{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"  SAMOHTBBURG R ","gend":0,"add":"DN2 5272EUNEVA ","city":"BIG STONE GAP                 ","state":"VA","zip":"24219-3733","dob":"1947-04-12","age":"","mstatus":"","insh":"30018629","cliId":"","pno":"2567284413","cno":2765247448,"email":"","ename":"","eno":"","pphy":"BURNS, LAUREN BARBARA","ppno":2765236715,"pcpadd":"1990 Holton Ave E,","pcpcity":"Big Stone Gap                 ","pcpstate":"VA","pcpzip":242193350,"pcpcounty":"","pcpid":"","pcpname":"WELLMONT MEDICAL ASSOCIATES INC","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"SOUTHWEST","aligned":"","ano":"","add2":"2725 2ND AVENUE","add3":"","madd1":"2725 2ND AVENUE","madd2":"APT E","madd3":"","mcity":"BIG STONE GAP                 ","mstate":"VA","mzip":"24219-3733","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I10","E11.9","E03.9","F41.1","Z13.9","E78.2","Z71.89","Z13.89","Z00.8","G47.9","Z96.1","H40.013","D31.31","E11.65","H17.9","Z23","L03.116","M79.673","M79.672","E66.9","L97.509","E11.621","F17.200","F20.9","Z12.5","D64.9","R53.82","R26.81","R47.81","R29.810","G11.8","R62.50","F84.0","I67.82","D32.9","E78.5","R21","E11.42","E11.51","K92.2","K92.1","R19.7","E07.9","R19.5","D50.9","K21.9","Z01.818","Z20.822","K22.70","E78.00","Z79.82","Z79.899","Z79.02","Z79.84","B35.1","R07.9","I50.20","I25.10"],"date":["2021-12-02","2021-09-16","2021-09-16","2019-03-20","2021-03-23","2021-12-02","2021-03-23","2021-03-23","2021-03-23","2020-11-23","2019-07-22","2019-07-22","2019-07-22","2021-12-02","2019-07-22","2019-09-25","2019-12-20","2019-12-20","2019-12-20","2019-12-20","2019-12-20","2019-12-20","2020-01-08","2021-03-23","2020-11-23","2021-07-09","2021-02-11","2021-12-10","2021-02-12","2021-02-12","2021-02-12","2021-02-12","2021-02-12","2021-02-12","2021-02-12","2021-09-16","2021-03-23","2021-11-02","2021-11-02","2021-05-20","2021-07-09","2021-05-20","2021-05-20","2021-07-09","2021-05-27","2021-07-09","2021-07-06","2021-07-09","2021-07-09","2021-07-09","2021-07-09","2021-09-16","2021-07-09","2021-07-09","2021-11-02","2021-10-14","2021-10-14","2021-10-14"],"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":[]},{"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":[["","68462011944","FLUCONAZOLE","TAB 150MG","1","Select","Select",""],["","00832046515","NYAMYC","POW 100000","15","Select","Select",""],["","51672127501","CLOTRIMAZOLE","CRE 0.01","30","Select","Select",""],["","42806054701","VITAMIN","CAP 1.25MG","4","Select","Select",""],["","64980051501","OFLOXACIN","DRO 0.3% OP","10","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","Select","Select",""],["","00536123441","ASPIRIN","TAB 81MG EC","60","Select","Select",""],["","70010006510","METFORMIN","TAB 1000MG","60","Select","Select",""],["","00536130723","OLOPATADINE","SOL 0.002","2.5","Select","Select",""],["","65862056090","PANTOPRAZOLE","TAB 40MG","90","Select","Select",""],["","00310654004","BYDUREON","INJ 2\/0.85ML","3.4","Select","Select",""],["","72205002490","ATORVASTATIN","TAB 40MG","30","Select","Select",""],["","52817029110","OXAZEPAM","CAP 15MG","30","Select","Select",""],["","69367022001","SOD","TAB 1GM","15","Select","Select",""],["","65862006401","METOPROL","TAB 100MG","90","Select","Select",""],["","31722070010","LOSARTAN","TAB 25MG","90","Select","Select",""],["","65862035705","CLOPIDOGREL","TAB 75MG","90","Select","Select",""],["","00002143380","TRULICITY","INJ 0.75\/0.5","2","Select","Select",""],["","16714079901","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","00597015390","JARDIANCE","TAB 25MG","30","Select","Select",""],["","00378911293","NITROGLYCER","DIS 0.4MG\/HR","90","Select","Select",""],["","00527328443","LEVOTHYROXIN","TAB 100MCG","90","Select","Select",""],["","16714004901","CHLORPROMAZ","TAB 50MG","90","Select","Select",""],["","16714000901","ISOSORB","TAB 20MG","120","Select","Select",""],["","16729000615","SIMVASTATIN","TAB 40MG","90","Select","Select",""],["","49348098023","SM","TAB 81MG EC","60","Select","Select",""],["","99073013001","FREESTYLE    MIS LANCETS","MIS LANCETS","100","Select","Select",""],["","99073070827","FREESTYLE    TES LITE","TES LITE","100","Select","Select",""],["","68382080601","TRAZODONE","TAB 100MG","90","Select","Select",""],["","16714089601","GLIPIZIDE","TAB 10MG","180","Select","Select",""],["","49281012165","FLUZONE","INJ 2021-22","0.7","Select","Select",""],["","16714029904","AMOXICILLIN","CAP 500MG","15","Select","Select",""],["","99073070805","FREESTYLE    MIS LITE","MIS LITE","1","Select","Select",""],["","00006057762","JANUMET","TAB 50-1000","60","Select","Select",""],["","36800022462","ANTI-DIARRHE","TAB 2MG","30","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","00113222462","LOPERAMIDE","TAB 2MG","24","Select","Select",""],["","65862018601","CLINDAMYCIN","CAP 300MG","30","Select","Select",""],["","00085113204","PROVENTIL","AER HFA","6.7","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":""}]}]}