{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LARRY D GATES","gend":0,"add":"209 HEAVENS LN","city":"SALTVILLE","state":"VA","zip":"24370-9998","dob":"1958-06-27","age":"","mstatus":"","insh":"20067306*01","cliId":"","pno":2762629123,"cno":2762629123,"email":"","ename":"","eno":"","pphy":"ORTIZ, VICENTE MD","ppno":2769443999,"pcpadd":"13168 MEADOWVIEW SQUARE","pcpcity":"MEADOWVIEW","pcpstate":"VA","pcpzip":"24361-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"SOUTHWEST","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":2769443882,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["D50.9","C64.2","Z87.891","Z79.899","D50.0","T81.718A","I72.1","I72.9","R91.1","N28.89","C78.01","C78.02","K76.89","I73.9","I70.213","I74.2","R53.83","R06.02","Z90.5","I48.91","Z85.528","J44.9","I10.","K76.9","NO DATA","R91.8","Z80.1","R59.0","K74.60","K25.9","K26.9","U07.1","J18.9","J44.0","J20.9","K59.01","F17.210","I50.9","I99.8","Z23.","K40.90","E78.00","R06.00"],"date":["2023-05-16","2023-05-16","2023-02-05","2022-05-31","2023-05-16","2023-03-27","2023-04-06","2023-03-27","2023-05-23","2023-05-16","2022-08-03","2022-08-03","2022-08-03","2023-03-07","2022-10-04","2022-12-22","2022-12-30","2022-12-30","2023-01-13","2023-03-07","2022-09-15","2023-02-05","2023-03-07","2022-09-15","2023-03-07","2022-05-10","2022-05-10","2022-08-02","2022-08-02","2022-08-02","2022-08-02","2023-02-05","2023-02-05","2022-09-08","2022-09-08","2022-09-08","2022-11-21","2023-04-28","2022-10-12","2022-10-12","2023-05-16","2023-03-07","2023-02-05"],"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":[["","00904759180","FEROSUL","325(65) MG","90","Select","Select",""],["","59762040105","SUCRALFATE","1 G","120","Select","Select",""],["","00173088710","TRELEGY","AER 100MCG","60","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","31722071310","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","69315011710","FUROSEMIDE","40 MG","60","Select","Select",""],["","00173069500","ADVAIR DISKU","AER 100\/50","60","Select","Select",""],["","50742025290","DILTIAZEM","24HR ER (CD) 360 MG","30","Select","Select",""],["","00832532510","POT CL MICRO","TAB 20MEQ ER","60","Select","Select",""],["","00093083201","CLONAZEPAM","0.5 MG","63","Select","Select",""],["","27241009706","DULOXETINE","CAP 20MG","60","Select","Select",""],["","68180096301","ALBUTEROL","AER HFA","8","Select","Select",""],["","57237010099","METOPROL TAR","TAB 25MG","60","Select","Select",""],["","00186037020","SYMBICORT","AER 160-4.5","10","Select","Select",""],["","00406012310","HYDROCO\/APAP","TAB 5-325MG","14","Select","Select",""],["","16729004517","ATORVASTATIN","TAB 20MG","30","Select","Select",""],["","33342006015","CLOPIDOGREL","TAB 75MG","30","Select","Select",""],["","68382024705","BENZONATATE","100 MG","15","Select","Select",""],["","63868034718","QC NATURAL","POW VEGETABL","368","Select","Select",""],["","72205000499","ROSUVASTATIN","TAB 20MG","30","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","00143980305","DOXYCYCL HYC","CAP 100MG","20","Select","Select",""],["","70010013510","POT CHLORIDE","TAB 20MEQ ER","60","Select","Select",""],["","00003089421","ELIQUIS","5 MG","60","Select","Select",""],["","00173088710","TRELEGY ELLIPTA","100-62.5","60","Select","Select",""],["","72888000400","METOPROLOL TARTRATE","25 MG","60","Select","Select",""],["","31722071310","PANTOPRAZOLE SODIUM","40 MG","30","Select","Select",""],["","00378827052","ALBUTEROL SULFATE","2.5 MG\/3ML","75","Select","Select",""],["","27241009706","DULOXETINE HCL","20 MG","60","Select","Select",""],["","58657050508","GUAIFENESIN-DEXTROMETHORPHAN","100-10MG\/5","237","Select","Select",""],["","31722088490","ROSUVASTATIN CALCIUM","20 MG","30","Select","Select",""],["","70010013510","POTASSIUM CHLORIDE","20 MEQ","60","Select","Select",""],["","51224002230","AZITHROMYCIN","250 MG","4","Select","Select",""],["","68180096301","ALBUTEROL SULFATE HFA","90 MCG","8.5","Select","Select",""],["","64380078408","PREDNISONE","10 MG","30","Select","Select",""],["","00113057826","TUSSIN DM","100-10MG\/5","118","Select","Select",""],["","42571016201","AMOXICILLIN-CLAVULANATE POTASS","875-125 MG","14","Select","Select",""],["","59746000103","METHYLPREDNISOLONE","4 MG","21","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":""}]}]}