{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"E   YORTRABNUD ","gend":0,"add":"TNUOM 9933DAOR YOJ ","city":"BUCHANAN                      ","state":"VA","zip":"24066-4651","dob":"1977-04-30","age":"","mstatus":"","insh":"50012054","cliId":"","pno":"5504577446","cno":5408753301,"email":"","ename":"","eno":"","pphy":"HABIB, ROY","ppno":5407723490,"pcpadd":"1900 Electric Rd,","pcpcity":"Salem                         ","pcpstate":"VA","pcpzip":241537474,"pcpcounty":"","pcpid":"","pcpname":"LEWIS GALE PHYSICIANS LLC","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"3399 MOUNT JOY ROAD","add3":"","madd1":"3399 MOUNT JOY ROAD","madd2":"                                                            ","madd3":"","mcity":"BUCHANAN                      ","mstate":"VA","mzip":"24066-4651","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E29.1","R68.89","J98.01","G43.909","Z72.0","E03.9","M25.50","K52.9","Z87.820","K62.5","R19.7","R63.4","E23.0","N52.8","E78.1","F41.8","G89.4","M54.9","K22.70","K21.9","G47.00","M54.5","K64.4","F17.220","Z79.899","R94.31","E34.9","E78.2","F41.9","F31.61","E55.9","F17.200","Z83.71","G43.009","F51.01","F12.10","F41.1","D12.0","D12.2","D12.3","D12.4","D12.5","K63.5","K92.2","Z80.0","K52.89","R35.1","K90.41","M79.605","M25.562","W19.XXXA","M25.572","R10.84","R16.1","D12.6","R10.10","R30.0","Z91.19","Z23","R31.9","R42","T50.905A","Z87.891","T65.291A","R44.2","R06.89","R45.7","E78.5","F32.9","Z00.00","R79.89","D48.5","L72.0","S61.213A","S69.92XA","R10.9","R35.0","R39.11","R32","R39.9","N40.0","G89.29","M79.645","M79.89","R52","M79.646","R60.9","S62.601A","S61.432A","W29.4XXA","W45.0XXA","S62.661A","M79.672","L84","F32.A","F99","R45.851","I10","Z20.822","F31.0","F33.2","F10.20","F31.9","F09","K64.9","K64.8"],"date":["2020-01-15","2021-02-15","2019-02-26","2019-02-26","2019-02-26","2019-03-11","2019-03-11","2019-07-23","2019-03-11","2019-03-27","2020-11-13","2021-04-22","2020-01-09","2020-01-09","2020-11-13","2019-11-10","2019-11-10","2019-03-26","2019-03-26","2021-12-03","2019-03-26","2021-04-26","2021-12-08","2021-12-08","2021-12-01","2019-03-26","2019-10-01","2019-10-01","2021-12-02","2019-10-17","2020-11-13","2020-11-13","2019-06-13","2019-06-13","2019-06-13","2021-12-03","2019-06-24","2019-07-23","2019-07-23","2019-07-23","2019-07-23","2019-07-23","2019-07-23","2019-07-23","2019-11-11","2019-07-23","2021-04-26","2020-11-13","2019-11-10","2019-11-10","2019-11-10","2019-11-10","2019-11-13","2019-11-13","2019-11-11","2019-11-13","2020-11-13","2020-11-13","2021-04-02","2020-11-14","2020-11-14","2020-11-14","2021-12-02","2020-11-14","2020-11-14","2020-11-14","2020-11-14","2021-01-13","2021-12-01","2021-01-13","2021-01-13","2021-03-25","2021-04-27","2021-04-02","2021-09-12","2021-04-26","2021-04-26","2021-04-22","2021-04-22","2021-04-26","2021-04-26","2021-04-26","2021-05-12","2021-05-12","2021-12-08","2021-05-12","2021-05-12","2021-05-12","2021-05-12","2021-05-12","2021-05-12","2021-05-12","2021-09-09","2021-09-09","2021-12-01","2021-12-01","2021-12-02","2021-12-01","2021-12-01","2021-12-04","2021-12-04","2021-12-04","2021-12-02","2021-12-02","2021-12-08","2021-12-10"],"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":[["","69097082112","GEMFIBROZIL","TAB 600MG","60","Select","Select",""],["","00904615760","VITAMIN","TAB 2000UNIT","30","Select","Select",""],["","62175061743","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","57237001401","TAMSULOSIN","CAP 0.4MG","30","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","16","Select","Select",""],["","00536123441","ASPIRIN","TAB 81MG EC","28","Select","Select",""],["","50428016183","CVS","CAP 2000UNIT","30","Select","Select",""],["","40093010231","VIT","CAP 2000UNIT","30","Select","Select",""],["","16571020106","DICLOFENAC","TAB 75MG DR","20","Select","Select",""],["","62559043130","HYDROCORTISO","CRE 0.025","30","Select","Select",""],["","00093221001","SUCRALFATE","TAB 1GM","120","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","15","Select","Select",""],["","68180065208","DOXYCYC","CAP 100MG","14","Select","Select",""],["","00135050802","NICORETTE","LOZ 2MG MINT","81","Select","Select",""],["","42806008301","BUSPIRONE","TAB 7.5MG","60","Select","Select",""],["","13668013601","ESCITALOPRAM","TAB 10MG","30","Select","Select",""],["","80777027398","MODERNA","INJ COVID-19","0.5","Select","Select",""],["","16729013716","CLONAZEPAM","TAB 1MG","90","Select","Select",""],["","50428029742","FISH","CAP 1000MG","60","Select","Select",""],["","43547034106","RISPERIDONE","TAB 1MG","30","Select","Select",""],["","69097083412","SERTRALINE","TAB 50MG","30","Select","Select",""],["","08290309637","LUER-LOK","MIS 1ML\/20G","4","Select","Select",""],["","69367016304","PHENAZOPYRID","TAB 200MG","6","Select","Select",""],["","57237023305","SMZ-TMP","TAB 800-160","14","Select","Select",""],["","14539067401","HYDROXYZ","CAP 25MG","30","Select","Select",""],["","00143965901","TESTOST","INJ 200MG\/ML","4","Select","Select",""],["","50111064801","FLUOXETINE","CAP 20MG","30","Select","Select",""],["","00781148710","AMITRIPTYLIN","TAB 25MG","30","Select","Select",""],["","67877057301","BENZONATATE","CAP 100MG","20","Select","Select",""],["","00054001829","PREDNISONE","TAB 20MG","10","Select","Select",""],["","65862052305","GABAPENTIN","TAB 600MG","90","Select","Select",""],["","00536589688","NICOTINE","DIS 21MG\/24H","28","Select","Select",""],["","00781261305","AMOXICILLIN","CAP 500MG","4","Select","Select",""],["","10702025350","BUT\/APAP\/CAF","TAB ","30","Select","Select",""],["","51672127502","CLOTRIMAZOLE","CRE 0.01","30","Select","Select",""],["","64764017530","DEXILANT","CAP 60MG DR","30","Select","Select",""],["","70461031903","FLUCLVX","INJ 2019-20","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":""}]}]}