{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"R YCART NOSLIW ","gend":1,"add":"SORLEM 8303WN EUNEVA E","city":"ROANOKE","state":"VA","zip":"24017-5925","dob":"1982-06-13","age":"","mstatus":"","insh":"21019414","cliId":"","pno":",78647950452498014517 ","cno":5405974687,"email":"","ename":"","eno":"","pphy":"NAZLI, AYESHA","ppno":"               ","pcpadd":"3716 Melrose Ave NW, ","pcpcity":"Roanoke","pcpstate":"VA","pcpzip":240172716,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP - VIRGINIA PREMIER","program":"MEDICAID","lob":"MLTSS","region":"ROANOKE","aligned":"","ano":"","add2":"APT 514","add3":"","madd1":"3038 MELROSE AVENUE NW","madd2":"APT 514","madd3":"","mcity":"ROANOKE","mstate":"VA","mzip":"24017-5925","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["L02.512","L08.9","G92","S66.101A","M00.9","E87.6","F19.10","F11.10","F15.10","M79.645","M25.562","M25.511","F11.20","F15.20","G93.49","A74.9","A41.9","M00.862","M65.842","N89.8","R00.0","R07.9","F14.90","Z86.59","E16.2","R59.0","J32.9","M79.89","R60.9","M00.869","M65.9","T50.904A","T65.91XA","A41.02","L03.211","L02.416","D72.829","M65.042","M67.844","T40.1X1A","F41.9","J45.909","F17.200","R41.82","L01.00","L02.01","L02.31","K58.9","M06.9","N80.9","B19.20","R53.1","L03.114","F15.929","G93.40","M25.512","R74.8","M79.605","M65.00","F14.10","F41.8","R07.89","F31.9","Z86.19","M25.462","R10.9","M79.601","R68.89","Z51.81","F63.3","F98.8","T50.901A","I49.8","Z72.0","F14.20","F15.229","I10","F43.10","F25.9","R45.1","M79.642","M25.561","F17.210","F10.10","R40.0","I45.81","R94.31","Y92.9","R53.83","F42.4"],"date":["2020-03-06","2020-02-26","2020-03-06","2020-02-23","2020-03-06","2020-04-29","2021-04-02","2020-02-23","2020-02-26","2020-02-19","2020-03-01","2020-02-19","2021-03-24","2020-02-26","2020-02-26","2020-03-06","2020-03-06","2020-02-26","2020-02-26","2020-03-02","2020-03-03","2020-04-29","2020-03-23","2021-01-25","2020-07-28","2019-08-04","2019-08-04","2020-02-26","2019-08-04","2020-02-07","2020-02-26","2020-04-02","2020-04-02","2019-08-11","2019-08-11","2019-08-11","2019-08-11","2020-02-26","2020-02-24","2020-04-29","2021-01-24","2021-04-02","2021-04-02","2020-04-29","2019-08-04","2019-08-04","2019-08-06","2019-08-04","2019-08-04","2019-08-04","2019-08-04","2020-02-06","2020-02-13","2020-02-10","2020-02-10","2020-02-10","2020-02-10","2020-02-10","2020-02-24","2020-02-26","2020-07-30","2020-04-29","2020-04-29","2020-04-29","2020-02-18","2020-03-01","2020-03-04","2020-03-06","2020-07-30","2021-04-02","2021-04-02","2020-04-29","2019-06-28","2019-08-10","2020-02-06","2020-02-06","2020-02-18","2020-02-06","2020-02-06","2020-02-06","2020-02-06","2021-04-02","2020-08-01","2020-02-18","2020-02-26","2020-04-29","2020-04-29","2020-04-02","2021-04-02","2021-04-02"],"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":[["","00781185220","AMOX\/K ","TAB 875-125","16","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","16","Select","Select",""],["","43547034106","RISPERIDONE ","TAB 1MG","10","Select","Select",""],["","12496120203","SUBOXONE ","MIS 2-0.5MG","6","Select","Select",""],["","16729020301","BUSPIRONE ","TAB 15MG","60","Select","Select",""],["","68382003416","VENLAFAXINE ","CAP 37.5 ER","30","Select","Select",""],["","69547035302","NARCAN ","SPR ","2","Select","Select",""],["","14539067401","HYDROXYZ ","CAP 25MG","7","Select","Select",""],["","59779076926","LICE ","LIQ 0.01","59","Select","Select",""],["","69097052444","DICLOFENAC ","GEL 0.01","100","Select","Select",""],["","00536589588","NICOTINE ","DIS 14MG\/24H","14","Select","Select",""],["","65162010350","GABAPENTIN ","CAP 400MG","90","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":[[["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["No","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":""}]}]}