{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"  ACISSEJYECATS A ","gend":1,"add":"V REPPU 723DAOR YELLA","city":"TAZEWELL","state":"VA","zip":"24651-9095","dob":"1990-09-02","age":"","mstatus":"","insh":"60013547","cliId":"","pno":"0267270102","cno":2762020107,"email":"","ename":"","eno":"","pphy":"CHAUDHRY, MUNA F","ppno":5715776300,"pcpadd":"1957 2nd St, ","pcpcity":"Richlands","pcpstate":"VA","pcpzip":246412303,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"SOUTHWEST","aligned":"","ano":2763857098,"add2":"                                                            ","add3":"","madd1":"327 UPPER VALLEY ROAD","madd2":"                                                            ","madd3":"","mcity":"TAZEWELL","mstate":"VA","mzip":"24651-9095","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["S39.91XA","W19.XXXA","S79.922A","S89.92XA","S39.012A","M54.5","M54.17","R32","I10","E11.9","F41.9","F17.210","M79.7","J44.9","K58.9","Z88.6","Z88.1","Z88.5","Z91.010","Z88.0","S99.912A","X50.1XXA","G62.9","M79.662","M62.838","R68.89","R07.9","Z74.3","O10.013","O24.119","O11.4","O24.12","Z37.0","Z3A.37","N93.9","Z30.09","S74.02XA","X50.0XXA","S79.912A","J45.909","S29.9XXA","M79.605","M54.2","W01.0XXD","M25.562","Z91.030","Z88.8","Z91.018","M79.672","D51.8","E55.9","Z51.81","E03.9","G56.03","M54.12","O99.89","Z3A.16","O24.112","O99.282","O10.012","Z3A.24","I51.7","O24.419","O13.3","O10.913","Z3A.34","O99.513","Z36.9","S96.911A","S99.921A","Y92.019","F32.9","G47.30","Z88.2","Z30.431","R53.81","R53.83","N93.8","R51.9","R42","R10.9","R53.1","R10.819","G54.4","M43.17","M48.061","M47.26","F41.1","J45.20","R60.0","G57.93","R07.89","D72.829","O36.8120","O24.012","E10.9","O26.892","O23.42","Z3A.36","Z3A.27","O09.93","O24.113","Z20.828","M54.42","M79.652","M25.552","W01.0XXA","S30.0XXA","M79.89","G47.33","K21.9","F41.0","E11.65","M51.17","M62.830","J20.8","J01.00","N91.1","E28.2","Z36.87","O24.111","O99.281","O10.011","Z3A.12","O47.03","Z3A.29","Z3A.31","O10.919","M54.9","W18.30XA","Y93.01","Y92.480","Z79.84","Z79.899","M62.831","E11.40","R00.0","M54.6","M54.16","Z01.419","N92.6","Z34.90","O13.9","Z3A.00","R07.2","Z99.81","O99.283","O43.193","O43.893","Z37.9","O99.345","S16.1XXA","X58.XXXA","Y93.9","Y92.9","N39.0","Z72.51","R69","R94.31","R10.2","R20.8","M32.9","F33.0","N10","R35.0","R11.0","R91.8","Z12.4","Z3A.20","O36.8130","Z3A.32","Z30.430","Z13.9","M25.572","I16.0","R51","N91.2","Z3A.01","Z3A.26","R00.2","Z91.041","Z86.718","Z90.89","Z98.1","Z91.81","M79.671","F34.1","M10.9","K59.04","O60.03","Z3A.30","M79.604","O10.92","O36.63X0","O99.52","Z79.4","O82","N94.10","K21.00"],"date":["2019-01-11","2019-01-22","2019-01-11","2019-01-11","2019-01-22","2019-10-21","2019-01-22","2019-01-22","2021-04-02","2021-04-02","2021-05-14","2019-01-22","2020-11-10","2021-01-27","2020-06-08","2021-01-27","2020-03-11","2020-11-10","2020-11-10","2020-11-10","2019-07-13","2020-11-10","2019-07-15","2019-07-15","2019-07-15","2021-01-22","2021-01-27","2019-10-19","2020-06-30","2020-08-04","2020-08-06","2020-08-06","2020-08-06","2020-08-06","2021-03-05","2021-05-24","2019-01-11","2019-01-11","2019-01-11","2020-12-12","2019-01-13","2019-01-17","2021-01-27","2019-01-17","2019-01-22","2020-11-10","2020-11-10","2020-11-10","2019-01-17","2019-12-23","2019-12-23","2019-05-23","2021-04-02","2019-11-06","2021-04-02","2020-06-13","2020-03-11","2020-05-27","2020-05-05","2020-05-27","2020-05-05","2020-06-26","2020-07-16","2020-07-14","2020-07-16","2020-07-16","2020-07-16","2020-07-28","2020-11-10","2020-11-10","2020-11-10","2021-04-02","2020-11-10