{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   ANIRTAKENILKCIW L","gend":1,"add":"SORLEM 8303WN EUNEVA E","city":"ROANOKE","state":"VA","zip":"24017-5924","dob":"1967-01-29","age":"","mstatus":"","insh":"60016875","cliId":"","pno":"2304590729","cno":5409778553,"email":"","ename":"","eno":"","pphy":"PAGAN, ELVIS R","ppno":5402243870,"pcpadd":"615 McDowell Ave NW, ","pcpcity":"Roanoke","pcpstate":"VA","pcpzip":240161225,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"APT 408","add3":"","madd1":"3038 MELROSE AVENUE NW","madd2":"APT 408","madd3":"","mcity":"ROANOKE","mstate":"VA","mzip":"24017-5924","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F31.63","J40","J44.9","B37.3","E66.9","A41.9","J18.9","Z66","J96.01","J44.0","J44.1","F31.89","F17.210","E87.6","G40.909","F41.9","M41.9","E87.70","K59.00","Z86.73","I73.9","R91.8","R06.02","Z72.0","M54.9","I08.1","I50.9","R09.02","R68.89","F11.20","F11.23","R11.2","M79.7","K21.9","F11.24","G89.29","F31.9","Z88.1","Z88.8","Z91.5","Z79.899","F19.94","F23","Z09","F31.0","M54.5","G89.4","Z79.891","F31.32","F10.24","F31.30","F14.20","I25.10","Z79.1","Z79.2","F19.10","F32.9","F10.10","F31.76","F10.94","F10.20","L73.2","F33.2","G47.9","F43.20","L02.419","L98.492","M65.4","E66.01","M12.572","M25.571","M25.572","M47.819","M51.36","M47.816","M19.071","F10.21","F14.10","F54","F51.04","R68.2","R10.9","Z87.19","Z80.3","Z68.39","Z01.419","Z12.31","Z20.828","E55.9","M25.561","N39.46","M25.562","L97.321","M19.172","L97.329","Z96.653","Z96.652","Z96.651","A59.01","Z11.3","Z11.8","R39.81","K43.2","L98.7","Z68.31","R10.2","K43.9","R26.9","G47.00","M25.551","M25.552","Z90.49","K58.1","Z86.010","K64.8","R56.9","Z86.19","Z12.11","M43.17","R20.0","R20.2","Z53.21","F17.200","H93.8X9","B35.1","R10.31","R10.32","D35.01","K44.9","R11.0","R26.2","M62.81","E65","K57.30","J43.9","Z68.32","Z20.822","Q43.8","F33.0","Z80.9","H91.90","R09.81","R51.9","H93.8X3","R49.0","R13.10","I11.0","F20.9","F41.1","G43.909","H90.3","E87.1","R41.0","Y90.0","Z68.41","R63.1","F43.12","R53.81","M79.18","Z23","F20.0","F31.60","Z91.19","K59.09","F31.4","R45.851","F15.10","B19.20","D75.839","F12.20","F90.9","K58.9","M62.08","K43.0","Y83.8","K91.840","K66.0","Z68.29","K91.89","L76.22","K94.23","R06.00","J98.4","T81.41XA","I26.93","E46","B00.2","T81.49XA","T81.43XA","I26.99","D64.9","D50.9","N76.0","R30.0","J98.11","R41.82","I51.7","I77.1","R40.20","T40.2X1A","T40.601A","R40.2342","R40.2112","R40.2222","Z96.659","M62.838","M70.61","M16.11","M17.11","M47.14","R26.89","F11.90","X58.XXXA","Y92.89","F11.10","Z53.29","G43.801","T50.904A","T88.7XXA","B37.0","R63.5","R73.09","G40.901","E87.2","E88.89","E53.8","G62.9","G93.40","G93.49","R82.4","E16.2","Z86.59","Z87.898","R05","R10.33","R11.10","W19.XXXA","M40.00","K59.03","T40.2X5A","G60.9","G43.719","F14.11","K64.9","L02.412","N90.89","L29.0","R63.4","Z71.3","K21.0","J45.909","M19.90","K29.50","Z01.818","K22.8"],"date":["2021-04-19","2020-08-06","2022-03-06","2020-01-23","2022-02-21","2022-03-07","2020-02-01","2020-01-26","2020-02-01","2020-01-26","2020-01-26","2020-01-26","2022-01-12","2022-03-07","2022-02-08","2022-03-06","2022-04-01","2020-01-26","2022-03