{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SUSAN   A SAVILLE","gend":1,"add":"4665 JACKSON RIVER RD RM 28","city":"COVINGTON","state":"VA","zip":"24426-9998","dob":"1958-09-22","age":"","mstatus":"","insh":"20034569*01","cliId":"","pno":"540\/958-8409","cno":"","email":"","ename":"","eno":"","pphy":"MONROE, JULIE DO","ppno":"540\/962-1122","pcpadd":"322 W RIVERSIDE ST","pcpcity":"COVINGTON","pcpstate":"VA","pcpzip":24426,"pcpcounty":"","pcpid":"","pcpname":"BATH COUNTY COMMUNITY HOSPITAL","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"ROANOKE ALLEGHANY","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"540\/839-4831","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G47.33","I10.","J44.9","F17.200","F41.9","F32.9","E11.9","E78.5","M79.672","Z01.419","Z00.00","F31.9","R41.9","F41.8","R73.01","F17.210","F41.1","F31.70","Z72.0","Z12.11","I71.4","Z68.41","S92.514A","J44.1","R30.0","R30.9","S92.354A","X50.1XXA","G47.36","Z87.820","Z23.","R91.1","K21.9","F17.219","Z09.","M54.32","M54.31","M54.16","J30.0","Z87.891","R94.6","S61.211A","W26.9XXA"],"date":["2020-05-28","2022-09-16","2022-09-16","2020-12-03","2020-05-28","2020-05-28","2022-09-16","2022-02-23","2021-12-20","2021-05-05","2021-05-05","2022-10-18","2021-05-05","2022-09-16","2021-08-17","2021-08-17","2020-04-08","2020-04-08","2021-08-26","2021-06-16","2021-12-09","2021-12-09","2020-06-03","2022-10-18","2021-03-24","2021-03-24","2020-05-31","2020-05-31","2020-12-10","2020-12-10","2022-10-18","2021-02-05","2021-02-05","2021-02-05","2021-02-05","2021-02-23","2021-02-23","2022-08-01","2022-05-23","2022-09-16","2022-09-16","2022-01-15","2022-01-15"],"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":[["","00597007541","SPIRIVA","CAP HANDIHLR","90","Select","Select",""],["","13668042990","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","16729028210","ARIPIPRAZOLE","TAB 20MG","30","Select","Select",""],["","16729020001","BUSPIRONE","TAB 5MG","90","Select","Select",""],["","69097014260","ALBUTEROL","AER HFA","7","Select","Select",""],["","31722055190","LEVOCETIRIZI","TAB 5MG","30","Select","Select",""],["","65862005299","SIMVASTATIN","TAB 20MG","30","Select","Select",""],["","00310737020","BUDES\/FORMOT","AER 160-4.5","10","Select","Select",""],["","65862057490","MONTELUKAST","TAB 10MG","30","Select","Select",""],["","59746036290","VALSARTAN","TAB 160MG","90","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","00186037020","SYMBICORT","AER 160-4.5","10","Select","Select",""],["","69097015907","MELOXICAM","TAB 15MG","30","Select","Select",""],["","70436001304","DESVENLAFAX","TAB 100MG ER","30","Select","Select",""],["","00603533815","PREDNISONE","PAK 10MG","21","Select","Select",""],["","68180016013","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","29300016915","TIZANIDINE","TAB 4MG","30","Select","Select",""],["","00603459315","METHYLPRED","TAB 4MG","21","Select","Select",""],["","00378967130","IPRATROPIUM\/","SOL ALBUTER","360","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","18","Select","Select",""],["","50428027709","CVS","LOZ 2MG","168","Select","Select",""],["","69097012403","TOPIRAMATE","TAB 100MG","30","Select","Select",""],["","50111033401","METRONIDAZOL","TAB 500MG","21","Select","Select",""],["","69097084507","CYCLOBENZAPR","TAB 5MG","30","Select","Select",""],["","00085113204","PROVENTIL","AER HFA","7","Select","Select",""],["","65862007701","CIPROFLOXACN","TAB 500MG","14","Select","Select",""],["","51991081403","AZELASTINE","SPR 0.001","30","Select","Select",""],["","43199001301","HYOSCYAMINE","TAB 0.125MG","20","Select","Select",""],["","49281042150","FLUZONE","INJ 2021-22","0","Select","Select",""],["","68180071160","CEFDINIR","CAP 300MG","20","Select","Select",""],["","80777027399","MODERNA","INJ COVID-19","0","Select","Select",""],["","13107015790","PAROXETINE","TAB 40MG","30","Select","Select",""],["","00597002402","COMBIVENT","AER 20-100","4","Select","Select",""],["","00173069600","ADVAIR","AER 250\/50","60","Select","Select",""],["","00378020810","FUROSEMIDE","TAB 20MG","30","Select","Select",""],["","00591024110","LORAZEPAM","TAB 1MG","60","Select","Select",""],["","00069046956","CHANTIX","TAB 1MG","60","Select","Select",""],["","10370010150","BUPROPN","TAB 150MG XL","30","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","28","Select","Select",""],["","16571020210","DICLOFENAC","TAB 50MG DR","10","Select","Select",""],["","58160082311","SHINGRIX","INJ 50\/0.5ML","1","Select","Select",""],["","58160084252","BOOSTRIX","INJ ","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":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"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":""}]}]}