","2020-11-10","2021-03-05","2020-11-17","2020-11-17","2020-12-12","2020-12-12","2020-12-12","2020-12-12","2020-12-12","2020-12-12","2019-01-12","2019-01-12","2019-01-22","2019-03-28","2019-05-23","2019-09-24","2019-05-23","2019-09-24","2019-10-20","2019-10-20","2020-03-11","2020-03-11","2020-03-11","2020-03-11","2020-05-22","2020-05-22","2020-05-27","2020-06-03","2020-06-24","2020-12-09","2019-01-11","2019-01-11","2019-01-11","2019-01-11","2019-01-11","2020-07-24","2019-03-29","2021-04-02","2019-05-02","2019-12-23","2019-12-23","2019-12-23","2019-12-23","2019-12-23","2020-01-24","2020-06-24","2020-01-24","2020-02-13","2020-02-13","2020-02-13","2020-02-13","2020-06-14","2020-06-14","2020-06-24","2020-07-28","2019-01-11","2020-11-10","2019-07-13","2019-07-13","2020-06-13","2020-06-08","2019-07-15","2019-11-09","2019-10-20","2019-10-21","2019-10-21","2019-11-22","2019-11-22","2020-01-31","2020-06-08","2020-08-06","2021-01-27","2020-06-08","2020-07-24","2020-08-06","2020-08-06","2020-08-06","2020-11-05","2021-01-27","2021-01-27","2021-01-27","2021-01-27","2021-01-27","2020-09-11","2020-12-08","2021-01-27","2021-03-05","2021-04-02","2021-04-09","2021-05-14","2019-03-26","2019-03-26","2019-03-26","2019-10-19","2019-11-22","2020-03-11","2020-06-29","2020-06-29","2020-10-20","2020-10-20","2019-01-22","2019-03-26","2019-10-20","2020-01-17","2020-01-17","2020-05-22","2020-06-08","2020-06-08","2020-06-08","2020-06-08","2020-06-08","2020-06-13","2020-11-05","2021-04-20","2019-01-22","2021-05-04","2020-06-13","2020-06-13","2020-07-24","2020-08-06","2020-08-06","2020-08-06","2020-08-06","2020-08-06","2021-01-22","2021-05-04"],"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":[["","00093727298","PIOGLITAZONE ","TAB 30MG","30","Select","Select",""],["","00591352530","LIDOCAINE ","PAD 0.05","10","Select","Select",""],["","08222082589","INSULIN ","MIS 28GX1\/2\"","100","Select","Select",""],["","50383066730","LIDO\/PRILOCN ","CRE 2.5-2.5%","30","Select","Select",""],["","00088222033","LANTUS ","INJ 100\/ML","10","Select","Select",""],["","00182451906","THERAPEUTIC ","","90","Select","Select",""],["","49884012201","LABETALOL ","TAB 100MG","60","Select","Select",""],["","68462030529","NORETHINDRON ","TAB 0.35MG","28","Select","Select",""],["","00456120130","LINZESS ","CAP 145MCG","30","Select","Select",""],["","71930005412","APAP\/CODEINE ","TAB 300-15MG","60","Select","Select",""],["","69543010250","CEPHALEXIN ","CAP 500MG","30","Select","Select",""],["","00904615760","VITAMIN ","TAB 2000UNIT","90","Select","Select",""],["","39328010610","PRENATAL ","TAB 27-1MG","30","Select","Select",""],["","23155000810","HYDROCHLOROT ","TAB 25MG","30","Select","Select",""],["","16729020301","BUSPIRONE ","TAB 15MG","60","Select","Select",""],["","70377002911","ATORVASTATIN ","TAB 40MG","30","Select","Select",""],["","60505014201","GLIPIZIDE ","TAB 10MG","30","Select","Select",""],["","00555087302","MEDROXYPR ","TAB 5MG","15","Select","Select",""],["","68180051703","LISINOPRIL ","TAB 40MG","30","Select","Select",""],["","99073012101","FREESTYLE    TES","TES ","100","Select","Select",""],["","62175018046","PANTOPRAZOLE ","TAB 20MG","30","Select","Select",""],["","59779046768","ASPIRIN ","CHW 81MG","30","Select","Select",""],["","00002751001","HUMALOG ","INJ 100\/ML","10","Select","Select",""],["","00904759180","FERROUS ","TAB 325MG","90","Select","Select",""],["","53746010901","HYDROCO\/APAP ","TAB 5-325MG","12","Select","Select",""],["","64380080308","RANITIDINE ","TAB 150MG","30","Select","Select",""],["","00172392680","DIAZEPAM ","TAB 