{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"D ALEGNAWORRUF ","gend":1,"add":"SDARB9608DAOR WAH","city":"SALEM","state":"VA","zip":"24153-2261","dob":"1971-02-05","age":"","mstatus":"","insh":"50010705","cliId":"","pno":"9304522221","cno":5403926921,"email":"","ename":"","eno":"","pphy":"FORD, CAROLINE","ppno":"","pcpadd":"6 HICKOK ST,","pcpcity":"Christiansburg","pcpstate":"VA","pcpzip":"24073-3524","pcpcounty":"","pcpid":"","pcpname":"LEWIS GALE PHYSICIANS LLC","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"ROANOKE ALLEGHANY","aligned":"","ano":"","add2":"8069BRADSHAW ROAD","add3":"","madd1":"8069BRADSHAW ROAD","madd2":"APARTMENT 1023","madd3":"","mcity":"SALEM","mstate":"VA","mzip":"24153-2261","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J44.1","F41.3","F33.42","G43.109","K21.9","K59.00","R10.32","R19.7","R13.10","Z86.010","K29.50","R10.13","K44.9","K21.00","B37.81","D12.0","K64.8","J44.9","Z87.891","M79.7","G89.29","Z79.01","Z01.810","R00.2","Z01.812","Z20.822","I74.5","I71.4","J43.2","I70.1","I77.4","K63.5","K20.90","R10.84","R13.19","I74.09","R09.89","S27.321A","I77.1","I73.9","F41.1","F17.200","F33.1","J43.9","J43.1","R06.00","I48.0","Z72.0","Z01.811","F17.290","G89.4","F41.9","K51.00","F32.9","I65.23","M79.661","M79.662","R93.89","Z01.818","R07.9","I20.8","Z82.49","F17.210","B37.0","J02.9","K08.109","R05","K14.6","I70.8","I70.0","I70.223","D62","K56.7","G43.909","E78.00","N39.0","K58.9","R06.02","G89.18","R94.31","R10.9","L03.314","W57.XXXA","S30.864A","R21","L29.9","B88.0","I70.90","R10.2","J01.10","R07.89","R51.9","R50.9","I95.9","Z90.49","I48.91","R06.83","R53.83","Z95.828","Z09","A41.9","N13.30","K42.9","N13.6","R33.9","R53.1","R39.89","R39.16","R30.0","R82.90","R35.1","R39.14","D17.22","N13.2","R11.2","R00.0","R11.0","R07.2","H53.149","I08.1","I34.0","G43.111","H53.8","E87.6","R03.0","Z79.51","R42","K83.8","M54.50","R10.12","R10.30","N32.89","M54.9","N32.9","R31.9","R93.6","K56.600","R93.5","K56.690","K52.9","Z87.442","Z88.1","Z90.710","R93.3","K50.018","R14.0","K59.09","I10","E78.5","F43.10","Z68.22","R10.11","D12.6","Z95.1","R10.10","R89.4","K31.7","K31.89","K31.9","Z95.820","Z87.440","R93.49","N13.4","L98.9","F41.8","Q62.61","N95.2","N10","N13.1","R10.31","Q62.10","D72.829","Z90.89","Z96.0","N12","T83.193A","R11.10","T83.592A","A41.51","F32.A","Z79.899","Z88.6","R78.81","B96.20","Z43.6","T81.89XA","B37.31","N30.01","N13.5","E83.42","E55.9","E53.8","T83.092A","Y73.2","T83.83XA","N28.89","Z93.6","D50.8","R25.2","R41.89","Z86.39","Z12.31","Z12.11","B37.9"],"date":["2021-03-01","2021-03-01","2021-03-01","2023-01-16","2022-12-09","2022-07-18","2022-07-21","2022-06-03","2021-03-16","2021-03-26","2021-03-26","2021-03-26","2022-10-03","2021-03-26","2021-03-26","2021-03-26","2021-03-26","2023-04-07","2022-02-20","2022-12-09","2021-03-26","2023-04-07","2022-08-04","2021-08-04","2021-06-11","2021-03-21","2021-05-27","2021-03-24","2021-03-24","2022-07-21","2022-07-21","2021-03-26","2021-03-26","2022-08-09","2021-03-26","2022-10-03","2021-04-29","2021-04-12","2021-04-30","2023-04-07","2022-07-10","2022-06-23","2021-07-30","2022-07-10","2021-08-19","2021-08-19","2023-02-06","2022-06-03","2021-05-11","2021-05-11","2023-04-07","2023-04-07","2021-04-22","2021-04-22","2022-08-09","2021-04-29","2021-04-29","2021-10-14","2023-03-28","2022-06-23","2021-05-10","2021-05-10","2022-12-08","2022-12-31","2021-05-13","2021-05-13","2021-05-13","2021-05-13","2021-06-16","2021-06-16","2021-06-16","2021-06-16","2021-06-16","2022-07-10","2022-12-08","2021-11-26","2022-12-09","2021-06-16","2021-06-16","2021-06-16","2023-02-18","2021-07-19","2021-07-19","2021-07-19","2021-07-19","2021-07-19","2021-07-19","2021-07-30","2022-11-18","2021-08-04","2022-06-23","2022-10-03","2021-12-11","2021-08-04","2022-11-18","2022-12-09","2021-08-19","2023-01-16","2022-10-03","2023-01-16","2022-12-09","2023-04-07","2022-06-02","2022-12-09","2023-04-07","2022-05-18","2022-05-23","2022-05-23","2023-04-18","2022-05-23","2021-11-30","2021-11-30","2021-12-02","2022-12-07","2021-12-11","2022-06-08","2023-01-16