{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"  YERFFOEGNOTLEKS S ","gend":0,"add":"YWH 412S 122 ","city":"FLOYD","state":"VA","zip":"24091-9998","dob":"1966-05-22","age":"","mstatus":"","insh":"60016316","cliId":"","pno":"9304576711","cno":5403911767,"email":"","ename":"","eno":"","pphy":"SAADAT, SEYED H","ppno":7574465700,"pcpadd":"140 Christiansburg Pike NE, ","pcpcity":"Floyd","pcpstate":"VA","pcpzip":240913742,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"APT D","add3":"","madd1":"214 HWY 221 S","madd2":"APT D","madd3":"","mcity":"FLOYD","mstate":"VA","mzip":"24091-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["B18.2","K74.60","C22.0","B20","R60.0","I85.00","D12.6","R68.89","K76.89","M54.42","G62.9","G62.2","K59.00","G89.29","J43.9","F17.200","R00.0","I49.9","R79.89","E55.9","K76.9","Z48.3","J45.909","R06.00","R11.2","J44.9","K74.69","F31.9","K76.6","R16.1","H92.09","B37.0","Z98.890","G47.33","Z91.030","Z79.899","Z23","B19.20","Z99.81","J44.1","R06.09","J96.11","J42","Z85.05","M51.16","M51.17","M47.26","M47.27"],"date":["2020-09-01","2020-09-01","2020-09-01","2021-01-22","2020-09-01","2020-09-01","2020-09-01","2021-01-22","2020-02-04","2020-01-22","2020-01-22","2019-10-17","2019-10-17","2020-04-28","2020-01-22","2020-01-22","2019-11-22","2019-11-22","2019-11-22","2019-11-22","2019-06-05","2019-01-21","2019-07-19","2019-07-19","2020-01-22","2021-04-04","2020-04-17","2020-09-08","2020-02-04","2020-02-04","2019-01-31","2019-01-31","2019-01-21","2019-01-26","2019-05-02","2019-05-02","2019-05-02","2020-05-18","2020-02-04","2021-01-22","2021-01-22","2021-01-22","2019-04-17","2020-02-04","2019-06-21","2019-06-21","2019-06-21","2019-06-21"],"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":[["","00121057716","LACTULOSE ","SOL 10GM\/15","946","Select","Select",""],["","59651000305","OMEPRAZOLE ","CAP 40MG","90","Select","Select",""],["","10702005601","OXYCODONE ","TAB 10MG","150","Select","Select",""],["","59779044874","CVS ","DIS 21MG\/24H","28","Select","Select",""],["","66993068130","OLANZAPINE ","TAB 5MG","60","Select","Select",""],["","00378020810","FUROSEMIDE ","TAB 20MG","30","Select","Select",""],["","69097014260","ALBUTEROL ","AER HFA","6.7","Select","Select",""],["","24658031205","DOXYCYCL ","TAB 100MG","10","Select","Select",""],["","60505009300","DOXAZOSIN ","TAB 1MG","30","Select","Select",""],["","00093081001","NORTRIPTYLIN ","CAP 10MG","60","Select","Select",""],["","00378064205","PREDNISONE ","TAB 20MG","10","Select","Select",""],["","61958250101","BIKTARVY ","TAB ","30","Select","Select",""],["","10702001150","HYDROXYZ ","TAB 25MG","60","Select","Select",""],["","70710113803","FLUCONAZOLE ","TAB 100MG","11","Select","Select",""],["","69452015120","VITAMIN ","CAP 50000UNT","4","Select","Select",""],["","00597010061","SPIRIVA ","SPR 2.5MCG","4","Select","Select",""],["","00054414622","CLOTRIMAZOLE ","TRO 10MG","28","Select","Select",""],["","59310057922","PROAIR ","AER ","8.5","Select","Select",""],["","00536589688","NICOTINE ","DIS 21MG\/24H","28","Select","Select",""],["","68462010530","ONDANSETRON ","TAB 4MG","20","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","12","Select","Select",""],["","65862007701","CIPROFLOXACN ","TAB 500MG","10","Select","Select",""],["","50428308240","MILK ","SUS 400\/5ML","355","Select","Select",""],["","43386035801","HYDROCO\/APAP ","TAB 10-325MG","180","Select","Select",""],["","00135046702","NICORETTE ","GUM 4MG CINN","100","Select","Select",""],["","49502010202","EPINEPHRINE ","INJ 0.3MG","2","Select","Select",""],["","43386009019","GAVILYTE-G ","SOL ","4,000.00","Select","Select",""],["","61958190101","GENVOYA ","TAB ","30","Select","Select",""],["","69547035302","NARCAN ","SPR ","2","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":""}]}]}