-07","2022-01-12","2020-01-26","2020-01-26","2020-01-26","2022-02-21","2022-01-15","2020-01-27","2022-03-07","2022-03-07","2020-03-10","2021-11-09","2020-03-31","2020-03-03","2020-03-04","2022-03-06","2020-03-04","2022-01-26","2021-11-08","2022-03-06","2022-02-21","2020-03-04","2021-12-01","2020-03-10","2020-03-04","2020-03-13","2022-01-25","2021-08-16","2020-03-26","2020-03-26","2021-01-06","2020-05-03","2022-04-08","2022-02-14","2020-05-03","2020-05-03","2020-05-03","2021-01-06","2020-05-03","2020-05-03","2022-02-14","2021-11-09","2021-11-09","2020-05-05","2021-01-06","2021-01-06","2021-01-06","2020-06-08","2020-06-08","2020-06-16","2020-08-27","2021-11-19","2021-04-07","2020-07-01","2021-11-15","2021-11-15","2022-01-26","2021-11-19","2021-11-08","2020-08-27","2020-08-27","2020-10-13","2020-10-13","2022-04-03","2020-10-26","2020-10-26","2020-10-26","2020-10-26","2020-10-26","2022-01-12","2021-04-02","2021-09-14","2021-04-02","2021-09-14","2021-05-07","2021-05-07","2021-04-21","2021-07-30","2021-05-06","2021-05-06","2021-05-17","2021-07-07","2021-07-07","2022-04-01","2022-02-21","2022-02-21","2022-02-17","2021-07-07","2022-02-21","2021-09-14","2022-03-06","2021-07-30","2021-07-30","2021-08-23","2021-08-05","2021-09-16","2021-08-05","2022-01-25","2021-09-15","2021-09-16","2021-08-09","2021-09-07","2021-09-07","2021-08-16","2022-03-06","2021-08-17","2021-08-17","2021-08-23","2021-08-23","2021-08-23","2021-08-23","2021-08-23","2021-09-14","2021-09-14","2022-02-21","2021-09-16","2021-09-15","2021-09-15","2022-02-21","2021-09-16","2021-09-24","2021-09-24","2021-10-26","2021-10-26","2021-10-26","2021-10-26","2021-10-26","2021-10-26","2021-09-28","2021-09-28","2021-09-28","2021-09-28","2021-10-26","2022-01-12","2021-11-08","2021-11-08","2021-11-08","2021-11-08","2022-02-14","2021-11-08","2022-01-26","2021-12-01","2021-12-17","2022-01-12","2022-03-06","2022-01-13","2022-02-08","2022-02-08","2022-02-08","2022-02-08","2022-02-08","2022-02-08","2022-02-08","2022-02-08","2022-02-21","2022-02-21","2022-02-21","2022-02-21","2022-02-21","2022-02-21","2022-02-22","2022-02-23","2022-03-06","2022-03-06","2022-03-06","2022-03-06","2022-03-06","2022-03-07","2022-03-06","2022-03-06","2022-03-07","2022-03-08","2022-03-07","2022-03-07","2019-01-04","2019-01-04","2019-01-18","2019-05-21","2019-01-18","2019-01-18","2019-01-18","2019-03-19","2019-01-19","2019-01-19","2019-01-19","2019-01-19","2019-01-19","2019-11-14","2019-04-11","2019-04-11","2019-04-11","2019-04-01","2019-04-01","2019-03-19","2019-03-19","2019-03-19","2019-03-19","2019-03-19","2019-03-19","2019-03-19","2019-03-19","2019-04-18","2019-04-30","2019-04-30","2019-05-22","2019-05-22","2019-05-21","2019-05-22","2019-05-21","2019-05-22","2019-05-20","2019-05-20","2019-05-22","2019-05-21","2019-05-21","2019-05-21","2019-06-23","2019-06-23","2019-07-11","2019-11-14","2019-08-13","2019-07-30","2019-09-17","2019-09-17","2019-09-17","2019-08-13","2019-08-15","2019-08-20","2019-08-20","2019-09-03","2019-11-26","2019-12-13","2019-12-13","2019-12-13","2019-12-13","2019-12-13","2019-12-13"],"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":[["","29300011405","LAMOTRIGINE","TAB 