{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"WILLIAM   W PERRIN","gend":0,"add":"21304 DELMAR ROAD","city":"DAMASCUS","state":"VA","zip":"24236-9998","dob":"1974-01-31","age":"","mstatus":"","insh":"20058467*01","cliId":"","pno":"276\/274-9585","cno":"276\/274-9585","email":"","ename":"","eno":"","pphy":"JESSEE, BRENDA T NP","ppno":"423\/968-6650","pcpadd":"350 BLOUNTVILLE HWY STE 205","pcpcity":"BRISTOL","pcpstate":"TN","pcpzip":37620,"pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"SOUTHWEST","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"423\/968-6690","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K86.1","E11.65","F31.81","R07.81","R11.0","Z23.","E10.65","E10.649","Z71.2","G89.29","M25.561","M25.562","F12.90","K86.0","H61.22","R10.13","E10.9","E10.69","E11.649","Z79.4","K76.6","N28.9","E78.2","R07.9","F17.200","I10.","R73.03","F10.10","Z79.899","D64.9","K85.90","Z00.00"],"date":["2022-06-17","2020-08-04","2022-11-08","2020-11-09","2020-11-09","2020-11-09","2022-06-10","2022-11-17","2022-03-18","2022-06-17","2020-04-15","2020-04-15","2020-04-15","2020-04-15","2020-02-13","2021-12-28","2022-09-14","2021-02-26","2021-02-26","2021-02-26","2021-11-17","2021-04-01","2022-11-17","2021-05-10","2021-05-10","2022-11-17","2020-05-21","2022-06-17","2020-08-04","2021-06-07","2021-12-14","2022-06-17"],"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":[]},{"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":[["","60760040130","NORTRIPTYLIN","CAP 50MG","30","Select","Select",""],["","16714070301","LAMOTRIGINE","TAB 200MG","30","Select","Select",""],["","69315012710","FOLIC","TAB 1000MCG","30","Select","Select",""],["","80681004001","MELATONIN","TAB 5MG","60","Select","Select",""],["","69097094307","GABAPENTIN","CAP 300MG","270","Select","Select",""],["","00185067401","HYDROXYZ","CAP 25MG","60","Select","Select",""],["","00603548321","PROPRANOLOL","TAB 20MG","60","Select","Select",""],["","00024586903","TOUJEO","INJ 300IU\/ML","4","Select","Select",""],["","53885024510","ONETOUCH","TES ULTRA","400","Select","Select",""],["","16729016901","ESCITALOPRAM","TAB 10MG","30","Select","Select",""],["","00023611401","ZENPEP","CAP 40000","90","Select","Select",""],["","00169750111","NOVOLOG","INJ 100\/ML","30","Select","Select",""],["","68645049154","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","40985022713","MAGNESIUM","TAB 250MG","60","Select","Select",""],["","53885004401","ONE","KIT VERIO FL","1","Select","Select",""],["","78742025771","MM","MIS DEVICE","1","Select","Select",""],["","59762040101","SUCRALFATE","TAB 1GM","60","Select","Select",""],["","16714098901","ROSUVASTATIN","TAB 10MG","90","Select","Select",""],["","43547035110","LISINOPRIL","TAB 2.5MG","90","Select","Select",""],["","00169266015","TRESIBA","INJ 100UNIT","15","Select","Select",""],["","00169368712","LEVEMIR","INJ ","10","Select","Select",""],["","68382035316","BUPROPN","TAB 150MG XL","30","Select","Select",""],["","00169185389","NOVOTWIST","MIS 32GX5MM","100","Select","Select",""],["","00088221905","LANTUS","INJ 100\/ML","15","Select","Select",""],["","00548585000","GLUCAGON","KIT 1MG","1","Select","Select",""],["","68382003416","VENLAFAXINE","CAP 37.5 ER","30","Select","Select",""],["","33342006807","OLANZAPINE","TAB 5MG","60","Select","Select",""],["","56151173101","INSULIN","MIS 0.3\/31G","100","Select","Select",""],["","68382004101","PROMETHAZINE","TAB 25MG","30","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":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"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":""}]}]}