5MG","6","Select","Select",""],["","99073011001","FREESTYLE    KIT SYSTEM","KIT SYSTEM","1","Select","Select",""],["","65862086001","FAMOTIDINE ","TAB 40MG","30","Select","Select",""],["","10702001801","OXYCODONE ","TAB 5MG","20","Select","Select",""],["","69618004410","DOCUSATE ","CAP 100MG","30","Select","Select",""],["","00904198280","MAPAP ","TAB 325MG","60","Select","Select",""],["","65862035790","CLOPIDOGREL ","TAB 75MG","30","Select","Select",""],["","00591565810","CYCLOBENZAPR ","TAB 10MG","20","Select","Select",""],["","47781030301","NITROFURANTN ","CAP 100MG","20","Select","Select",""],["","29300016915","TIZANIDINE ","TAB 4MG","40","Select","Select",""],["","00591554301","ALLOPURINOL ","TAB 100MG","60","Select","Select",""],["","99073013001","FREESTYLE    MIS LANCETS","MIS LANCETS","100","Select","Select",""],["","67777012114","ALCOHOL ","PAD ","100","Select","Select",""],["","63824000815","MUCINEX ","TAB 600MG ER","20","Select","Select",""],["","99073070822","FREESTYLE    TES LITE","TES LITE","100","Select","Select",""],["","69097028907","LEVOFLOXACIN ","TAB 500MG","10","Select","Select",""],["","51991029305","OXCARBAZEPIN ","TAB 300MG","60","Select","Select",""],["","00555902658","JUNEL ","TAB 44216","28","Select","Select",""],["","00904688365","ACETAMINOPHE ","TAB 650MG ER","180","Select","Select",""],["","16729000201","GLIMEPIRIDE ","TAB 2MG","30","Select","Select",""],["","00093221005","SUCRALFATE ","TAB 1GM","60","Select","Select",""],["","91237000177","EASY ","MIS 32GX5\/32","100","Select","Select",""],["","68382003416","VENLAFAXINE ","CAP 37.5 ER","30","Select","Select",""],["","00186037220","SYMBICORT ","AER 80-4.5","10.2","Select","Select",""],["","62175026037","NIFEDIPINE ","TAB 30MG ER","30","Select","Select",""],["","00904671980","ACETAMINOPHEN ","TA B 325","60","Select","Select",""],["","00093506110","HYDROXYZ ","TAB 25MG","60","Select","Select",""],["","59310057922","PROAIR ","AER ","8.5","Select","Select",""],["","00536478701","B ","CAP ","30","Select","Select",""],["","56151014401","TRUPLUS ","MIS 30G","100","Select","Select",""],["","00591544310","PREDNISONE ","TAB 20MG","5","Select","Select",""],["","00487020103","IPRATROPIUM\/ ","SOL ALBUTER","90","Select","Select",""],["","99073070805","FREESTYLE    MIS LITE","MIS LITE","1","Select","Select",""],["","16729000617","SIMVASTATIN ","TAB 40MG","30","Select","Select",""],["","00006027731","JANUVIA ","TAB 100MG","30","Select","Select",""],["","65862039010","ONDANSETRON ","TAB 4MG ODT","10","Select","Select",""],["","00093317431","ALBUTEROL ","FAT E HFA INH","8.5","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","20","Select","Select",""],["","00173068220","VENTOLIN ","AER ","18","Select","Select",""],["","91237000174","HEALTH ","MIS BLOOD PR","1","Select","Select",""],["","59651000305","OMEPRAZOLE ","CAP 40MG","30","Select","Select",""],["","00832105410","BACLOFEN ","TAB 10MG","15","Select","Select",""],["","50111064701","FLUOXETINE ","10MG","30","Select","Select",""],["","63402030430","LATUDA ","40MG","30","Select","Select",""],["","65862022701","LAMOTRIGINE ","25MG","60","Select","Select",""],["","68180072003","AMLODIPINE ","5MG","90","Select","Select",""],["","43598043611","NITROGLYCERN ","0.4MG","25","Select","Select",""],["","00536121429","DIPHENHYDRAM ","25MG","30","Select","Select",""],["","08290320119","BD  PEN NEEDL","31GX5MM","100","Select","Select",""],["","00169633910","NOVOLOG ","FLEXPEN","15","Select","Select",""],["","68180038909","FENOFIBRATE ","145MG","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":""}]}]}