200MG","30","Select","Select",""],["","50111056101","TRAZODONE","TAB 100MG","60","Select","Select",""],["","48582000336","BIOTENE","LIQ DRY MTH","473","Select","Select",""],["","63402030430","LATUDA","TAB 40MG","30","Select","Select",""],["","43547022406","LEVETIRACETA","TAB 1000MG","60","Select","Select",""],["","50111033401","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","65162068090","PROMETHAZINE","SOL DM","360","Select","Select",""],["","14539067501","HYDROXYZ","CAP 50MG","120","Select","Select",""],["","43598029490","PREGABALIN","CAP 100MG","90","Select","Select",""],["","00536252525","CAPSAICIN","CRE 0.00025","120","Select","Select",""],["","37864090901","VITAMIN","TAB 50MG","120","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","23155022701","ACYCLOVIR","TAB 400MG","60","Select","Select",""],["","57896053101","ONE","TAB MINERALS","30","Select","Select",""],["","40985021151","B-1","TAB 100MG","30","Select","Select",""],["","40985027503","MELATONIN","SUB 10MG","30","Select","Select",""],["","00536118399","FLUTICASONE","SPR 50MCG","9.9","Select","Select",""],["","43547040211","FUROSEMIDE","TAB 40MG","30","Select","Select",""],["","16729020301","BUSPIRONE","TAB 15MG","120","Select","Select",""],["","00143312601","DICYCLOMINE","CAP 10MG","270","Select","Select",""],["","62175044231","POLYETH","POW 3350 NF","527","Select","Select",""],["","75826011410","PHENAZOPYRID","TAB 100MG","10","Select","Select",""],["","59011044010","OXYCONTIN","TAB 40MG CR","60","Select","Select",""],["","68382060001","POT  CHLORIDE","TAB 10MEQ ER","30","Select","Select",""],["","00487020160","IPRATROPIUM\/","SOL ALBUTER","180","Select","Select",""],["","57896045501","SENNA","TAB 8.6-50MG","60","Select","Select",""],["","60505025203","TIZANIDINE","TAB 4MG","60","Select","Select",""],["","63824000834","MUCINEX","TAB 600MG ER","30","Select","Select",""],["","00228212750","CLONIDINE","TAB 0.1MG","90","Select","Select",""],["","24658031205","DOXYCYCL","TAB 100MG","14","Select","Select",""],["","51991074890","DULOXETINE","CAP 60MG","30","Select","Select",""],["","49483060450","IBUPROFEN","TAB 800MG","90","Select","Select",""],["","13668042905","PANTOPRAZOLE","TAB 40MG","60","Select","Select",""],["","65162019010","NAPROXEN","TAB 500MG","60","Select","Select",""],["","59651017301","DOXEPIN","CAP 10MG","30","Select","Select",""],["","00395100392","GENTIAN","SOL 0.01","59","Select","Select",""],["","59779027953","HEMORRHOIDAL","SUP ","24","Select","Select",""],["","00132030140","FLEET","ENE ","399","Select","Select",""],["","59779045806","CVS","TAB 10MG","69","Select","Select",""],["","70954001910","PRAZOSIN","CAP 1MG","30","Select","Select",""],["","62332009730","ARIPIPRAZOLE","TAB 2MG","30.00","Select","Select",""],["","65162053650","BENZONATATE","CAP 100MG","30","Select","Select",""],["","68180016013","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","00904678744","MAG","SOL LEMON","888","Select","Select",""],["","43386031214","GAVILAX","POW ","510","Select","Select",""],["","50428041924","ACETAMINOPHN","TAB 500MG","120","Select","Select",""],["","00536114397","PETROLATUM","OIN 