","2019-10-07","2020-02-19","2020-02-04","2020-04-20","2020-04-20","2020-10-06","2020-12-03","2020-03-13","2021-06-25","2020-02-19","2020-02-19","2020-02-19","2021-06-25","2021-06-25"],"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":[["","","AMLODIPINE"," AMLODIPINE ","30","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","Select","Select",""],["","59267100001","PFIZER","INJ COVID-19","0","Select","Select",""],["","","VITAMIN"," VITAMIN ","4","Select","Select",""],["","","QVAR"," QVAR ","11","Select","Select",""],["","","AMITRIPTYLIN"," AMITRIPTYLIN ","30","Select","Select",""],["","","MONTELUKAST"," MONTELUKAST ","30","Select","Select",""],["","","MELOXICAM","TAB 15MG","","Select","Select",""],["","","ALBUTEROL"," ALBUTEROL ","8","Select","Select",""],["","","COMBIVENT","AER 20-100","","Select","Select",""],["","52817033200","CYCLOBENZAPR","TAB 10MG","60","Select","Select",""],["","","CITALOPRAM"," CITALOPRAM ","30","Select","Select",""],["","42571016242","AMOX\/K","TAB 875-125","20","Select","Select",""],["","60758018805","GENTAMICIN","SOL 0.3% OP","5","Select","Select",""],["","","PREDNISONE"," PREDNISONE ","10","Select","Select",""],["","65162062750","TRAMADOL","TAB 50MG","21","Select","Select",""],["","","ROPINIROLE"," ROPINIROLE ","30","Select","Select",""],["","","DICLOFENAC","GEL 0.01","","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","42806001101","SULINDAC","TAB 200MG","23","Select","Select",""],["","","LIDOCAINE","PAD 0.05","","Select","Select",""],["","","BENZONATATE","CAP 100MG","","Select","Select",""],["","","D3","CAP 25MCG","","Select","Select",""],["","","PROMETHAZINE","SYP DM","","Select","Select",""],["","","PROVENTIL","AER HFA","","Select","Select",""],["","","PEG-3350","SOL ELECTROL","","Select","Select",""],["","","KETOROLAC","TAB 10MG","","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":""}]}]}