{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ANGELA CORDLE","gend":1,"add":"PO BOX 447","city":"DORAN","state":"VA","zip":"24612-9998","dob":"1972-09-22","age":"","mstatus":"","insh":"20046694*01","cliId":"","pno":"276\/701-5593","cno":"","email":"","ename":"","eno":"","pphy":"HARMAN, NICHOLAS DO","ppno":"276\/889-3700","pcpadd":"495 EAST MAIN ST","pcpcity":"LEBANON","pcpstate":"VA","pcpzip":"24266","pcpcounty":"","pcpid":"","pcpname":"HOLSTON MEDICAL GROUP PC","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"SOUTHWEST","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"276\/889-5505","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K92.1","K74.60","K64.1","K57.30","D64.9","K62.5","R18.8","N17.9","D69.6","R14.0","R10.84","R60.1","N93.9","N83.202","R06.02","R19.07","R10.31","R11.2","K74.69","K22.8","Z01.818","J32.0","I10.","M54.9","J01.90","E55.9","E61.2","R56.9","Z20.822","J02.9","R09.81","R51.9","T83.511A","I82.612","N39.0","K75.81","I85.01","Z86.19","D10.1","J01.81","K56.7","D61.818","D68.4","E44.0","E87.1","Z68.42","I85.10","B18.2","D63.8","D69.59","K72.10","D69.1","G89.29","R10.13","K92.2","I85.00","I86.4","K31.89","D62.","N30.00","R11.0","K72.90","G40.909","R71.0","D68.9","N83.9","D53.9","D72.819","J44.9","Z01.810","R33.9","E72.20","G43.909","R53.1","A41.9","L03.311","Z68.41","K76.6","R73.9","E66.01","K31.84","K76.7","N83.209","Z90.710","R51.","Z00.00","R11.10","D12.3","F19.10","K81.0","K85.90","K29.80","K29.71","K70.31","K29.81","Z68.43","Z88.8","F43.22","E87.8","R19.5","R60.0","J06.9","R05.","R79.1","F31.89","E86.0","E87.6","E83.42","Z11.59","N83.8","R07.9","I95.9","I49.8","K65.2","Z76.82","Z79.51","Z79.899","R07.2","R10.9","F31.9","K14.0","K72.00","I07.1","Z29.9","L03.90","T83.518A","K64.9","Z86.59","M79.89","M79.662","G93.40","K92.0","E43.","R16.1","I36.1","N64.4","R17.","N20.0","Z82.49","Z85.42","Z88.5","Z88.6","Z91.041","Z01.419","Z12.72","Z87.42","I49.3","J31.0","R09.82","R00.0","R94.31"],"date":["2021-10-27","2021-11-30","2021-10-27","2021-10-27","2021-11-16","2021-10-28","2021-11-30","2021-10-28","2021-11-04","2021-11-30","2021-11-30","2021-11-01","2021-11-16","2021-11-16","2021-10-16","2021-10-16","2021-11-15","2021-11-15","2021-11-15","2020-02-21","2020-03-20","2021-01-20","2021-11-30","2021-02-01","2020-10-08","2020-10-08","2020-10-08","2021-11-30","2021-11-15","2021-01-18","2021-01-18","2021-02-10","2021-03-13","2021-03-12","2021-11-16","2021-11-30","2021-03-15","2021-11-30","2021-07-14","2021-07-14","2021-10-04","2021-11-16","2021-11-15","2021-08-07","2021-08-07","2021-10-16","2021-10-16","2021-11-01","2021-11-15","2021-10-16","2021-11-01","2021-08-07","2021-08-07","2021-08-13","2021-10-10","2021-10-05","2021-10-05","2021-10-16","2021-10-05","2021-10-18","2021-11-11","2021-11-16","2021-11-15","2020-07-16","2021-11-16","2020-07-16","2020-07-16","2020-07-16","2021-11-30","2020-11-02","2020-11-27","2021-02-12","2021-11-15","2021-02-12","2021-02-27","2021-11-01","2021-02-27","2021-11-16","2021-02-27","2021-11-01","2021-02-27","2021-11-16","2021-11-15","2021-11-30","2020-01-06","2020-03-19","2020