{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   SEMAJYDARF M","gend":0,"add":"SD YTNUOC TTOCSECIVRES TLUDA S","city":"GATE CITY","state":"VA","zip":"24251-3600","dob":"1962-12-21","age":"","mstatus":"","insh":"60015400","cliId":"","pno":"2667259588","cno":2766288595,"email":"","ename":"","eno":"","pphy":"HAGER, SHELTON","ppno":4233926200,"pcpadd":"105 W STONE DRIVE, SUITE 3A","pcpcity":"KINGSPORT","pcpstate":"TN","pcpzip":376603365,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"SOUTHWEST","aligned":"","ano":2766399144,"add2":"190 BEECH STREET STE 101","add3":"","madd1":"SCOTT COUNTY DSS ADULT SERVICE","madd2":"190 BEECH STREET STE 101","madd3":"","mcity":"GATE CITY","mstate":"VA","mzip":"24251-3600","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z79.899","E72.20","B19.20","K25.3","R68.89","F25.9","Z51.81","E55.9","I10","R56.9","I25.10","E78.5","L89.90","L03.116","E11.9","G62.9","S91.111A","W26.9XXA","L98.9","K72.90","F41.1","R94.6","R73.9","R09.81","R09.3","L89.522","Z79.4","J20.9","W27.2XXA","K74.60","Z79.02","F17.210","F39","M54.5","D51.0","J44.9","I11.9","B18.2","E78.1","I73.9","I70.1","R73.09","E78.89","S91.114A","Z11.1","R19.7","G93.40","Z74.1","F42.4","R58","S91.101A","W26.8XXA","R79.89","L40.9","B56.9","L25.9","R05","S91.321A"],"date":["2020-08-17","2020-06-08","2019-04-11","2019-04-11","2020-10-26","2021-04-15","2020-08-17","2020-10-26","2020-11-04","2019-12-30","2021-03-08","2020-11-09","2019-11-13","2019-11-13","2021-03-08","2019-11-13","2020-06-02","2020-06-02","2020-06-03","2020-06-03","2020-06-03","2021-05-17","2019-04-17","2019-06-11","2019-06-11","2019-11-06","2020-06-02","2020-01-03","2020-06-02","2020-06-02","2020-06-02","2020-06-02","2020-06-02","2020-08-26","2021-03-08","2021-03-08","2021-03-08","2021-03-08","2019-10-02","2019-01-17","2019-01-17","2020-10-26","2020-05-11","2020-06-01","2020-02-05","2019-07-03","2019-07-03","2019-12-04","2019-12-04","2020-06-01","2020-06-01","2020-06-01","2020-10-26","2020-11-04","2019-04-01","2019-08-14","2019-08-14","2020-06-02"],"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":[["","69315013610","BENZTROPINE ","TAB 0.5MG","30","Select","Select",""],["","40985022731","FISH ","CAP 1000MG","120","Select","Select",""],["","00228212850","CLONIDINE ","TAB 0.2MG","90","Select","Select",""],["","10006073043","VITAMIN ","TAB 1000MCG","30","Select","Select",""],["","51672400503","CARBAMAZEPIN ","TAB 200MG","60","Select","Select",""],["","00603548421","PROPRANOLOL ","TAB 40MG","60","Select","Select",""],["","16729018317","HYDROCHLOROT ","TAB 25MG","30","Select","Select",""],["","43547035611","LISINOPRIL ","TAB 40MG","30","Select","Select",""],["","00185041552","BUPROPION ","TAB 150MG SR","30","Select","Select",""],["","16729009612","QUETIAPINE ","TAB 300MG ER","30","Select","Select",""],["","08496315601","INSULIN ","MIS 0.5\/31G","100","Select","Select",""],["","00536741008","L-CARNITINE ","CAP 250MG","360","Select","Select",""],["","23155010210","METFORMIN ","TAB 500MG","120","Select","Select",""],["","68382007901","HALOPERIDOL ","TAB 5MG","30","Select","Select",""],["","64980017005","HYDROXYZ ","CAP 50MG","90","Select","Select",""],["","60505009600","DOXAZOSIN ","TAB 8MG","30","Select","Select",""],["","00169750111","NOVOLOG ","INJ 100\/ML","10","Select","Select",""],["","59267100001","PFIZER ","INJ COVID-19","0.3","Select","Select",""],["","00591530710","PROMETHAZINE ","TAB 25MG","30","Select","Select",""],["","00143962125","CYANOCOBALAM ","INJ 1000MCG","1","Select","Select",""],["","00088222033","LANTUS ","INJ 100\/ML","30","Select","Select",""],["","45963043965","CONSTULOSE ","SOL 10GM\/15","1,892.00","Select","Select",""],["","37864000110","ACETAMIN ","TAB 500MG","30","Select","Select",""],["","00310620530","FARXIGA ","TAB 5MG","30","Select","Select",""],["","69097082112","GEMFIBROZIL ","TAB 600MG","60","Select","Select",""],["","00168025846","CLOTRIM\/BETA ","CRE DIPROP","45","Select","Select",""],["","58160088552","FLUARIX ","INJ 2020-21","0.5","Select","Select",""],["","69097094615","ATORVASTATIN ","TAB 40MG","30","Select","Select",""],["","00536408610","SENEXON-S ","TAB 8.6-50MG","30","Select","Select",""],["","60505025303","CLOPIDOGREL ","TAB 75MG","30","Select","Select",""],["","29300022605","METRONIDAZOL ","TAB 250MG","120","Select","Select",""],["","63824000850","MUCINEX ","TAB 600MG ER","14","Select","Select",""],["","00113048490","PAIN ","TAB 500MG","30","Select","Select",""],["","64380080308","RANITIDINE ","TAB 150MG","60","Select","Select",""],["","00472038045","BETAMETH ","CRE 0.0005","45","Select","Select",""],["","50383070016","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","20","Select","Select",""],["","00904110309","POVIDONE-IOD ","SOL 0.1","240","Select","Select",""],["","70461031903","FLUCLVX ","INJ 2019-20","0.5","Select","Select",""],["","00781261305","AMOXICILLIN ","CAP 500MG","21","Select","Select",""],["","67877057501","BENZONATATE ","CAP 200MG","15","Select","Select",""],["","00143211205","DOXYCYCL ","TAB 100MG","20","Select","Select",""],["","57896092110","ASPIRIN ","TAB 325MG EC","10","Select","Select",""],["","69543010250","CEPHALEXIN ","CAP 500MG","21","Select","Select",""],["","00591544301","PREDNISONE ","TAB 20MG","18","Select","Select",""],["","00536097085","EXTRA ","SYP 100-10\/5","473","Select","Select",""],["","45802006003","BACITRACIN ","OIN 500\/GM","28","Select","Select",""],["","24208055555","BACIT\/POLYMY ","OIN OP","3.5","Select","Select",""],["","51672131200","MUPIROCIN ","OIN 0.02","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":[[["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":""}]}]}