{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"M   ASILYELVARG ","gend":1,"add":"          EVIRD DOOWENIP   301                              ","city":"PEARISBURG                    ","state":"VA","zip":"24134-2472","dob":"1973-07-28","age":"","mstatus":"","insh":"50019545","cliId":"","pno":"9304591684","cno":5406263330,"email":"","ename":"","eno":"","pphy":"STEWART, KNOTRESHA F                                        ","ppno":5408350500,"pcpadd":"28 Town Center Dr,","pcpcity":"Dublin                        ","pcpstate":"VA","pcpzip":240846069,"pcpcounty":"","pcpid":"","pcpname":"RIVER VALLEY HEALTHCARE ASSOCIATES PC","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"LOT 2                                                       ","add3":"","madd1":"103 PINEWOOD DRIVE","madd2":"LOT 2","madd3":"","mcity":"PEARISBURG                    ","mstate":"VA","mzip":"24134-2472","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z79.899","G89.4","N95.1","F31.81","F41.1","F33.2","Z86.59","M54.9","E34.9","F32.9","Z09","R68.89","Z87.898","G47.00","F17.210","M17.31","M16.52","M17.32","M47.817","M54.17","Z68.31","M25.551","W19.XXXA","M25.552","M79.18","W00.0XXA","Y93.89","Y92.9","R51","J45.909","B18.2","R06.02","M79.10","F11.10","F11.20","R52","Z68.29","R30.0","Z68.28","J32.9","E80.20","R11.0","F39","R53.82","R74.8","E66.9","Z63.6","F31.9","B19.20","M25.571","S92.301A","S92.351A","W10.9XXA","Y93.01","Y99.8","S92.351D","S92.354A","S99.191K","Z98.890","L03.116","M79.89","M54.10","R32","R15.9","I10","M54.16","R20.2","R26.9","G89.29","E80.21","M54.2","M54.5","M54.6","W18.39XA","M62.81","M48.061","M51.36","F41.9","J44.9","Z87.81","Z88.0","Z90.710","Z99.3","M48.00","F43.20","R73.9","R73.09","M25.461","M23.91","M25.061","M25.561","Z87.891","S89.91XA","X58.XXXA","M25.569","R19.7","M79.661","M79.669","R22.2","G57.71","M79.604","M54.42","M54.41","R45.89","K21.00","R07.89","R10.13","R13.10","R79.1","R07.9","R91.8","R91.1","R06.2","M51.17","M47.27","K21.9","Z86.010","Z80.0","R19.4","R13.19","D12.3","K22.2","K57.30","K44.9","Z90.49","K20.80","Z68.35","K63.5"],"date":["2021-11-07","2019-05-20","2020-11-20","2021-12-16","2021-12-16","2021-09-08","2021-12-16","2021-12-16","2019-01-18","2020-11-20","2019-01-23","2020-10-29","2019-10-29","2020-11-20","2021-12-20","2019-03-28","2019-04-16","2019-04-16","2019-04-16","2019-02-15","2019-03-26","2020-10-27","2020-06-19","2019-03-05","2019-03-05","2019-03-05","2019-03-05","2020-06-19","2019-03-05","2021-12-20","2019-10-29","2019-03-05","2019-03-06","2019-04-16","2019-05-20","2021-08-06","2019-04-26","2021-03-18","2019-10-17","2019-07-19","2021-11-18","2021-11-18","2019-10-29","2020-01-30","2019-10-29","2020-11-20","2020-11-20","2021-03-17","2021-12-20","2020-06-19","2020-06-19","2020-07-01","2020-06-19","2020-06-19","2020-06-19","2020-07-01","2020-07-01","2020-07-01","2020-07-01","2020-10-04","2021-09-13","2020-10-27","2020-10-28","2020-10-28","2021-12-20","2020-10-29","2020-10-27","2020-10-27","2021-12-27","2020-10-27","2020-10-27","2020-10-27","2020-10-27","2020-10-27","2020-10-27","2020-10-28","2020-10-28","2021-08-06","2020-10-28","2021-05-03","2020-10-28","2020-10-28","2020-10-28","2021-08-06","2021-08-06","2021-07-12","2021-07-12","2021-05-03","2021-05-03","2021-05-03","2021-05-10","2021-11-07","2021-05-03","2021-05-03","2021-07-12","2021-08-19","2021-09-16","2021-09-22","2021-09-13","2021-09-22","2021-10-15","2021-10-15","2021-10-15","2021-10-15","2021-12-20","2021-11-07","2021-12-15","2021-12-20","2021-11-07","2021-11-07","2021-11-07","2021-11-18","2021-11-18","2021-12-27","2021-11-24","2021-12-20","2021-12-20","2021-12-20","2021-12-15","2021-12-15","2021-12-20","2021-12-20","2021-12-20","2021-12-20","2021-12-20","2021-12-20","2021-12-20","2021-12-20"],"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":[["","65162015008","LYLLANA","DIS 