-07-15","2020-08-06","2021-01-26","2021-02-11","2021-06-24","2021-02-12","2021-02-11","2021-02-11","2021-02-12","2021-11-01","2021-11-30","2021-02-12","2021-02-12","2021-03-13","2021-10-26","2020-03-24","2020-03-24","2020-03-24","2020-04-06","2020-07-15","2020-07-15","2020-07-15","2020-07-15","2020-07-30","2021-06-21","2021-02-01","2021-02-11","2021-11-16","2020-02-21","2020-02-21","2021-11-30","2021-02-01","2021-06-09","2021-06-09","2021-06-09","2021-10-04","2021-10-26","2020-03-24","2021-02-01","2021-03-06","2021-03-06","2021-03-06","2021-03-29","2021-07-02","2021-10-04","2021-10-04","2021-10-16","2020-03-20","2021-03-15","2021-11-01","2021-11-15","2021-11-30","2021-11-30","2021-11-30","2021-11-30","2021-11-30","2021-11-30","2020-02-13","2020-02-13","2020-02-13","2020-03-20","2021-01-20","2021-01-20","2021-02-28","2021-02-28"],"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":[["","65162070684","AZELASTINE","SPR 0.0015","30","Select","Select",""],["","75826011510","PHENAZOPYRID","TAB 200MG","10","Select","Select",""],["","00121087316","LACTULOSE","SOL 10GM\/15","473","Select","Select",""],["","43547040211","FUROSEMIDE","TAB 40MG","180","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","63304069301","CLINDAMYCIN","CAP 300MG","40","Select","Select",""],["","53746051401","SPIRONOLACT","TAB 50MG","45","Select","Select",""],["","00131247835","VIMPAT","TAB 100MG","60","Select","Select",""],["","65862052405","GABAPENTIN","TAB 800MG","270","Select","Select",""],["","00093221001","SUCRALFATE","TAB 1GM","360","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","65649030302","XIFAXAN","TAB 550MG","28","Select","Select",""],["","68180071160","CEFDINIR","CAP 300MG","20","Select","Select",""],["","65862069201","PHENYTOIN","CAP 100MG","270","Select","Select",""],["","76385011150","CARVEDILOL","TAB 6.25MG","90","Select","Select",""],["","13668000905","CITALOPRAM","TAB 10MG","30","Select","Select",""],["","65862050320","AMOX\/K","TAB 875-125","20","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","28","Select","Select",""],["","0",""," ","260","Select","Select",""],["","10702001801","OXYCODONE","TAB 5MG","12","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","00603533715","PREDNISONE","PAK 5MG","21","Select","Select",""],["","23155022901","ACYCLOVIR","CAP 200MG","200","Select","Select",""],["","51672126705","TRIAMCINOLON","PST DEN 0.1%","5","Select","Select",""],["","00115165903","PROPRANOLOL","TAB 10MG","270","Select","Select",""],["","59779066916","HEMORRHOIDAL","OIN CVS","57","Select","Select",""],["","00143992801","CIPROFLOXACN","TAB 500MG","14","Select","Select",""],["","69097014260","ALBUTEROL","AER HFA","7","Select","Select",""],["","43547030203","ARIPIPRAZOLE","TAB 2MG","30","Select","Select",""],["","57237001401","TAMSULOSIN","CAP 0.4MG","90","Select","Select",""],["","62175061743","PANTOPRAZOLE","TAB 40MG","60","Select","Select",""],["","65162052110","PROMETHAZINE","TAB 25MG","40","Select","Select",""],["","60432053760","NYSTATIN","SUS 100000","60","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":""}]}]}