{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"AH ASILNOTLIM","gend":1,"add":"DAVEN 76TEERTS A","city":"BRISTOL","state":"VA","zip":"24201-2251","dob":"1979-07-03","age":"","mstatus":"","insh":"81015891","cliId":"","pno":"9692237369","cno":2296996373,"email":"","ename":"","eno":"","pphy":"WILSON, RACHEL C","ppno":2764660584,"pcpadd":"410 Stagecoach Rd, ","pcpcity":"Bristol","pcpstate":"VA","pcpzip":242018359,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"SOUTHWEST","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"67 NEVADA STREET","madd2":"                                                            ","madd3":"","mcity":"BRISTOL","mstate":"VA","mzip":"24201-2251","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R11.2","N30.01","C50.412","R19.7","R79.89","R10.13","R50.9","R10.10","D70.9","E27.9","C50.419","C50.919","C50.911","C50.912","Z01.810","L03.313","N64.4","R69","L03.90","N39.0","R11.10","R21","R31.9","F17.290","Z85.3","R10.84","F31.81","R91.8","Z90.13","F31.76","N60.31","N60.32","N61.0","F43.23","F31.9","F12.90","F13.90","F31.75","T85.79XA","Y83.1","A41.1","R65.20","C77.9","F11.20","F43.10","M19.90","T45.1X5A","G89.3","E87.6","Z45.2","A41.02","N61.1","L03.818","C77.3","G62.9","Z79.2","R59.0","J34.89","Z17.0","R53.83","C79.89","I08.1","M79.18","D70.2","E86.0","E83.40","B37.0","R11.0","R50.81","R55","S46.219A","S46.819A","S76.111A","W19.XXXA","M70.61","M25.50","Z71.89","Z01.812","Z01.811","R05","T81.40XD","Z79.899","F41.9","K21.9","T81.31XA","K27.9","R73.03","Y83.8","F41.8","E66.9","Z68.31","Z87.11","X58.XXXD","S83.91XD","Z86.19","M51.36","M15.9","Z76.89","T81.41XA","T81.31XD","I97.2","G56.91","Z91.89","I51.7","K52.1","Z51.81","K59.03","Z13.820","T81.30XA","X58.XXXA","Y93.9","A41.9","B37.41","C79.9","L76.82","F32.9","Z68.30","Z45.811","Z45.812","Z51.11","G70.89","I63.9","Y95","J18.9","A04.72","R53.1","R47.81","E83.42","D69.6","D53.9","R47.1","D64.81","Z79.891","M25.561","W01.0XXA","R68.89","G89.29","K76.9","R91.1","E11.9","F17.210","Z20.822","I67.82","D61.810","Z72.0","D53.8","T45.1X5D","R10.9","Y83.4","F42.9","R59.1","L76.34","T85.44XA","Z98.86","N64.89","K52.9","F41.1","Z78.9","Z92.21","F32.89","Z68.32","G89.18","Z51.5","Z51.12","K12.0","K12.1","Z40.01","J98.11","R60.0","Z42.1","M12.9","Z79.1","R22.1","S83.91XA","M79.89","Z95.828","M79.604","M79.605","R10.11","D05.92","G89.4","F31.62","R30.0","Z98.890"],"date":["2021-02-26","2019-09-04","2021-04-28","2021-01-22","2021-03-17","2019-11-09","2019-10-13","2019-10-13","2019-10-23","2019-10-13","2019-10-29","2021-05-12","2021-02-11","2021-05-12","2019-12-13","2021-05-12","2021-02-26","2020-01-05","2021-05-03","2021-04-28","2021-01-03","2021-01-03","2021-01-03","2021-02-26","2021-02-11","2021-01-03","2021-03-18","2021-01-08","2021-02-11","2021-01-14","2021-02-11","2021-02-11","2021-04-28","2021-03-18","2021-04-28","2021-03-18","2021-03-18","2021-03-18","2021-05-01","2021-02-26","2021-02-26","2021-02-26","2021-02-26","2021-04-28","2021-04-28","2021-05-02","2021-02-26","2021-04-16","2021-04-28","2021-04-16","2021-04-16","2021-04-16","2021-05-04","2021-04-16","2021