{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" LIGRIVKOOC F","gend":0,"add":"XOB OP2331 ","city":"HONAKER","state":"VA","zip":"24260-1332","dob":"1956-12-07","age":"","mstatus":"","insh":"50012379","cliId":"","pno":"7967239351","cno":"","email":"","ename":"","eno":"","pphy":"COUCH, JILL","ppno":2765463001,"pcpadd":"276 FIELDSTONE DR,","pcpcity":"Jonesville","pcpstate":"VA","pcpzip":"24263-1215","pcpcounty":"","pcpid":"","pcpname":"JONESVILLE FAMILY HEALTH CENTER","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"SOUTHWEST","aligned":"","ano":"","add2":"PO BOX 1332","add3":"","madd1":"PO BOX 1332","madd2":"","madd3":"","mcity":"HONAKER","mstate":"VA","mzip":"24260-1332","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I10","J44.9","M54.5","F41.1","Z79.891","F17.200","Z13.89","Z00.8","J43.1","R91.1","J60","F17.209","F17.210","I71.4","S76.011A","R10.31","M25.551","K40.90","I25.10","I25.2","F17.290","K56.41","Z79.02","Z79.899","Z82.49","Z95.5","X58.XXXA","I25.118","K21.9","E78.2","I11.0","J84.10","I50.9","F32.9","J43.9","G44.039","Z20.822","G44.049","R42","R06.02","M54.50","Z12.5","R91.8","R55","S09.90XA","V89.2XXA","Y92.410","S00.93XA","S00.81XA","Z23","S00.83XA","V89.9XXA","R07.81","S06.350D","S01.81XA","R51.9","R07.1","V49.9XXA","S41.112A","S41.111A","M50.30","S20.212A","S06.359A","S41.111D","S41.112D","S00.11XD","F33.9","M71.9","J64","Z71.3","Z71.82","J44.1"],"date":["2023-03-13","2023-03-29","2021-06-02","2022-09-12","2023-03-13","2021-04-01","2021-04-01","2021-04-01","2022-08-11","2022-08-11","2022-08-11","2021-04-14","2022-08-11","2022-04-12","2021-05-15","2021-05-15","2021-05-15","2021-05-15","2021-05-15","2021-09-11","2022-04-11","2021-05-15","2022-04-11","2022-04-11","2021-05-15","2021-05-15","2021-05-15","2021-09-11","2022-09-12","2021-09-11","2021-09-11","2021-09-11","2022-09-12","2021-09-11","2022-04-11","2022-02-09","2022-02-09","2022-02-09","2022-02-09","2022-02-09","2022-09-12","2023-03-13","2022-04-12","2022-04-11","2022-04-11","2022-04-11","2022-04-12","2022-04-11","2022-04-11","2022-04-11","2022-04-11","2022-04-11","2022-04-12","2022-04-12","2022-04-12","2022-04-12","2022-04-12","2022-04-12","2022-04-12","2022-04-12","2022-04-12","2022-04-12","2022-04-12","2022-04-12","2022-04-12","2022-04-12","2022-06-14","2022-06-14","2022-08-11","2022-09-12","2022-09-12","2022-11-22"],"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":[["","59267100002","PFIZER VACC","INJ COVID-19","0.3","Select","Select",""],["","27808003702","HYDROCO\/APAP","TAB 10-325MG","120","Select","Select",""],["","52817036000","METOPROL TAR","TAB 25MG","60","Select","Select",""],["","50383070016","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","65862035705","CLOPIDOGREL","TAB 75MG","30","Select","Select",""],["","49483060610","GABAPENTIN","CAP 300MG","90","Select","Select",""],["","59762330403","NITROGLYCERN","SUB 0.4MG","100","Select","Select",""],["","65862055990","PANTOPRAZOLE","TAB 20MG","30","Select","Select",""],["","65862059805","TAMSULOSIN","CAP 0.4MG","30","Select","Select",""],["","51991070610","ALPRAZOLAM","TAB 1MG","38","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","45963043965","CONSTULOSE","SOL 10GM\/15","600","Select","Select",""],["","00597007541","SPIRIVA","CAP HANDIHLR","30","Select","Select",""],["","69097012715","AMLODIPINE","TAB 5MG","30","Select","Select",""],["","57896040110","DOCUSATE SOD","CAP 100MG","30","Select","Select",""],["","45802081184","NALOXONE HCL","SPR 4MG","2","Select","Select",""],["","59746017509","PREDNISONE","TAB 20MG","10","Select","Select",""],["","51224002206","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","42806071405","BENZONATATE","CAP 100MG","15","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":""}]}]}