{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   AYNATSSORC L","gend":1,"add":"        TEERTS TNECSERC   1701                              ","city":"PULASKI                       ","state":"VA","zip":"24301-9998","dob":"1980-09-12","age":"","mstatus":"","insh":"50019955","cliId":"","pno":"1404526200","cno":5404100262,"email":"","ename":"","eno":"","pphy":"JUDY, CHARLES                                               ","ppno":"","pcpadd":"600 Randolph St","pcpcity":"Radford                       ","pcpstate":"VA","pcpzip":241412428,"pcpcounty":"","pcpid":"P9058633","pcpname":"FAMILY HEALTH CLINIC INC","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"1071   CRESCENT STREET                                      ","madd2":"                                                            ","madd3":"","mcity":"PULASKI                       ","mstate":"VA","mzip":"24301-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F11.20","M79.602","R00.2","R05","K50.90","E66.9","F17.200","Z68.30","J06.9","R09.81","J02.9","N94.6","N93.9","E66.3","Z68.36","B19.20","R74.8","R25.2","D52.9","M19.90","Z78.9","E55.9","R51","G47.33","F31.9","K21.9","F19.21","E04.1","R53.1","G40.909","Z68.41","G81.94","R56.9","R09.89","R06.00","R93.89","R41.82","F10.929","F39","G62.9","R53.82","Z79.899","F11.10","F31.60","F10.129","X78.1XXA","F10.239","F41.9","F22","Z56.0","Z88.2","Z87.820","Z90.49","Z91.19","Z91.5","I10","S61.512A","F31.63","F10.10","S51.812A","T14.91XA","R45.851","Z23","J18.9","M62.830","M54.9","R06.02","F41.0","R06.89","L03.011","S60.426A","F43.10","L03.012","L23.7","R21","L30.9","L02.411","M79.621","L25.9"],"date":["2021-11-22","2019-01-18","2019-01-18","2020-09-11","2019-02-19","2020-06-18","2021-09-13","2019-01-18","2019-02-19","2019-02-19","2019-02-19","2019-08-02","2019-08-02","2019-08-02","2019-08-02","2020-06-18","2019-09-27","2019-09-27","2020-04-03","2020-06-18","2020-06-18","2020-06-18","2020-06-18","2020-06-18","2021-01-01","2020-06-18","2020-06-18","2019-09-29","2020-09-11","2021-08-20","2019-09-29","2019-09-29","2019-09-29","2019-09-29","2019-09-29","2019-09-29","2019-09-29","2019-09-29","2019-12-13","2020-06-18","2020-04-03","2020-04-03","2020-05-25","2020-05-25","2020-05-25","2020-06-01","2020-05-25","2020-05-25","2020-05-25","2020-05-25","2020-05-25","2020-05-25","2020-05-25","2020-05-25","2020-05-25","2020-06-18","2020-05-25","2020-06-01","2020-07-07","2020-05-25","2020-05-25","2020-05-25","2020-05-25","2020-09-11","2020-09-11","2020-09-11","2020-09-11","2020-12-31","2020-09-11","2021-01-01","2020-12-31","2020-12-31","2021-01-01","2021-06-24","2021-09-13","2021-06-24","2021-08-20","2021-08-20","2021-09-13"],"priorHcc":[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":[["","40985027288","VITAMIN","5000UNIT","90","Select","Select",""],["","62332004890","LOSARTAN\/HCT","50-12.5","30","Select","Select",""],["","43598029390","PREGABALIN","75MG","60","Select","Select",""],["","69315012710","FOLIC","1000MCG","30","Select","Select",""],["","69238183407","LEVOTHYROXIN","100MCG","30","Select","Select",""],["","00591354060","BUPROPION","100MG SR","60","Select","Select",""],["","00603017929","FERROUS","325MG FC","30","Select","Select",""],["","16729030017","TRAZODONE","100MG","30","Select","Select",""],["","68382018105","BUSPIRONE","10MG","60","Select","Select",""],["","31722070190","LOSARTAN","50MG","30","Select","Select",""],["","29300013005","HYDROCHLOROT","12.5MG","30","Select","Select",""],["","00054418425","DEXAMETHASON","4MG","15","Select","Select",""],["","52817033200","CYCLOBENZAPR","10MG","16","Select","Select",""],["","00093031401","KETOROLAC","10MG","15","Select","Select",""],["","00363007428","MUCUS","0MG ER TA","14","Select","Select",""],["","65862018601","CLINDAMYCIN","300MG","40","Select","Select",""],["","57237000511","FLUCONAZOLE","150MG","1","Select","Select",""],["","00093314705","CEPHALEXIN","500MG","40","Select","Select",""],["","65162027250","SMZ\/TMP","800-160","20","Select","Select",""],["","00115180301","HYDROXYZ","25MG","12","Select","Select",""],["","00591544305","PREDNISONE","20MG","10","Select","Select",""],["","00135019502","NICODERM","14MG\/24H","7","Select","Select",""],["","69097012403","TOPIRAMATE","100MG","60","Select","Select",""],["","40985027288","VITAMIN ","TAB 5000UNIT","90","Select","Select",""],["","62332004890","LOSARTAN\/HCT ","TAB 50-12.5","30","Select","Select",""],["","43598029390","PREGABALIN ","CAP 75MG","60","Select","Select",""],["","69315012710","FOLIC ","TAB 1000MCG","30","Select","Select",""],["","69238183407","LEVOTHYROXIN ","TAB 100MCG","30","Select","Select",""],["","00591354060","BUPROPION ","TAB 100MG SR","60","Select","Select",""],["","00603017929","FERROUS ","TAB 325MG FC","30","Select","Select",""],["","16729030017","TRAZODONE ","TAB 100MG","30","Select","Select",""],["","68382018105","BUSPIRONE ","TAB 10MG","60","Select","Select",""],["","31722070190","LOSARTAN ","TAB 50MG","30","Select","Select",""],["","29300013005","HYDROCHLOROT ","CAP 12.5MG","30","Select","Select",""],["","00054418425","DEXAMETHASON ","TAB 4MG","15","Select","Select",""],["","52817033200","CYCLOBENZAPR ","TAB 10MG","16","Select","Select",""],["","00093031401","KETOROLAC ","TAB 10MG","15","Select","Select",""],["","00363007428","MUCUS ","120 0MG ER TA","14","Select","Select",""],["","65862018601","CLINDAMYCIN ","CAP 300MG","40","Select","Select",""],["","57237000511","FLUCONAZOLE ","TAB 150MG","1","Select","Select",""],["","00093314705","CEPHALEXIN ","CAP 500MG","40","Select","Select",""],["","65162027250","SMZ\/TMP ","TAB 800-160","20","Select","Select",""],["","00115180301","HYDROXYZ ","CAP 25MG","12","Select","Select",""],["","00591544305","PREDNISONE ","TAB 20MG","10","Select","Select",""],["","00135019502","NICODERM ","DIS 14MG\/24H","7","Select","Select",""],["","69097012403","TOPIRAMATE ","TAB 100MG","60","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":""}]}]}