","2022-02-03","2022-02-20","2022-02-23","2022-02-24","2022-02-26","2022-02-26","2023-04-18","2022-02-26","2022-08-09","2022-03-07","2022-05-18","2022-05-18","2022-07-21","2022-05-20","2022-09-09","2022-05-20","2022-05-20","2023-02-18","2022-05-26","2022-06-03","2022-09-12","2022-06-02","2022-06-02","2022-06-02","2022-12-08","2022-06-02","2022-06-03","2022-06-08","2022-07-15","2022-06-08","2023-04-04","2022-12-09","2022-12-08","2022-07-10","2022-12-07","2022-09-12","2022-07-21","2022-09-12","2022-08-03","2022-08-09","2022-08-09","2022-08-09","2022-08-09","2022-08-09","2022-08-11","2022-09-09","2022-09-12","2022-12-09","2022-10-03","2022-10-03","2023-02-18","2023-04-04","2022-12-07","2022-11-18","2022-11-18","2022-11-18","2023-02-18","2023-02-18","2022-12-07","2022-12-07","2022-12-08","2022-12-08","2023-04-07","2023-02-18","2022-12-08","2022-12-09","2022-12-09","2023-04-07","2023-03-07","2022-12-31","2022-12-31","2023-03-28","2023-01-16","2023-01-16","2023-01-16","2023-02-18","2023-02-18","2023-02-18","2023-02-18","2023-04-04","2023-04-18","2023-04-18","2023-04-18","2023-04-18","2023-04-18","2023-04-18","2023-04-18"],"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":[["","70069000510","CYANOCOBALAM","INJ 1000MCG","1","Select","Select",""],["","65862029390","ROSUVASTATIN","TAB 5MG","30","Select","Select",""],["","00115180401","HYDROXYZ PAM","CAP 50MG","30","Select","Select",""],["","00003089421","ELIQUIS","TAB 5MG","60","Select","Select",""],["","00002143611","EMGALITY","INJ 120MG\/ML","1","Select","Select",""],["","13703010391","3ML SYRINGE","MIS 25GX1\"","5","Select","Select",""],["","00536589588","NICOTINE TD","DIS 14MG\/24H","28","Select","Select",""],["","70010075401","METHOCARBAM","TAB 500MG","90","Select","Select",""],["","68382004101","PROMETHAZINE","TAB 25MG","9","Select","Select",""],["","65862042005","SMZ\/TMP DS","TAB 800-160","14","Select","Select",""],["","00574705012","BISACODYL","SUP 10MG","7","Select","Select",""],["","76204060005","IPRATROPIUM\/","SOL ALBUTER","180","Select","Select",""],["","00172392770","DIAZEPAM","TAB 10MG","90","Select","Select",""],["","55111015830","OMEPRAZOLE","CAP 20MG","60","Select","Select",""],["","13107003134","MIRTAZAPINE","TAB 15MG","30","Select","Select",""],["","59267100002","PFIZER VACC","INJ COVID-19","0.3","Select","Select",""],["","00904699860","DOCUSATE SOD","CAP 100MG","90","Select","Select",""],["","00143122701","DICYCLOMINE","TAB 20MG","120","Select","Select",""],["","00023650116","UBRELVY","TAB 100MG","16","Select","Select",""],["","69618003206","SIMETHICONE","CHW 125MG","120","Select","Select",""],["","52817036000","METOPROL TAR","TAB 25MG","60","Select","Select",""],["","67877021905","CEPHALEXIN","CAP 500MG","40","Select","Select",""],["","00406055201","OXYCODONE","TAB 5MG","12","Select","Select",""],["","00093220301","METOCLOPRAM","TAB 10MG","20","Select","Select",""],["","00904693181","PEG 3350","POW ","60","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","75834002001","VITAMIN D3","CAP 50000UNT","4","Select","Select",""],["","68382013201","TAMSULOSIN","CAP 0.4MG","90","Select","Select",""],["","45802071708","TERCONAZOLE","SUP 80MG","3","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","36","Select","Select",""],["","65162068110","PHENAZOPYRID","TAB 100MG","6","Select","Select",""],["","43598043611","NITROGLYCERN","SUB 0.4MG","25","Select","Select",""],["","68462010430","FLUCONAZOLE","TAB 200MG","3","Select","Select",""],["","66689000816","NYSTATIN","SUS 100000","224","Select","Select",""],["","00245531911","KLOR-CON M20","TAB 20MEQ ER","28","Select","Select",""],["","72618300002","NURTEC","TAB 75MG ODT","16","Select","Select",""],["","67877054360","CEFDINIR","CAP 300MG","6","Select","Select",""],["","65862017601","PENICILLN VK","TAB 500MG","30","Select","Select",""],["","31722072320","LEVOFLOXACIN","TAB 750MG","12","Select","Select",""],["","00406012301","HYDROCO\/APAP","TAB 5-325MG","5","Select","Select",""],["","21922002107","PERMETHRIN","CRE 0.05","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":""}]}]}