0.42","200","Select","Select",""],["","86790016280","BENEFIBER","POW THE GO","84","Select","Select",""],["","00904198760","MAPAP","CAP 500MG","100","Select","Select",""],["","49100040007","CULTURELLE","CAP ","30","Select","Select",""],["","43386035801","HYDROCO\/APAP","TAB 10-325MG","15.00","Select","Select",""],["","51672400305","NORTRIPTYLIN","CAP 50MG","30","Select","Select",""],["","00173086910","ANORO","AER 62.5-25","60","Select","Select",""],["","00228287811","OXYCODONE","TAB 15MG","120","Select","Select",""],["","59148003713","REXULTI","TAB 1MG","60","Select","Select",""],["","00310197030","MOVANTIK","TAB 25MG","30","Select","Select",""],["","59779048478","PAIN","TAB 500MG","120","Select","Select",""],["","45802091987","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","50383077504","LIDOCAINE","SOL 2% VISC","100","Select","Select",""],["","69543038430","OLANZAPINE","TAB 15MG","30","Select","Select",""],["","00135046702","NICORETTE","GUM 4MG CINN","100.00","Select","Select",""],["","00536340501","NICOTINE","GUM 4MG","100","Select","Select",""],["","00536116361","MUCUS","TAB 600MG ER","30","Select","Select",""],["","00904673080","ACETAMIN","TAB 500MG","120","Select","Select",""],["","60505083305","AZELASTINE","SPR 0.001","30","Select","Select",""],["","00603533815","PREDNISONE","PAK 10MG","21","Select","Select",""],["","70710113908","FLUCONAZOLE","TAB 150MG","3","Select","Select",""],["","59267100002","PFIZER","INJ COVID-19","0.3","Select","Select",""],["","45802014167","CICLOPIROX","SOL 0.08","6.6","Select","Select",""],["","00121087308","LACTULOSE","SOL 10GM\/15","473.00","Select","Select",""],["","45963043864","ENULOSE","SOL 10GM\/15","473.00","Select","Select",""],["","70010075401","METHOCARBAM","TAB 500MG","90.00","Select","Select",""],["","45802000403","HYDROCORT","CRE 0.025","30","Select","Select",""],["","59746011506","PROCHLORPER","TAB 10MG","40","Select","Select",""],["","65162055310","METAXALONE","TAB 800MG","60","Select","Select",""],["","70000029902","MUCUS+CHST","LIQ 100\/5ML","237","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","20","Select","Select",""],["","00093365740","BUPRENORPHIN","DIS 10MCG\/HR","4","Select","Select",""],["","65862050320","AMOX\/K","TAB 875-125","10.00","Select","Select",""],["","50458057930","XARELTO","TAB 20MG","30.00","Select","Select",""],["","42858010201","OXYCOD\/APAP","TAB 5-325MG","20.00","Select","Select",""],["","67877045001","TAMSULOSIN","CAP 0.4MG","60","Select","Select",""],["","69315030230","PROCTO-MED","CRE HC 2.5%","30","Select","Select",""],["","00173068220","VENTOLIN","AER ","36","Select","Select",""],["","57237023301","SMZ-TMP","TAB 800-160","10","Select","Select",""],["","00456120230","LINZESS","CAP 290MCG","30","Select","Select",""],["","29300014005","DIVALPROEX","TAB 500MG DR","120","Select","Select",""],["","00071101568","LYRICA","CAP 100MG","180","Select","Select",""],["","00904386575","DEEP","SPR 0.0065","44","Select","Select",""],["","11534016503","FOLIC","TAB 1MG","30","Select","Select",""],["","00000000000",""," ","30","Select","Select",""],["","64376065716","BROM\/PSE\/DM","SYP ","250","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":""}]}]}