{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"EK ASILKCIRDN","gend":1,"add":"SNUS5913DAOR TE","city":"COLLINSVILLE","state":"VA","zip":"24078-1566","dob":"1981-05-29","age":"","mstatus":"","insh":"1324079","cliId":"","pno":"2267234836","cno":2767909795,"email":"","ename":"","eno":"","pphy":"HAGAN, ELIZABETH V","ppno":2766322966,"pcpadd":"287 COMMONWEALTH BLVD W,","pcpcity":"Martinsville","pcpstate":"VA","pcpzip":"24112-1820","pcpcounty":"","pcpid":"","pcpname":"HEALTH CENTER OF THE PIEDMONT MARTINSVILLE","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"ROANOKE ALLEGHANY","aligned":"","ano":"","add2":"3195SUNSET ROAD","add3":"","madd1":"3195SUNSET ROAD","madd2":"","madd3":"","mcity":"COLLINSVILLE","mstate":"VA","mzip":"24078-1566","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F31.12","F41.1","I10","M25.561","E11.9","F25.1","M41.9","S23.3XXA","J32.9","J01.90","R68.84","K02.9","F31.9","R05","M79.671","E78.00","F32.9","M79.7","Z20.822","N17.9","K04.7","B35.0","Z23","L85.3","E87.2","H92.09","R09.81","Z11.59","J02.9","D64.9","E08.40","R21","N92.1","F31.32","E22.1","M94.0","R11.0","N18.2","F43.12","D50.9","Z68.39","Z12.31","D75.839","F32.A","Z81.8","Z82.49","Z87.891","Z88.1","Z88.8","Z79.899","Z79.84","Z79.891","N18.1","E87.20","D22.5","L91.9","L28.0","Z30.011","Z98.51","G62.9","B34.9","D75.829","E11.40"],"date":["2021-03-07","2021-03-07","2023-04-19","2021-01-13","2023-03-22","2023-05-22","2021-02-21","2021-02-21","2021-04-14","2021-05-02","2021-06-06","2021-06-06","2023-05-22","2021-06-16","2022-04-19","2022-10-25","2021-09-13","2023-04-19","2023-04-03","2022-01-26","2021-10-27","2021-11-17","2022-10-25","2023-03-30","2022-02-10","2022-03-29","2022-03-30","2022-03-29","2022-03-30","2023-01-19","2022-04-19","2022-04-19","2022-04-26","2022-08-24","2022-08-25","2022-08-29","2022-08-29","2022-09-06","2023-05-22","2023-04-19","2022-10-25","2023-01-26","2023-02-13","2023-04-19","2023-01-19","2023-04-19","2023-04-19","2023-04-19","2023-04-19","2023-04-19","2023-04-19","2023-02-20","2023-03-22","2023-03-22","2023-03-30","2023-03-30","2023-03-30","2022-05-03","2022-05-03","2023-02-13","2023-04-03","2023-04-19","2023-04-19"],"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":[["","10702000350","PROMETHAZINE","TAB 25MG","30","Select","Select",""],["","55111018015","TIZANIDINE","TAB 4MG","90","Select","Select",""],["","00093321205","CLONAZEPAM","TAB 1MG","90","Select","Select",""],["","10702025350","BUT\/APAP\/CAF","TAB","90","Select","Select",""],["","57237007710","ONDANSETRON","TAB 4MG ODT","15","Select","Select",""],["","64380080707","IBUPROFEN","TAB 800MG","90","Select","Select",""],["","65862018601","CLINDAMYCIN","CAP 300MG","21","Select","Select",""],["","00054001925","PREDNISONE","TAB 50MG","6","Select","Select",""],["","00093317431","ALBUTEROL SUL","FAT E","8.5","Select","Select",""],["","00378718605","METFORMIN","TAB 850MG","30","Select","Select",""],["","67877024601","QUETIAPINE","TAB 200MG","30","Select","Select",""],["","68462012605","GABAPENTIN","TAB 600MG","180","Select","Select",""],["","68180072103","AMLODIPINE","TAB 10MG","30","Select","Select",""],["","45802046564","KETOCONAZOLE","SHA 0.02","120","Select","Select",""],["","68462010905","TOPIRAMATE","TAB 100MG","60","Select","Select",""],["","68180031909","BUPROPN HCL","TAB 150MG XL","90","Select","Select",""],["","27241009903","DULOXETINE","CAP 60MG","60","Select","Select",""],["","42794001208","GRISEOFULVIN","TAB MICR 500","60","Select","Select",""],["","68462086301","CHLORPROMAZ","TAB 50MG","20","Select","Select",""],["","63402030430","LATUDA","TAB 40MG","30","Select","Select",""],["","31722072690","MONTELUKAST","TAB 10MG","90","Select","Select",""],["","65162062711","TRAMADOL HCL","TAB 50MG","60","Select","Select",""],["","00193658621","MICROLET","MIS LANCETS","100","Select","Select",""],["","00781185220","AMOX\/K CLAV","TAB 875-125","20","Select","Select",""],["","00904698640","MUCUS RELIEF","TAB 600MG ER","10","Select","Select",""],["","00193731150","CONTOUR","TES NEXT","50","Select","Select",""],["","57237000511","FLUCONAZOLE","TAB 150MG","1","Select","Select",""],["","57237004105","PENICILLN VK","TAB 500MG","40","Select","Select",""],["","68462018905","NAPROXEN","TAB 375MG","30","Select","Select",""],["","64980052810","SODIUM BICAR","TAB 650MG","60","Select","Select",""],["","59148003813","REXULTI","TAB 2MG","5","Select","Select",""],["","00045044905","TYLENOL","TAB 500MG","24","Select","Select",""],["","00904759080","FEROSUL","TAB 325MG","90","Select","Select",""],["","31722088490","ROSUVASTATIN","TAB 20MG","30","Select","Select",""],["","69238158306","NORLYDA","TAB 0.35MG","84","Select","Select",""],["","00378727253","NORETHINDRON","TAB 0.35MG","84","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":""}]}]}