{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"J   IRREMKCIRTAP ","gend":1,"add":"OMDRA 204TEERTS ER","city":"BLACKSBURG","state":"VA","zip":"24060-5904","dob":"1966-02-15","age":"","mstatus":"","insh":"70015630","cliId":"","pno":"3204503770","cno":5408086968,"email":"","ename":"","eno":"","pphy":"JONES, BRITTANY DIXON","ppno":5407311600,"pcpadd":"3700 S Main St, ","pcpcity":"Blacksburg","pcpstate":"VA","pcpzip":240607017,"pcpcounty":"","pcpid":"","pcpname":"CHRISTIANBURG INTERNAL MEDICINE","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"","add3":"","madd1":"402 ARDMORE STREET","madd2":"","madd3":"","mcity":"BLACKSBURG","mstate":"VA","mzip":"24060-5904","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z87.19","Z94.4","Z02.89","D22.5","D22.61","D22.62","D22.39","D22.71","D22.72","L81.4","L82.1","Z08","Z85.828","L57.0","F41.8","Z13.220","Z01.419","K64.8","K64.9","K21.9","F32.9","F41.9","F17.200","Z11.59","M25.462","W01.0XXA","S89.92XA","Z79.82","M25.562","D16.9","S82.002A","Z48.298","R74.8","Z79.899","Z51.81","S82.035D","Z23","R79.89","R94.5","Z90.49","Z48.23","Z71.89","N18.2","H25.13","H25.043","H43.812","H11.153","H52.13","H52.223","F10.20","H25.11","H25.12","D23.5","D48.5","D89.9","M81.8","C44.91","D84.9","F33.0","M81.0","Z72.0","Z12.31","Z13.31","M85.89","M85.80","Z76.89"],"date":["2020-01-30","2021-11-11","2020-01-30","2021-09-13","2021-09-13","2021-09-13","2021-09-13","2021-09-13","2021-09-13","2022-03-14","2022-03-14","2022-03-14","2022-03-14","2021-09-13","2021-11-11","2020-05-13","2021-07-13","2020-07-02","2020-07-02","2020-06-30","2020-06-30","2020-06-30","2020-08-06","2020-06-30","2020-08-06","2020-08-06","2020-08-06","2020-08-06","2020-09-24","2020-08-10","2020-08-27","2021-09-20","2021-09-20","2021-09-20","2020-10-27","2020-09-24","2021-11-11","2020-11-16","2020-11-16","2020-11-16","2020-11-18","2021-09-13","2021-03-23","2022-01-05","2021-09-10","2021-09-10","2021-09-10","2021-09-10","2021-09-10","2021-09-20","2022-01-20","2022-01-25","2022-03-14","2022-03-14","2019-12-18","2019-07-05","2019-03-04","2019-05-03","2019-05-31","2019-12-02","2019-05-31","2019-07-05","2019-05-31","2019-07-05","2019-07-05","2019-12-02"],"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":[["","13668001005","CITALOPRAM","13668001005 CITALOPRAM ","90","Select","Select",""],["","64380074207","BUSPIRONE","64380074207 BUSPIRONE ","180","Select","Select",""],["","27808003503","HYDROCO\/APAP","TAB 5-325MG","8","Select","Select",""],["","54629007501","MULTI-VIT\/","54629007501 MULTI-VIT\/ ","30","Select","Select",""],["","55111015810","OMEPRAZOLE","55111015810 OMEPRAZOLE ","90","Select","Select",""],["","16729004201","TACROLIMUS","16729004201 TACROLIMUS ","90","Select","Select",""],["","00603020922","MAG","00603020922 MAG ","360","Select","Select",""],["","13107004405","OXYCOD\/APAP","TAB 5-325MG","12","Select","Select",""],["","59676058015","JANSSEN","59676058015 JANSSEN ","0.5","Select","Select",""],["","00904404073","ASPIRIN","00904404073 ASPIRIN ","90","Select","Select",""],["","80777027310","MODERNA","80777027310 MODERNA ","0.5","Select","Select",""],["","00536344238","CEROVITE","TAB ADVANCED","30","Select","Select",""],["","70710101002","OSELTAMIVIR","CAP 75MG","10","Select","Select",""],["","52268001201","SUPREP","SOL PREP KIT","354","Select","Select",""],["","00065924007","DUREZOL","EMU 0.0005","5.00","Select","Select",""],["","24208060203","PROLENSA","SOL 0.0007","3.00","Select","Select",""],["","17478071310","OFLOXACIN","DRO 0.3% OP","5.00","Select","Select",""],["","65862041901","SMZ-TMP","TAB 400-80MG","30","Select","Select",""],["","37000045503","PRILOSEC","TAB 20MG","56","Select","Select",""],["","55111057503","IBANDRONATE","TAB 150MG","1","Select","Select",""],["","16729009401","MYCOPHENOLAT","CAP 250MG","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":""}]}]}