{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"G ASILLLEDO ","gend":1,"add":" HTYMS 14103DAOR LEPAHC","city":"MEADOWVIEW","state":"VA","zip":24361,"dob":"1966-11-04","age":"","mstatus":"","insh":"60017438","cliId":"","pno":"1667284044","cno":"","email":"","ename":"","eno":"","pphy":"BRESOWAR, KRISTIN O","ppno":2766144048,"pcpadd":"319 5TH AVE,","pcpcity":"SALTVILLE","pcpstate":"VA","pcpzip":24370,"pcpcounty":"","pcpid":"","pcpname":"SOUTHWEST VIRGINIA COMMUNITY H","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"SOUTHWEST","aligned":"","ano":"","add2":"","add3":"","madd1":"30141 SMYTH CHAPEL ROAD","madd2":"","madd3":"","mcity":"MEADOWVIEW","mstate":"VA","mzip":"24361-4207","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["D69.3","M24.271","M79.2","G89.28","Z79.899","D64.9","D47.2","D69.6","J32.9","E66.9","K76.0","R07.81","R53.83","R16.1","Z71.89","R79.89","G43.909","R51","R11.0","I10","E11.9","Z79.4","Z79.84","F32.9","K75.81","K22.70","K21.9","K58.9","K31.84","G62.89","M79.671","M79.672","K31.7","K21.0","K29.50","E11.40","Z51.81","E11.65","Z01.818","E88.81","Z51.11","R51.9","E11.49","Z91.14","G25.81","M25.571","G47.33","F41.9","Z11.59","Z20.822","G60.3","Z79.891","E11.42","H57.11","Z23","K59.8","K57.30","R10.2","K50.90","R10.9","R10.10","R42","E86.0","Z90.49","R16.2","N39.0","R10.32","R10.33","E66.01","K74.60","Z12.11","M24.272","D75.1"],"date":["2022-04-04","2021-07-15","2021-05-19","2022-03-02","2022-02-01","2021-07-26","2022-03-22","2022-04-04","2020-09-10","2020-09-10","2020-09-10","2020-09-10","2020-09-10","2020-09-10","2021-03-16","2020-03-16","2020-04-09","2020-04-09","2020-04-09","2021-09-20","2020-11-30","2021-09-20","2020-11-30","2021-09-20","2020-12-07","2020-06-19","2021-09-20","2020-06-17","2020-06-19","2020-06-15","2020-06-15","2020-06-15","2020-06-19","2020-06-19","2020-06-19","2022-03-02","2020-09-10","2020-10-05","2020-11-30","2020-12-07","2021-01-18","2021-01-25","2021-11-04","2021-07-15","2021-06-01","2022-03-02","2021-09-20","2021-09-20","2021-10-07","2021-10-07","2022-02-01","2022-02-01","2019-02-18","2019-02-22","2019-10-02","2019-02-27","2019-03-02","2019-02-27","2019-02-27","2019-02-27","2019-02-27","2019-02-27","2019-02-27","2019-03-02","2019-03-02","2019-03-02","2019-03-02","2019-03-02","2019-03-28","2019-03-28","2019-03-28","2019-06-20","2019-09-04"],"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":[["","65162010150","GABAPENTIN","65162010150 GABAPENTIN ","30","Select","Select",""],["","42858000201","OXYCODONE","42858000201 OXYCODONE ","120","Select","Select",""],["","69547035302","NARCAN","69547035302 NARCAN ","2","Select","Select",""],["","00093220405","METOCLOPRAM","00093220405 METOCLOPRAM ","120","Select","Select",""],["","59267100001","PFIZER","59267100001 PFIZER ","0.3","Select","Select",""],["","00904759080","FEROSUL","TAB 325MG","90","Select","Select",""],["","24510011010","XTAMPZA","CAP 9MG","30","Select","Select",""],["","13668042990","PANTOPRAZOLE","TAB 40MG","180","Select","Select",""],["","67877056110","METFORMIN","TAB 500MG","120","Select","Select",""],["","13668009390","PRAMIPEXOLE","TAB 0.5MG","60","Select","Select",""],["","68382080510","TRAZODONE","TAB 50MG","30","Select","Select",""],["","00193731150","CONTOUR","TES NEXT","50","Select","Select",""],["","65862039010","ONDANSETRON","TAB 4MG ODT","20","Select","Select",""],["","16729000916","PRAVASTATIN","TAB 20MG","30","Select","Select",""],["","69452015120","VITAMIN","CAP 50000UNT","4","Select","Select",""],["","00591555501","PROPRANOLOL","TAB 20MG","90","Select","Select",""],["","68462024920","RANITIDINE","TAB 300MG","30","Select","Select",""],["","57237023305","SMZ-TMP","TAB 800-160","10","Select","Select",""],["","16729018317","HYDROCHLOROT","TAB 25MG","30","Select","Select",""],["","29300022705","METRONIDAZOL","TAB 500MG","30","Select","Select",""],["","68001033203","LISINOPRIL","TAB 2.5MG","30","Select","Select",""],["","51991074710","DULOXETINE","CAP 30MG","30","Select","Select",""],["","00169406013","VICTOZA","INJ 18MG\/3ML","9","Select","Select",""],["","55111012705","CIPROFLOXACN","TAB 500MG","20","Select","Select",""],["","00169185189","NOVOFINE","MIS 32GX6MM","100","Select","Select",""],["","68001023508","POT  CL MICRO","TAB 20MEQ ER","30","Select","Select",""],["","42192080201","PHENAZOPYRID","TAB 200MG","9","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":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["1",""],"comment":["",""],"sub":{"indx":[["","",""],[""],[""],[""],[""]],"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":""}]}]}