{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" ELOCINRENKCUB","gend":1,"add":" DLO 289511 ETUOR","city":"DUBLIN","state":"VA","zip":"24084-5847","dob":"1981-12-26","age":"","mstatus":"","insh":"7634763","cliId":"","pno":"5504579853","cno":5405535897,"email":"","ename":"","eno":"","pphy":"ULLMAN, CHRISTINE","ppno":5406748804,"pcpadd":"118 Broad St, ","pcpcity":"Dublin","pcpstate":"VA","pcpzip":240843211,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"LOT 73","add3":"","madd1":"2161 Whispering Pine Cir","madd2":"                                                            ","madd3":"","mcity":"Christiansburg","mstate":"VA","mzip":"24073-6029","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K82.8","R10.31","R10.11","A41.9","D69.6","F41.9","F31.9","G89.4","E44.1","F17.200","Z68.31","R30.0","R76.8","R74.8","K76.0","F19.11","B18.2","M25.50","K21.9","M79.7","M46.1","H53.9","M54.16","G35","H53.2","R20.2","G93.89","M79.601","M79.602","Z79.899","T63.301A","B17.11","M46.96","Z72.0","Z13.39","R68.82","N92.1","M16.12","M25.552","F32.9","M51.16","R68.89","F43.10","F31.32","K82.9","F31.30","M19.90","G62.9","F11.23","M25.362","F39","R23.2","H53.8","R32","M47.816","K81.1","G47.00","B19.20","R94.5","R16.0","M25.542","M25.541","N39.0","M79.674","M54.5"],"date":["2019-04-10","2019-03-24","2019-03-24","2019-03-24","2019-03-24","2020-09-03","2020-09-03","2021-05-24","2019-03-24","2020-06-06","2019-03-24","2019-04-02","2020-05-06","2020-05-06","2020-01-13","2020-01-15","2020-05-06","2020-09-03","2020-05-06","2020-09-03","2020-06-11","2020-05-12","2021-05-24","2020-09-03","2020-09-04","2020-09-04","2020-09-04","2020-09-04","2020-09-04","2021-05-24","2020-04-02","2020-01-08","2021-05-24","2021-04-12","2021-03-16","2021-03-16","2021-03-16","2020-06-23","2020-06-23","2020-06-06","2020-07-23","2020-08-19","2020-10-30","2019-01-09","2019-04-10","2019-09-30","2020-06-06","2020-01-03","2020-01-03","2020-01-03","2020-01-03","2020-01-03","2020-06-11","2020-06-11","2021-05-24","2019-04-10","2019-04-10","2020-01-13","2020-01-13","2020-01-13","2020-05-12","2020-05-12","2019-03-24","2020-06-06","2020-06-23"],"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":[["","16729014617","QUETIAPINE ","TAB 50MG","60","Select","Select",""],["","51991083675","EPINASTINE ","DRO 0.0005","5","Select","Select",""],["","43547040711","CLONAZEPAM ","TAB 1MG","120","Select","Select",""],["","76385012450","METHOCARBAM ","TAB 750MG","180","Select","Select",""],["","61442010201","DICLOFENAC ","TAB 50MG DR","90","Select","Select",""],["","00406117001","NALTREXONE ","TAB 50MG","30","Select","Select",""],["","65162018810","NAPROXEN ","TAB 250MG","9","Select","Select",""],["","00054418425","DEXAMETHASON ","TAB 4MG","3","Select","Select",""],["","10702001110","HYDROXYZ ","TAB 25MG","90","Select","Select",""],["","00093031401","KETOROLAC ","TAB 10MG","20","Select","Select",""],["","47781030301","NITROFURANTN ","CAP 100MG","10","Select","Select",""],["","69315011610","FUROSEMIDE ","TAB 20MG","30","Select","Select",""],["","64764075030","TRINTELLIX ","TAB 20MG","30","Select","Select",""],["","29300024605","BUSPIRONE ","TAB 15MG","60","Select","Select",""],["","45802010901","TRIAMCINOLON ","AER 55MCG\/AC","16.9","Select","Select",""],["","67877032105","IBUPROFEN ","TAB 800MG","90","Select","Select",""],["","61874011530","VRAYLAR ","CAP 1.5MG","30","Select","Select",""],["","59746017310","PREDNISONE ","TAB 10MG","21","Select","Select",""],["","00093317431","ALBUTEROL ","FAT E","8.5","Select","Select",""],["","58657062250","GABAPENTIN ","CAP 400MG","90","Select","Select",""],["","64679096105","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","67405060203","FLUCONAZOLE ","TAB 100MG","10","Select","Select",""],["","55111068405","IBU ","TAB 800MG","90","Select","Select",""],["","45802011222","MUPIROCIN ","OIN 0.02","22","Select","Select",""],["","29300011205","LAMOTRIGINE ","TAB 100MG","30","Select","Select",""],["","29300022705","METRONIDAZOL ","TAB 500MG","30","Select","Select",""],["","64980041310","PREGABALIN ","CAP 100MG","90","Select","Select",""],["","55111018010","TIZANIDINE ","TAB 4MG","90","Select","Select",""],["","70700010916","CLOBETASOL ","CRE 0.0005","60","Select","Select",""],["","51991074710","DULOXETINE ","CAP 30MG","30","Select","Select",""],["","10702019010","HYDROCO\/APAP ","TAB 7.5-325","30","Select","Select",""],["","67877021905","CEPHALEXIN ","CAP 500MG","30","Select","Select",""],["","53746027205","SMZ\/TMP ","TAB 800-160","20","Select","Select",""],["","54092038701","ADDERALL ","CAP 20MG","30","Select","Select",""],["","00074262528","MAVYRET ","TAB 100-40MG","84","Select","Select",""],["","43598016405","OLANZAPINE ","TAB 5MG","30","Select","Select",""],["","59310057922","PROAIR ","AER ","8.5","Select","Select",""],["","45802026937","PERMETHRIN ","CRE 0.05","60","Select","Select",""],["","00378668910","PANTOPRAZOLE ","TAB 40MG","30","Select","Select",""],["","00173068220","VENTOLIN ","AER ","18","Select","Select",""],["","57237023305","SMZ-TMP ","TAB 800-160","14","Select","Select",""],["","69097012215","TOPIRAMATE ","TAB 25MG","30","Select","Select",""],["","42571025101","CLINDAMYCIN ","CAP 150MG","40","Select","Select",""],["","00904645760","DOK ","CAP 100MG","30","Select","Select",""],["","68180086673","BLISOVI ","TAB 1.5\/30","84","Select","Select",""],["","29300012510","MELOXICAM ","15MG","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":[[["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","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":""}]}]}