{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ALRADYAR ","gend":1,"add":"C REKNIT 4302EN EVIRD KEER","city":"ROANOKE","state":"VA","zip":"24012-5550","dob":"1968-04-11","age":"","mstatus":"","insh":"50015496","cliId":"","pno":"7904581450","cno":5409705721,"email":"","ename":"","eno":"","pphy":"KLAUS, CHRISTIAN","ppno":5402655500,"pcpadd":"6415 Peters Creek Rd, ","pcpcity":"Roanoke","pcpstate":"VA","pcpzip":240194021,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":5408557014,"add2":"                                                            ","add3":"","madd1":"2034 TINKER CREEK DRIVE NE","madd2":"                                                            ","madd3":"","mcity":"ROANOKE","mstate":"VA","mzip":"24012-5550","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G43.709","Z79.899","M54.81","G24.3","M79.7","I95.1","G89.4","F41.8","R74.8","M47.26","M62.838","M54.2","R51","T50.904A","R94.31","R09.02","F11.20","Z23","G93.40","R41.82","R79.89","R33.9","N28.1","G93.41","F10.20","F43.10","F60.3","F39","R06.02","I10","E78.5","R07.81","M79.89","Z51.81","F33.1","R49.0","N18.3","K52.9","D50.0","E55.9","R93.2","R06.83","F41.9","J96.00","M79.602","M79.601","R06.09","Z01.818","J96.11","K21.0","F33.0","F31.4","E03.8","E53.8","F99","Z86.59","E66.9","T40.3X1A","R55","K21.9","R07.89","J98.11","R91.8","R07.9","R07.82","Z74.3","J96.01","F41.0","R19.7","Z72.0","Z99.81","Y84.8","F32.9","F11.10","E03.9","G89.29","J45.909","K58.9","Z85.41","F31.9","F42.4","R00.0","N39.0","R05","Z85.89","J98.4","G47.34","R35.0","R06.00","R60.0","T78.2XXS","L03.818","J20.8","F19.20","F60.89","N76.0","M79.18","R53.1","R46.4","R03.0","Z90.710","Z12.39","Z12.31","S00.522A","N39.46","N32.81","Z13.1","M54.5","Z71.2","S89.91XA","M25.561","W01.198A","R29.898","N18.30","Z09","T50.901D","A41.9","R94.5","R10.9","E34.2","M79.603","M19.90","Z20.828","Z11.1","Z78.9","Z91.89","G92","E83.39","E87.6","F19.129","K76.89","R26.81","J20.9","R25.1","R16.0","S89.82XA","M17.12","J01.90","U07.1","G24.01","I45.10","Z80.3","J06.9","T88.7XXA","R13.10","K62.5","G47.33","K22.2","Z90.49","M25.562","W18.40XA","Z68.36","E11.22"],"date":["2019-01-24","2021-01-11","2019-01-24","2019-01-29","2020-06-10","2019-08-22","2021-01-11","2019-01-24","2019-12-20","2019-01-24","2019-01-24","2020-01-22","2019-01-29","2019-03-16","2019-11-12","2019-08-20","2019-06-21","2021-01-11","2019-06-26","2019-06-26","2019-06-27","2019-06-27","2019-06-26","2019-06-27","2020-10-12","2021-03-22","2021-03-22","2019-08-08","2020-06-17","2019-08-22","2021-01-11","2019-08-22","2020-04-09","2019-10-11","2021-05-17","2019-12-11","2020-05-27","2021-01-11","2019-12-05","2021-01-11","2019-12-20","2019-12-22","2021-05-18","2020-09-20","2020-04-09","2020-04-09","2020-04-10","2020-05-24","2021-03-12","2020-06-10","2021-03-16","2019-01-21","2019-01-24","2019-03-06","2019-06-07","2019-03-06","2020-05-27","2019-03-16","2019-03-16","2020-05-27","2019-08-28","2019-03-18","2019-03-17","2019-03-21","2019-03-21","2019-03-17","2019-09-25","2019-10-11","2020-05-27","2019-03-18","2020-12-26","2019-03-18","2020-05-27","2019-10-11","2019-06-24","2019-06-24","2020-05-27","2019-03-21","2019-03-21","2021-05-18","2019-05-09","2019-06-24","2020-10-20","2019-12-11","2019-08-28","2019-07-25","2019-08-29","2019-07-29","2019-08-23","2019-08-26","2019-09-25","2019-11-26","2020-02-17","2021-05-18","2021-05-18","2019-03-06","2019-03-13","2020-06-17","2019-03-16","2019-03-16","2019-06-07","2019-06-07","2019-06-10","2019-07-10","2019-08-27","2019-08-27","2020-06-10","2020-01-22","2020-01-22","2020-03-11","2020-03-11","2020-03-11","2020-12-08","2021-01-11","2019-07-29","2019-03-22","2019-06-24","2019-06-27","2019-06-27","2021-01-11","2020-04-09","2020-06-17","2020-12-26","2019-06-13","2019-06-13","2019-06-13","2019-06-24","2019-06-24","2019-06-24","2019-06-24","2019-06-24","2019-06-24","2019-11-07","2021-01-11","2019-12-20","2020-03-11","2020-03-11","2020-05-13","2020-12-26","2021-02-19","2019-03-17","2019-06-10","2019-11-12","2019-11-12","2020-05-27","2020-05-27","2019-12-22","2020-05-27","2020-05-27","2020-03-11","2020-03-11","2020-05-27","2020-05-27"],"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":[["","13668001005","CITALOPRAM ","TAB 20MG","30","Select","Select",""],["","69238131409","PREGABALIN ","CAP 150MG","120","Select","Select",""],["","00469260130","MYRBETRIQ ","TAB 25MG","30","Select","Select",""],["","64764075030","TRINTELLIX ","TAB 20MG","30","Select","Select",""],["","68180061407","QUETIAPINE ","TAB 200MG ER","1","Select","Select",""],["","37000045504","PRILOSEC ","TAB 20MG","60","Select","Select",""],["","29300012810","HYDROCHLOROT ","TAB 25MG","30","Select","Select",""],["","55111029136","SUMATRIPTAN ","TAB 25MG","9","Select","Select",""],["","00904615760","VITAMIN ","TAB 2000UNIT","30","Select","Select",""],["","70069000510","CYANOCOBALAM ","INJ 1000MCG","1","Select","Select",""],["","63402030430","LATUDA ","TAB 40MG","30","Select","Select",""],["","10702001150","HYDROXYZ ","TAB 25MG","90","Select","Select",""],["","00071101668","LYRICA ","CAP 150MG","120","Select","Select",""],["","68180036109","FENOFIBRATE ","TAB 145MG","30","Select","Select",""],["","51862048601","TRIMETHOPRIM ","TAB 100MG","30","Select","Select",""],["","65862007701","CIPROFLOXACN ","TAB 500MG","10","Select","Select",""],["","00093310905","AMOXICILLIN ","CAP 500MG","30","Select","Select",""],["","61874013030","VRAYLAR ","CAP 3MG","30","Select","Select",""],["","00115165903","PROPRANOLOL ","TAB 10MG","90","Select","Select",""],["","65162019050","NAPROXEN ","TAB 500MG","15","Select","Select",""],["","10702000601","CYCLOBENZAPR ","TAB 5MG","90","Select","Select",""],["","00378064110","PREDNISONE ","TAB 10MG","21","Select","Select",""],["","00093360140","BUPRENORPHINE ","10 MCG\/HR P","4","Select","Select",""],["","69547035302","NARCAN ","SPR ","2","Select","Select",""],["","57664049983","MIRTAZAPINE ","TAB 15MG","15","Select","Select",""],["","00093317431","ALBUTEROL ","FAT E HFA INH","8.5","Select","Select",""],["","68180012202","CEPHALEXIN ","CAP 500MG","20","Select","Select",""],["","16729008110","NALTREXONE ","TAB 50MG","3","Select","Select",""],["","43547040610","CLONAZEPAM ","TAB 0.5MG","30","Select","Select",""],["","50111033401","METRONIDAZOL ","TAB 500MG","14","Select","Select",""],["","16729020216","BUSPIRONE ","TAB 10MG","60","Select","Select",""],["","12496120803","SUBOXONE ","MIS 8-2MG","1","Select","Select",""],["","00143122701","DICYCLOMINE ","TAB 20MG","56","Select","Select",""],["","67877057505","BENZONATATE ","CAP 200MG","60","Select","Select",""],["","41167000891","ICY ","CRE EX ST","85","Select","Select",""],["","65862039010","ONDANSETRON ","TAB 4MG ODT","60","Select","Select",""],["","42806000501","OXYCODONE ","TAB 5MG","135","Select","Select",""],["","58160082311","SHINGRIX ","INJ 50MCG","1","Select","Select",""],["","60505025203","TIZANIDINE ","TAB 4MG","90","Select","Select",""],["","70461031903","FLUCLVX ","INJ 2019-20","0.5","Select","Select",""],["","47781030301","NITROFURANTN ","CAP 100MG","14","Select","Select",""],["","67877032005","IBUPROFEN ","TAB 600MG","20","Select","Select",""],["","59746000103","METHYLPRED ","TAB 4MG","21","Select","Select",""],["","80777027399","MODERNA ","INJ COVID-19","0.5","Select","Select",""],["","55111015810","OMEPRAZOLE ","CAP 20MG","60","Select","Select",""],["","00378110101","PRAZOSIN ","CAP 1MG","90","Select","Select",""],["","69097012315","TOPIRAMATE ","TAB 50MG","30","Select","Select",""],["","00093031401","KETOROLAC ","TAB 10MG","6","Select","Select",""],["","53489011905","DOXYCYCL ","CAP 100MG","20","Select","Select",""],["","65862050320","AMOX\/K ","TAB 875-125","14","Select","Select",""],["","00378180010","LEVOTHYROXIN ","TAB 25MCG","30","Select","Select",""],["","00228212750","CLONIDINE ","TAB 0.1MG","21","Select","Select",""],["","43386005019","GAVILYTE-N ","SOL FLAV PK","4,000.00","Select","Select",""],["","50111043403","TRAZODONE ","TAB 100MG","30","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","14","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","",""],["Yes","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":""}]}]}