{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"  EINROLFREGAH M ","gend":1,"add":"OB O P423 X","city":"MAXIE","state":"VA","zip":"24628-0324","dob":"1965-04-19","age":"","mstatus":"","insh":"60017910","cliId":"","pno":"3567214001","cno":2765310041,"email":"","ename":"","eno":"","pphy":"PATEL, DINKAR N","ppno":2769352148,"pcpadd":"1520 Slate Creek Rd Ste 101, ","pcpcity":"Grundy","pcpstate":"VA","pcpzip":246146975,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"SOUTHWEST","aligned":"","ano":2765319504,"add2":"                                                            ","add3":"","madd1":"P O BOX 324","madd2":"                                                            ","madd3":"","mcity":"MAXIE","mstate":"VA","mzip":"24628-0324","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M25.512","M19.90","D69.2","R50.9","M79.10","R60.0","W57.XXXA","Y99.8","S20.96XA","E11.9","I10","K21.9","J45.909","K29.70","Z79.899","R21","R06.00","R06.2","M10.9","F41.9","Z79.84","J20.9","R60.9","L20.9","M31.0","M25.571","M24.571","S82.63XA","K30","R11.0","R33.9","N20.0","R82.993","S82.90XD","M79.89","M25.50","A08.4","B34.9","M06.9","R06.02","J02.9","R53.83","R53.81","Z12.31","Z80.3","S82.64XA","W01.0XXA","Z78.0","M12.30","L95.9","Z68.42","R76.0","M54.5","E78.5","S83.412A","W17.89XA","S89.92XA","S70.02XA","S39.93XA","M79.605","L95.8","M79.642","M79.641","M70.62","R79.89","R30.0","R05","S82.61XA","E11.42","Z87.442","J32.1","N36.42","D48.5","L97.921","L23.7","M1A.0720","L30.9","S99.911A","F34.1","M25.552","G43.009"],"date":["2019-06-26","2021-04-27","2019-08-01","2020-01-13","2020-09-10","2019-08-19","2019-08-01","2019-08-01","2019-08-01","2021-04-27","2021-04-27","2020-12-16","2019-08-17","2019-08-17","2021-05-04","2019-08-11","2019-08-17","2019-08-17","2019-08-17","2019-08-17","2021-03-11","2020-03-13","2019-08-21","2019-08-27","2019-11-25","2020-10-08","2020-10-08","2020-10-08","2020-12-16","2019-07-02","2021-05-04","2020-03-17","2021-05-04","2020-08-19","2020-09-16","2020-09-10","2019-07-27","2019-07-27","2019-08-27","2019-08-17","2020-01-13","2020-10-27","2021-01-18","2020-01-17","2020-01-17","2020-08-03","2021-03-11","2020-09-10","2021-04-13","2021-01-12","2020-09-10","2020-09-10","2021-04-13","2021-01-18","2021-03-11","2021-03-11","2021-03-11","2021-03-11","2021-03-11","2021-04-15","2020-04-27","2020-04-27","2020-04-27","2021-04-13","2019-10-14","2020-10-12","2020-03-13","2020-08-05","2020-12-16","2021-05-04","2019-05-06","2019-09-04","2019-09-13","2019-07-24","2019-07-24","2019-09-04","2019-09-13","2020-08-03","2020-12-16","2021-01-12","2021-01-18"],"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":[["","55111032105","GLIMEPIRIDE ","TAB 2MG","30","Select","Select",""],["","13668011510","LOSARTAN ","TAB 100MG","30","Select","Select",""],["","59746017210","PREDNISONE ","TAB 5MG","20","Select","Select",""],["","68382000106","PAROXETINE ","TAB 40MG","30","Select","Select",""],["","68001016208","PROMETHAZINE ","TAB 25MG","20","Select","Select",""],["","00904053913","THERA ","TAB ","30","Select","Select",""],["","67877019805","AMLODIPINE ","TAB 5MG","60","Select","Select",""],["","46122004378","GNP ","PAD SWABS","100","Select","Select",""],["","67877056105","METFORMIN ","TAB 500MG","120","Select","Select",""],["","08470058501","UNILET ","MIS 33G","100","Select","Select",""],["","31722053405","METHOCARBAM ","TAB 750MG","30","Select","Select",""],["","00093317431","ALBUTEROL ","FAT E","8.5","Select","Select",""],["","67877032105","IBUPROFEN ","TAB 800MG","60","Select","Select",""],["","62175013643","OMEPRAZOLE ","CAP 40MG","30","Select","Select",""],["","69452015120","VITAMIN ","CAP 50000UNT","4","Select","Select",""],["","59762040101","SUCRALFATE ","TAB 1GM","90","Select","Select",""],["","00378037301","HYDROXYCHLOR ","TAB 200MG","60","Select","Select",""],["","45802006436","TRIAMCINOLON ","CRE 0.001","80","Select","Select",""],["","53489012002","DOXYCYCL ","TAB 100MG","28","Select","Select",""],["","65862059805","TAMSULOSIN ","CAP 0.4MG","30","Select","Select",""],["","00093540189","OMEGA-3-ACID ","CAP 1GM","60","Select","Select",""],["","68382053701","POT  CITRATE ","TAB 1080MG","60","Select","Select",""],["","00378773293","ONDANSETRON ","TAB 4MG ODT","18","Select","Select",""],["","16729013501","ALLOPURINOL ","TAB 300MG","30","Select","Select",""],["","68382005005","MELOXICAM ","TAB 7.5MG","60","Select","Select",""],["","08271036100","LANCETS ","MIS THIN","100","Select","Select",""],["","00193731150","CONTOUR ","TES NEXT","100","Select","Select",""],["","31722055190","LEVOCETIRIZI ","TAB 5MG","30","Select","Select",""],["","55111012705","CIPROFLOXACN ","TAB 500MG","14","Select","Select",""],["","68180016013","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","00904005316","ROBAFEN ","SYP 100-10\/5","480","Select","Select",""],["","68462025301","ROPINIROLE ","TAB 0.25MG","60","Select","Select",""],["","42571016242","AMOX\/K ","TAB 875-125","20","Select","Select",""],["","68001000501","METHYLPRED ","TAB 4MG","21","Select","Select",""],["","57664047758","METOPROL ","TAB 50MG","30","Select","Select",""],["","51672131200","MUPIROCIN ","OIN 0.02","22","Select","Select",""],["","69315011610","FUROSEMIDE ","TAB 20MG","30","Select","Select",""],["","50383077504","LIDOCAINE ","SOL 2% VISC","100","Select","Select",""],["","59310057922","PROAIR ","AER ","8.5","Select","Select",""],["","45802065087","LORATADINE ","TAB 10MG","30","Select","Select",""],["","00781261305","AMOXICILLIN ","CAP 500MG","30","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":""}]}]}