{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   NYLORACDROFNUD J","gend":1,"add":"                DR DROFNUD 217                              ","city":"MAX MEADOWS                   ","state":"VA","zip":"24360-3681","dob":"1961-08-24","age":"","mstatus":"","insh":"50016345","cliId":"","pno":"6267260806","cno":2766205098,"email":"","ename":"","eno":"","pphy":"BOWSER, ERIN M                                              ","ppno":"","pcpadd":"791 Fort Chiswell Rd","pcpcity":"Max Meadows                   ","pcpstate":"VA","pcpzip":243604139,"pcpcounty":"","pcpid":"P0060082","pcpname":"FORT CHISWELL MEDICAL CENTER","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"712 DUNFORD RD                                              ","madd2":"                                                            ","madd3":"","mcity":"MAX MEADOWS                   ","mstate":"VA","mzip":"24360-3681","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R10.11","R11.0","Z85.3","Z79.899","Z00.00","Z01.419","L60.0","M79.671","M25.571","B00.1","M77.31","M79.89","M79.661","M79.675","M65.871","R92.1","L90.5","L03.031","C50.919","C50.112","Z17.0","M51.36","M47.816","M54.5","Z79.82","Z88.5","M51.26","M51.37","M47.817","Q76.49","J06.9","R05","C50.912","M41.9","F41.8","M25.50","K21.9","Z23","N60.31","N64.89","M79.672","R20.2","G60.9","M51.16","R26.81","M51.17","M54.16","M77.32","M25.572","M65.9","G60.8","R60.9","M54.9","M23.91","M17.0","G57.02","N64.4","N63.20","Z98.890","I89.0","Z79.811","D70.9","Z91.89","Z71.2","Z71.3","Z71.82","R10.9","R06.00","R07.9","K76.0","F41.9","M17.12","M19.90","X58.XXXA","M23.92","S83.242A","S83.282A","S83.512A","M77.9","E66.9","Z68.34","Z20.822","M23.301","M23.304","M17.11","I10","E55.9","M54.89","G62.9","G89.29","R51.9","J10.1","H61.21","I51.7","R91.8"],"date":["2019-03-05","2019-03-05","2021-04-30","2021-08-26","2019-04-17","2019-04-17","2019-06-11","2020-05-19","2020-07-14","2019-05-29","2020-07-14","2019-05-31","2019-05-31","2019-06-11","2019-07-16","2020-02-27","2019-06-12","2019-06-25","2019-07-08","2021-10-18","2021-05-17","2019-10-16","2019-08-29","2021-08-26","2021-08-26","2021-08-26","2019-09-09","2019-09-09","2019-09-09","2019-09-09","2021-11-23","2019-09-13","2021-08-26","2019-10-16","2021-07-28","2019-12-19","2021-08-26","2020-12-21","2020-02-27","2020-02-27","2020-05-19","2020-05-19","2021-03-03","2020-06-05","2020-06-05","2020-06-10","2020-12-07","2020-07-14","2020-07-14","2020-06-16","2020-06-16","2021-03-03","2021-08-26","2020-09-28","2021-04-21","2020-12-07","2020-12-22","2020-12-22","2020-12-22","2021-02-02","2021-08-26","2021-03-02","2021-03-03","2021-03-03","2021-03-03","2021-03-03","2021-08-26","2021-04-30","2021-10-18","2021-10-18","2021-05-12","2021-11-15","2021-05-12","2021-05-12","2021-09-17","2021-05-13","2021-05-13","2021-05-12","2021-05-12","2021-05-12","2021-05-12","2021-08-26","2021-09-17","2021-09-17","2021-06-21","2021-07-28","2021-07-28","2021-08-26","2021-08-26","2021-08-26","2021-10-05","2021-10-05","2021-10-05","2021-10-18","2021-10-18"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",null,"","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",null,"","","","","","","","","","","","","","","","","","","","","","",""]}},{"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":[["","65862037301","ESCITALOPRAM","5MG","90","Select","Select",""],["","16729003510","ANASTROZOLE","1MG","30","Select","Select",""],["","00378870006","ACYCLOVIR","5%","30","Select","Select",""],["","60505006501","OMEPRAZOLE","20MG","60","Select","Select",""],["","69315090405","LORAZEPAM","0.5MG","60","Select","Select",""],["","55566410001","EUFLEXXA","10MG\/ML","6","Select","Select",""],["","16729018317","HYDROCHLOROT","25MG","30","Select","Select",""],["","65162062711","TRAMADOL","50MG","12","Select","Select",""],["","31722053401","METHOCARBAM","750MG","40","Select","Select",""],["","67877022310","GABAPENTIN","300MG","90","Select","Select",""],["","61442010310","DICLOFENAC","75MG DR","60","Select","Select",""],["","52817031910","BACLOFEN","5MG","60","Select","Select",""],["","50228043605","NAPROXEN","500MG","60","Select","Select",""],["","69097015915","MELOXICAM","15MG","30","Select","Select",""],["","68462015713","ONDANSETRON","4MG ODT","20","Select","Select",""],["","00143314205","DOXYCYCL","100MG","20","Select","Select",""],["","52817033200","CYCLOBENZAPR","10MG","9","Select","Select",""],["","00093314705","CEPHALEXIN","500MG","28","Select","Select",""],["","65862037301","ESCITALOPRAM ","TAB 5MG","90","Select","Select",""],["","16729003510","ANASTROZOLE ","TAB 1MG","30","Select","Select",""],["","00378870006","ACYCLOVIR ","OIN 0.05","30","Select","Select",""],["","60505006501","OMEPRAZOLE ","CAP 20MG","60","Select","Select",""],["","69315090405","LORAZEPAM ","TAB 0.5MG","60","Select","Select",""],["","55566410001","EUFLEXXA ","INJ 10MG\/ML","6","Select","Select",""],["","16729018317","HYDROCHLOROT ","TAB 25MG","30","Select","Select",""],["","65162062711","TRAMADOL ","TAB 50MG","12","Select","Select",""],["","31722053401","METHOCARBAM ","TAB 750MG","40","Select","Select",""],["","67877022310","GABAPENTIN ","CAP 300MG","90","Select","Select",""],["","52817031910","BACLOFEN ","TAB 5MG","60","Select","Select",""],["","61442010310","DICLOFENAC ","TAB 75MG DR","60","Select","Select",""],["","50228043605","NAPROXEN ","TAB 500MG","60","Select","Select",""],["","69097015915","MELOXICAM ","TAB 15MG","30","Select","Select",""],["","68462015713","ONDANSETRON ","TAB 4MG ODT","20","Select","Select",""],["","00143314205","DOXYCYCL ","CAP 100MG","20","Select","Select",""],["","52817033200","CYCLOBENZAPR ","TAB 10MG","9","Select","Select",""],["","00093314705","CEPHALEXIN ","CAP 500MG","28","Select","Select",""],["","64380071306","BENZONATATE ","CAP 200MG","30","Select","Select",""],["","31722063231","OSELTAMIVIR ","CAP 75MG","10","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","",""],["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":""}]}]}