{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" I HTIAFNOTSELGGE","gend":1,"add":" 394 XOB OP ","city":"MONETA ","state":"VA","zip":"24121-0493","dob":"1994-03-18","age":"","mstatus":"","insh":"30010007","cliId":"","pno":"2404536045","cno":"","email":"","ename":"","eno":"","pphy":"NEVIN, MARC G ","ppno":5402970023,"pcpadd":"1308 W Main St , ","pcpcity":"Salem ","pcpstate":"VA","pcpzip":241534708,"pcpcounty":"","pcpid":"","pcpname":"LONG TERM CARE OF AMERICA VIRGINIA INC","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"PO BOX 493 ","add3":"","madd1":"PO BOX 493 ","madd2":"P O BOX 493 ","madd3":"","mcity":"MONETA ","mstate":"VA","mzip":"24121-0493","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R10.13","R68.81","R19.7","Z94.0","R10.9","J45.909","Z79.899","Z23","D58.2","N25.89","I15.1","E80.6","E53.8","N28.89","N18.6","R41.840","E83.42","D56.1","R10.33","K21.9","E03.9","Z11.59","E66.9","Z68.39","Z12.4","Z11.51","D22.5","Z12.83","L90.5","D22.9","Z00.00","H47.323","D64.2","D64.9","I10","E87.6","D84.9","M25.571","S93.401A","X50.1XXA","M79.661","S86.891A","Z29.8","Z71.85","E55.9","S89.92XA","Z94.4","S60.212A","S69.92XA","W22.8XXA","J02.9","R50.9","H69.80","J32.9","R10.32","R16.1","R59.0","R68.89","Q82.5","E78.5","E21.3","N28.1","N18.5","Z71.89","J11.1","Z88.0","S86.912A","K52.9","S86.812A","M25.562","M22.8X2","M25.362","Z68.36","Z01.89","M62.81","M25.662","M79.642","M79.89","M79.645","F41.9","Z01.419","Q68.2"],"date":["2022-11-27","2020-06-23","2020-10-23","2022-11-02","2022-04-08","2022-07-20","2022-04-13","2021-10-28","2022-10-18","2020-01-15","2020-01-15","2020-01-15","2020-01-15","2020-01-15","2020-06-23","2020-03-26","2021-07-08","2022-10-18","2020-06-23","2020-06-23","2020-06-23","2020-06-23","2022-06-17","2020-06-23","2020-06-26","2020-06-26","2021-07-16","2020-07-08","2020-07-08","2021-07-16","2020-09-24","2022-04-12","2022-10-18","2022-07-20","2022-06-22","2021-07-08","2021-07-16","2021-10-24","2021-10-21","2021-10-21","2021-10-24","2021-10-24","2021-10-28","2021-10-28","2021-10-28","2022-04-06","2019-01-07","2019-01-17","2019-01-17","2022-04-06","2019-12-15","2019-02-06","2019-02-06","2019-04-03","2019-02-17","2019-02-17","2019-02-17","2019-03-27","2019-07-03","2019-09-03","2019-09-03","2019-07-11","2019-07-18","2019-11-20","2019-12-15","2019-12-15","2022-04-06","2022-04-08","2022-04-10","2022-12-06","2022-06-17","2022-12-06","2022-06-17","2022-06-17","2022-08-31","2022-08-31","2022-07-20","2022-07-20","2022-07-20","2022-07-20","2022-10-04","2022-12-06"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}}]},{"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":[]},{"a":[]},{"a":{"indx":[false,false],"comment":["",""],"score":["",""]}},{"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":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","64380073706","VITAMIN","CAP 50000UNT","4","Select","Select",""],["","00378420178","MYCOPHENOLIC","TAB 180MG DR","90","Select","Select",""],["","51525011501","HYOSCYAMINE","TAB 0.375 ER","60","Select","Select",""],["","","FOLIC","TAB 1MG","30","Select","Select",""],["","69097012715","AMLODIPINE","TAB 5MG","90","Select","Select",""],["","70377001511","TACROLIMUS","CAP 1MG","210","Select","Select",""],["","68462015713","ONDANSETRON","TAB 4MG ODT","12","Select","Select",""],["","65862056090","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","00054472831","PREDNISONE","TAB 5MG","30","Select","Select",""],["","69097052444","DICLOFENAC","GEL 0.01","200","Select","Select",""],["","80777027310","MODERNA","INJ COVID-19","0.5","Select","Select",""]]}},{"a":[]},{"a":[]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":[]}]},{"t":"Mini-Cog","q":[{"a":[]},{"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":"","a13":""}]}]}