{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   ADNAMANROCLA B","gend":1,"add":" HCOITNA 151TEERTS TRUHC","city":"RIDGEWAY","state":"VA","zip":"24148-1108","dob":"1988-12-05","age":"","mstatus":"","insh":"0128004","cliId":"","pno":"3767232192","cno":2768354147,"email":"","ename":"","eno":"","pphy":"FAVERO, JOHN P","ppno":2766387205,"pcpadd":"2696 Greensboro Rd, ","pcpcity":"Martinsville","pcpstate":"VA","pcpzip":241128106,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":2768354147,"add2":"                                                            ","add3":"","madd1":"151 ANTIOCH CHURT STREET","madd2":"                                                            ","madd3":"","mcity":"RIDGEWAY","mstate":"VA","mzip":"24148-1108","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z34.82","I26.99","I16.0","N39.0","O88.23","O86.20","O14.95","O13.5","O24.439","O99.215","E66.01","Z79.899","Z91.040","Z82.49","I95.9","R55","O90.89","N93.9","I10","O15.2","R10.9","R51","R42","R07.9","R09.89","D64.9","R06.02","O11.5","O72.1","O10.93","F06.8","N93.8","Z34.81","R58","R23.1","O9A.23","O72.2","Y92.019","T45.511A","I73.00","O99.43","O24.430","D62","O90.81","Z87.891","R14.1","O99.89","Z32.02","Z86.711","Z98.890","E78.2","K21.9","R53.83","O10.412","Z13.79","O36.8130","O24.425","O13.4","O40.3XX0","O34.211","Z3A.37","Z37.0","O34.219","R07.2","I16.1","R60.9","Z75.1","Z34.83","Z13.1","Z11.3","R07.89","O10.03","Z76.0","O13.9","F53.0","J02.9","H92.02","E86.0","Z33.1","O99.511","Z3A.12","Z3A.13","Z3A.38","R93.89","Z79.02","I95.2","F41.8","Z3A.21","O44.22","Z3A.33","O24.410","R07.82","R07.1","R03.0","Z3A.28","O62.8","Z3A.00","Z3A.35","O13.3","I26.93","R06.00","O99.03"],"date":["2019-09-16","2020-01-24","2019-12-05","2019-12-05","2019-12-14","2019-12-02","2019-12-07","2019-12-02","2019-12-02","2019-12-02","2019-12-07","2019-12-14","2020-01-23","2019-12-02","2019-12-07","2019-12-07","2019-12-17","2019-12-17","2020-01-24","2019-07-11","2019-12-09","2019-12-07","2019-12-07","2020-01-23","2019-12-14","2019-12-14","2019-12-14","2019-12-16","2019-12-16","2019-12-16","2019-12-16","2019-12-17","2019-05-29","2019-12-07","2019-12-07","2019-12-08","2019-12-08","2019-12-08","2019-12-08","2019-12-08","2019-12-08","2019-12-08","2019-12-08","2019-12-08","2019-12-11","2019-12-08","2019-12-09","2020-01-23","2020-01-24","2020-01-23","2020-01-24","2020-01-24","2020-01-24","2019-09-16","2019-07-08","2019-10-31","2019-11-24","2019-11-24","2019-11-24","2019-11-25","2019-11-24","2019-11-25","2019-11-25","2020-01-23","2019-12-02","2019-12-03","2019-12-07","2019-10-17","2019-10-17","2019-10-17","2019-12-11","2019-12-10","2020-01-24","2020-01-24","2020-01-24","2019-05-20","2019-05-20","2019-05-20","2019-05-20","2019-05-20","2019-05-20","2019-05-29","2019-11-25","2019-12-07","2019-12-07","2019-12-07","2019-12-26","2019-07-29","2019-07-29","2019-10-21","2019-10-31","2019-11-28","2019-11-28","2019-11-28","2019-09-16","2019-10-31","2019-10-31","2019-10-31","2019-11-18","2019-12-02","2019-12-02","2019-12-14"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}},{"a":[]}]},{"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":[]}]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","65862037501","ESCITALOPRAM ","TAB 20MG","90","Select","Select",""],["","52817033010","CYCLOBENZAPR ","TAB 5MG","30","Select","Select",""],["","68462016305","CARVEDILOL ","TAB 6.25MG","180","Select","Select",""],["","67877019810","AMLODIPINE ","TAB 5MG","30","Select","Select",""],["","68180098103","LISINOPRIL ","TAB 20MG","60","Select","Select",""],["","47781055201","LABETALOL ","TAB 100MG","60","Select","Select",""],["","00093834301","GLYBURIDE ","TAB 2.5MG","30","Select","Select",""],["","65862018601","CLINDAMYCIN ","CAP 300MG","40","Select","Select",""],["","00093317431","ALBUTEROL ","FAT E","8.5","Select","Select",""],["","68382050010","OMEPRAZOLE ","CAP 40MG","30","Select","Select",""],["","65862001305","SERTRALINE ","TAB 100MG","30","Select","Select",""],["","42806071401","BENZONATATE ","CAP 100MG","15","Select","Select",""],["","70954005940","PREDNISONE ","PAK 10MG","48","Select","Select",""],["","00003089421","ELIQUIS ","TAB 5MG","60","Select","Select",""],["","00904759080","FEROSUL ","TAB 325MG","90","Select","Select",""],["","00781808926","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","67877031901","IBUPROFEN ","TAB 400MG","30","Select","Select",""],["","11534016503","FOLIC ","TAB 1MG","30","Select","Select",""],["","00093005301","BUSPIRONE ","TAB 5MG","60","Select","Select",""],["","29300013510","CLONIDINE ","TAB 0.1MG","30","Select","Select",""],["","45802086803","POLYETH ","POW 3350 NF","510","Select","Select",""],["","31722052101","HYDRALAZINE ","TAB 50MG","60","Select","Select",""],["","60505079604","ENOXAPARIN ","INJ 120\/0.8","48","Select","Select",""],["","47781030301","NITROFURANTN ","CAP 100MG","6","Select","Select",""],["","00172392670","DIAZEPAM ","TAB 5MG","4","Select","Select",""],["","42858010201","OXYCOD\/APAP ","TAB 5-325MG","25","Select","Select",""],["","16571020210","DICLOFENAC ","50MG DR","30","Select","Select",""]]}},{"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":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[[["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""]]]},{"t":"Mini-Cog","q":[{"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":""}]}]}