{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   AYNOTNOSBIG R","gend":1,"add":"EVARG 9731DR LLIH L","city":"TROUTVILLE","state":"VA","zip":"24175-7101","dob":"1974-08-23","age":"","mstatus":"","insh":"50017984","cliId":"","pno":"8604558662","cno":5406826685,"email":"","ename":"","eno":"","pphy":"HILLDRUP, KELLEY M","ppno":5409660400,"pcpadd":"150 Market Ridge Ln, ","pcpcity":"Daleville","pcpstate":"VA","pcpzip":240833258,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":5407590975,"add2":"                                                            ","add3":"","madd1":"1379 GRAVEL HILL RD","madd2":"                                                            ","madd3":"","mcity":"TROUTVILLE","mstate":"VA","mzip":"24175-7101","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R06.02","R05","I27.24","J96.91","J45.30","Z79.891","J02.9","R50.9","M51.36","M17.10","M47.816","G89.29","R06.2","R51","R53.1","R68.89","M25.50","R20.0","M54.16","G89.4","R91.1","J45.20","R10.9","L02.211","R19.00","R91.8","J21.9","K74.00","K76.6","R16.1","I86.8","M54.6","M54.2","M46.02","M46.04","M46.06","M51.35","M50.30","M17.0","M46.03","M46.07","R09.82","K21.9","J84.89","G60.9","G62.9","J01.11","Z79.899","I07.1","M54.5","M46.96","J01.90","E03.9","F51.01","G43.909","L03.311","R60.9","I10","R25.2","T15.11XA","H11.31","H25.013","H43.393","H02.412","J98.4","R09.02","Z99.81","J96.11","E66.01","Z98.84","Z83.6","R26.89","R42","T78.40XD","B00.1","R29.90","M79.89","K65.9","R10.30","G47.33","D64.9","Z86.79","J18.1","Z87.891","R61","H91.8X2","M79.7","Z51.81","M79.604","Z01.810","R94.31","F41.1","G43.009","M79.661","I89.0"],"date":["2020-09-30","2020-09-30","2019-01-15","2021-03-13","2019-10-19","2019-04-30","2019-08-21","2019-08-21","2019-12-19","2019-12-19","2019-12-19","2021-03-29","2021-03-29","2020-09-30","2021-03-29","2021-03-29","2021-03-29","2021-03-29","2021-03-29","2021-03-29","2020-10-13","2021-03-13","2021-02-25","2021-02-25","2021-02-25","2021-02-25","2021-02-25","2021-02-25","2021-02-25","2021-02-25","2021-02-25","2019-04-30","2019-04-30","2019-04-30","2019-04-30","2019-04-30","2019-04-30","2019-03-05","2019-05-01","2019-04-30","2019-02-05","2019-09-23","2020-08-12","2019-02-27","2019-03-12","2020-10-16","2020-02-06","2021-03-29","2019-01-04","2019-04-30","2019-08-30","2020-01-23","2020-10-01","2020-10-01","2020-04-02","2020-09-17","2020-10-01","2020-10-01","2019-03-29","2019-03-21","2019-03-21","2019-03-21","2019-03-21","2019-03-21","2020-09-30","2020-09-30","2020-09-30","2020-09-30","2020-09-30","2020-09-30","2020-09-30","2019-03-29","2019-03-29","2019-09-23","2020-08-05","2020-08-05","2020-08-14","2021-02-25","2021-02-25","2019-09-23","2019-09-23","2019-09-23","2019-01-14","2019-01-14","2019-01-14","2019-01-14","2019-03-01","2020-08-12","2020-08-14","2019-01-14","2019-01-14","2019-03-01","2019-03-01","2020-08-12","2020-10-01"],"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":[["","00904054460","VITAMIN ","TAB 100MG","30","Select","Select",""],["","59746032430","VALACYCLOVIR ","TAB 500MG","30","Select","Select",""],["","68180097401","LEVOTHYROXIN ","TAB 175MCG","30","Select","Select",""],["","11534016503","FOLIC ","TAB 1MG","60","Select","Select",""],["","00781577626","AZITHROMYCIN ","TAB 250MG","15","Select","Select",""],["","49348050538","SM ","LOT THERAPY","480","Select","Select",""],["","57237016199","OMEPRAZOLE ","CAP 20MG","30","Select","Select",""],["","00093317431","ALBUTEROL ","FAT E HFA INH","8.5","Select","Select",""],["","69315011610","FUROSEMIDE ","TAB 20MG","30","Select","Select",""],["","68382009201","CARVEDILOL ","TAB 3.125MG","120","Select","Select",""],["","00172409660","BACLOFEN ","TAB 10MG","90","Select","Select",""],["","00071101668","LYRICA ","CAP 150MG","90","Select","Select",""],["","65862020190","LOSARTAN ","TAB 25MG","30","Select","Select",""],["","45802042237","DESONIDE ","CRE 0.0005","60","Select","Select",""],["","00093363020","ACYCLOVIR ","CRE 0.05","5","Select","Select",""],["","00143211250","DOXYCYCL ","TAB 100MG","20","Select","Select",""],["","37205074685","D3 ","CAP 1000UNIT","60","Select","Select",""],["","00832532510","POT  CL MICRO","TAB 20MEQ ER","30","Select","Select",""],["","60258095106","SENNA-S ","TAB 8.6-50MG","30","Select","Select",""],["","00186037020","SYMBICORT ","AER 160-4.5","10.2","Select","Select",""],["","13668000701","ZOLPIDEM ","TAB 5MG","30","Select","Select",""],["","68382066001","SPIRONOLACT ","TAB 25MG","30","Select","Select",""],["","67877057301","BENZONATATE ","CAP 100MG","30","Select","Select",""],["","00173069500","ADVAIR ","AER 100\/50","120","Select","Select",""],["","74312015605","D3-1000 ","CAP 1000UNIT","60","Select","Select",""],["","59011043010","OXYCONTIN ","TAB 30MG CR","60","Select","Select",""],["","65862014736","SUMATRIPTAN ","TAB 50MG","9","Select","Select",""],["","00597007541","SPIRIVA ","CAP HANDIHLR","30","Select","Select",""],["","65862018601","CLINDAMYCIN ","CAP 300MG","21","Select","Select",""],["","10702000801","OXYCODONE ","TAB 15MG","120","Select","Select",""],["","60505082901","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","49348054419","STOOL ","TAB 8.6-50MG","30","Select","Select",""],["","00135020003","ABREVA ","CRE 0.1","2","Select","Select",""],["","67877021905","CEPHALEXIN ","CAP 500MG","20","Select","Select",""],["","59310057922","PROAIR ","AER ","8.5","Select","Select",""],["","57896045501","SENNA ","TAB 8.6-50MG","30","Select","Select",""],["","69238131409","PREGABALIN ","CAP 150MG","90","Select","Select",""],["","00121072716","RANITIDINE ","SYP 75MG\/5ML","473","Select","Select",""],["","00378932032","WIXELA ","AER 100\/50","120","Select","Select",""],["","55111028050","LEVOFLOXACIN ","TAB 500MG","5","Select","Select",""],["","69547035302","NARCAN ","","2","Select","Select",""],["","11845014775","D ","1000UNIT","60","Select","Select",""],["","59762330403","NITROGLYCERN ","0.4MG","25","Select","Select",""],["","51672131200","MUPIROCIN ","2%","22","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","",""],["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":""}]}]}