0.075MG","8","Select","Select",""],["","70436005902","BUPROPION","TAB 150MG SR","30","Select","Select",""],["","64980043710","ATENOLOL","TAB 25MG","60","Select","Select",""],["","31722071390","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","00254101196","SUCRALFATE","SUS 1GM\/10ML","400","Select","Select",""],["","68968347508","ESTRADIOL","DIS 0.075MG","8","Select","Select",""],["","43547040650","CLONAZEPAM","TAB 0.5MG","56","Select","Select",""],["","65862067705","ALPRAZOLAM","TAB 0.5MG","90","Select","Select",""],["","68382002001","VENLAFAXINE","TAB 50MG","90","Select","Select",""],["","43547035211","LISINOPRIL","TAB 5MG","30","Select","Select",""],["","68462039710","OMEPRAZOLE","CAP 40MG","30","Select","Select",""],["","69097094312","GABAPENTIN","CAP 300MG","28","Select","Select",""],["","68382005005","MELOXICAM","TAB 7.5MG","40","Select","Select",""],["","72606050902","FAMOTIDINE","TAB 20MG","30","Select","Select",""],["","00378351501","MIRTAZAPINE","TAB 15MG","30","Select","Select",""],["","80777027310","MODERNA","INJ COVID-19","0.5","Select","Select",""],["","00054022125","QUETIAPINE","TAB 100MG","30","Select","Select",""],["","33342007007","OLANZAPINE","TAB 10MG","30","Select","Select",""],["","00186037020","SYMBICORT","AER 160-4.5","10.2","Select","Select",""],["","10702000350","PROMETHAZINE","TAB 25MG","12","Select","Select",""],["","68382080510","TRAZODONE","TAB 50MG","90","Select","Select",""],["","00143992801","CIPROFLOXACN","TAB 500MG","14","Select","Select",""],["","64980015603","RISAQUAD-2","CAP ","30","Select","Select",""],["","68180031902","BUPROPN","TAB 150MG XL","30","Select","Select",""],["","79854007941","VITAMIN","0 UNIT TAB","90","Select","Select",""],["","11917010573","PROBIOTIC","CAP SUPER","30","Select","Select",""],["","52817032010","BACLOFEN","TAB 10MG","30","Select","Select",""],["","68180012101","CEPHALEXIN","CAP 250MG","15","Select","Select",""],["","00406012301","HYDROCO\/APAP","TAB 5-325MG","15","Select","Select",""],["","00143314250","DOXYCYCL","CAP 100MG","20","Select","Select",""],["","00093553901","ESZOPICLONE","TAB 3MG","30","Select","Select",""],["","00006483703","PNEUMOVAX","INJ 25\/0.5","0.5","Select","Select",""],["","49281041950","FLUZONE","INJ 2019-20","0.5","Select","Select",""],["","45802065087","LORATADINE","TAB 10MG","30","Select","Select",""],["","49100040007","CULTURELLE","CAP ","30","Select","Select",""],["","12496120803","SUBOXONE","MIS 8-2MG","9","Select","Select",""],["","68462010530","ONDANSETRON","TAB 4MG","15","Select","Select",""],["","69238110305","IBUPROFEN","TAB 800MG","40","Select","Select",""],["","65862001305","SERTRALINE","TAB 100MG","60","Select","Select",""],["","64764024060","AMITIZA","CAP 24MCG","30","Select","Select",""],["","68462024805","RANITIDINE","TAB 150MG","60","Select","Select",""],["","59746012106","MECLIZINE","TAB 25MG","30","Select","Select",""],["","00069046903","CHANTIX","PAK 1MG","56","Select","Select",""],["","47335030888","ZOLPIDEM","TAB 12.5MG","30","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","14","Select","Select",""],["","00904645760","DOK","CAP 100MG","60","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":""}]}]}