{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"F LEINADKCIREDER","gend":0,"add":"AS DLO 02262DAOR SKROWTL","city":"ABINGDON","state":"VA","zip":"24210-9310","dob":"1972-11-01","age":"","mstatus":"","insh":"50012949","cliId":"","pno":"5767295419","cno":"","email":"","ename":"","eno":"","pphy":"CLAMPITT, ROBERT V","ppno":2767837167,"pcpadd":"1020 Terrace Dr, Ste 100","pcpcity":"Marion","pcpstate":"VA","pcpzip":243544392,"pcpcounty":"","pcpid":"","pcpname":"FAMILY PHYSICIANS OF MARION","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"SOUTHWEST","aligned":"","ano":"","add2":"","add3":"","madd1":"26220 OLD SALTWORKS ROAD","madd2":"","madd3":"","mcity":"ABINGDON","mstate":"VA","mzip":"24210-9310","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F43.10","I10","H92.01","F10.10","R63.5","G89.29","M25.511","R19.7","R11.2","R35.1","J01.90","L50.1","R42","S49.91XA","R60.9","W19.XXXA","Y93.9","Y92.9","S43.401A","F90.9","Z72.0","X58.XXXA","M54.6","S23.3XXA","S29.9XXA","X50.0XXA","Z79.899","F17.210","X50.1XXA","I21.19","R07.89","R07.2","I50.9","I11.0","I34.0","Z88.0","E66.9","Z71.6","I21.3","R07.9","I21.4","I21.9","I25.10","F17.200","Z99.81","R10.84","Z95.5","I25.2","F15.11","J98.4","R06.02","E78.5","Z68.42","Z95.1","Z79.82","G47.30","E66.01","F90.1","R61","Z74.3","F91.8","R09.89","E78.00","N52.9","R53.1","M79.89","M54.50","R30.0","N39.0","J02.9","G47.34","F90.0","H65.193","Z71.89","F32.9","F15.20","F41.9","Z11.59"],"date":["2020-07-16","2021-12-15","2020-01-15","2020-01-15","2020-06-25","2020-07-16","2020-07-16","2020-01-15","2020-01-15","2020-01-15","2020-07-16","2020-01-17","2020-01-17","2020-01-17","2022-02-25","2020-01-17","2020-01-17","2020-01-17","2020-01-17","2020-06-21","2020-06-07","2020-01-17","2020-02-15","2020-02-15","2020-02-15","2020-02-15","2020-08-14","2020-08-14","2020-02-15","2020-06-07","2020-08-14","2020-06-07","2020-06-07","2020-06-07","2020-06-08","2020-06-21","2020-06-21","2020-06-25","2020-06-07","2020-08-14","2020-06-07","2020-06-08","2020-08-14","2020-06-07","2020-06-07","2020-06-07","2020-06-08","2020-08-14","2020-06-15","2020-06-21","2020-08-14","2020-08-14","2020-06-21","2020-06-21","2020-08-14","2020-06-25","2020-06-25","2020-07-16","2020-08-14","2020-08-14","2021-12-10","2021-12-13","2021-12-13","2021-12-13","2022-02-25","2022-02-25","2022-02-25","2022-02-25","2022-03-02","2019-01-17","2019-05-27","2019-02-20","2019-02-20","2019-06-19","2019-08-29","2019-08-29","2019-08-29","2021-12-13"],"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":[["","57664016758","METOPROL","TAB 100MG","60","Select","Select",""],["","69097012815","AMLODIPINE","TAB 10MG","30.00","Select","Select",""],["","68382013201","TAMSULOSIN","CAP 0.4MG","30","Select","Select",""],["","42806031250","DOXYCYCL","TAB 100MG","20","Select","Select",""],["","55111012305","ATORVASTATIN","TAB 40MG","30","Select","Select",""],["","68180098003","LISINOPRIL","TAB 10MG","30","Select","Select",""],["","00904679480","ASPIRIN","CHW 81MG","30","Select","Select",""],["","00186077760","BRILINTA","TAB 90MG","60","Select","Select",""],["","16729021816","CLOPIDOGREL","TAB 75MG","30","Select","Select",""],["","00406012405","HYDROCO\/APAP","TAB 7.5-325","12","Select","Select",""],["","16571040250","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","29300012810","HYDROCHLOROT","TAB 25MG","30","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","00363021807","ASPIRIN-81","CHW 81MG","30","Select","Select",""],["","52817033200","CYCLOBENZAPR","TAB 10MG","15","Select","Select",""],["","64380080707","IBUPROFEN","TAB 800MG","30","Select","Select",""],["","00781577626","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","00135024202","NICORETTE","GUM 4MGFRUIT","100.00","Select","Select",""],["","00904681552","MUCUS","TAB 400MG","14","Select","Select",""],["","00363042816","NICOTINE","GUM 2MG MINT","320","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","20.00","Select","Select",""],["","66689000802","NYSTATIN","SUS 100000","120.00","Select","Select",""],["","00093221001","SUCRALFATE","TAB 1GM","120.00","Select","Select",""],["","20525096956","DIGESTIVE","CHW PRE+PRO","48.00","Select","Select",""],["","68462010430","FLUCONAZOLE","TAB 200MG","14.00","Select","Select",""],["","00228212710","CLONIDINE","TAB 0.1MG","60.00","Select","Select",""],["","39423044048","FLORAJEN","CAP DIGESTIO","30.00","Select","Select",""],["","66993068530","OLANZAPINE","TAB 20MG","30","Select","Select",""],["","00228259711","INDAPAMIDE","TAB 1.25MG","30","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","10702010101","METHYLPHENID","TAB 10MG","90","Select","Select",""],["","33332031901","AFLURIA","INJ 2019-20","0.5","Select","Select",""],["","59267100002","PFIZER","INJ COVID-19","0.3","Select","Select",""],["","60505036301","OFLOXACIN","DRO 0.3%OTIC","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":""}]}]}