-04-16","2021-04-16","2021-05-12","2021-05-12","2021-05-12","2019-09-01","2021-02-09","2019-09-15","2020-01-14","2020-01-14","2021-04-28","2019-11-15","2020-01-14","2021-04-15","2020-01-14","2020-01-14","2019-11-26","2019-11-26","2019-11-26","2019-11-26","2019-12-11","2020-01-14","2020-01-14","2019-12-13","2019-12-13","2020-01-03","2020-01-05","2021-02-11","2021-03-11","2020-01-05","2021-02-01","2020-01-07","2020-01-07","2021-02-11","2021-05-25","2021-05-02","2020-02-01","2020-01-07","2020-01-14","2020-01-14","2020-01-14","2020-01-23","2020-01-23","2020-01-23","2020-02-01","2020-02-01","2020-02-01","2020-02-01","2020-02-12","2020-02-12","2021-01-08","2021-03-24","2021-03-18","2021-03-30","2021-04-28","2021-04-28","2021-04-28","2021-04-28","2021-04-28","2021-04-28","2021-05-02","2021-05-02","2021-05-02","2021-05-02","2021-05-02","2020-02-13","2019-09-13","2019-09-17","2019-09-13","2019-09-14","2019-10-15","2019-09-17","2019-09-13","2019-09-17","2019-10-15","2019-10-15","2019-09-16","2019-10-13","2021-02-11","2019-11-24","2019-11-24","2021-03-17","2020-01-31","2021-05-12","2020-02-13","2020-02-01","2020-02-01","2021-04-28","2019-09-13","2019-09-13","2019-11-24","2019-09-17","2019-09-17","2019-11-09","2020-01-23","2021-02-11","2021-01-08","2021-02-28","2021-02-28","2021-03-01","2021-04-28","2019-10-23","2019-10-15","2019-10-23","2019-12-20","2019-12-20","2019-12-20","2020-02-13","2020-02-13","2020-02-13","2019-10-13","2019-10-13","2019-12-20","2020-01-25","2020-01-26","2021-02-11","2021-02-11","2021-02-11","2021-05-12","2019-11-26","2019-11-24","2019-12-12","2020-02-19","2020-02-19","2019-10-03","2020-01-27","2020-02-13","2020-02-13","2020-02-13","2021-01-08"],"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":[["","70720010102","VARUBI ","TAB 90MG","4","Select","Select",""],["","65862018830","ONDANSETRON ","TAB 8MG","90","Select","Select",""],["","63402030230","LATUDA ","TAB 20MG","30","Select","Select",""],["","42858080201","MORPHINE ","TAB 30MG ER","42","Select","Select",""],["","42858000201","OXYCODONE ","TAB 10MG","126","Select","Select",""],["","70437024018","NERLYNX ","TAB 40MG","180","Select","Select",""],["","51862058001","BUDESONIDE ","CAP 3MG DR","30","Select","Select",""],["","00093762056","LETROZOLE ","TAB 2.5MG","90","Select","Select",""],["","64380080707","IBUPROFEN ","TAB 800MG","30","Select","Select",""],["","16729013716","CLONAZEPAM ","TAB 1MG","90","Select","Select",""],["","67877021905","CEPHALEXIN ","CAP 500MG","40","Select","Select",""],["","62332014131","CELECOXIB ","CAP 100MG","180","Select","Select",""],["","00093220301","METOCLOPRAM ","TAB 10MG","12","Select","Select",""],["","00406051205","OXYCOD\/APAP ","TAB 5-325MG","18","Select","Select",""],["","00536106210","STOOL ","CAP 100MG","30","Select","Select",""],["","55111028130","LEVOFLOXACIN ","750MG","10","Select","Select",""],["","59746011506","PROCHLORPER ","10MG","60","Select","Select",""],["","69618004410","DOCUSATE ","100MG","30","Select","Select",""],["","70000041503","CLEARLAX ","","510","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":""}]}]}