{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"P ANNATNUH ","gend":1,"add":"OB OP669 X","city":"LEBANON","state":"VA","zip":"24266-0966","dob":"1962-06-22","age":"","mstatus":"","insh":"50014579","cliId":"","pno":"5267260194","cno":2762107269,"email":"","ename":"","eno":"","pphy":"HENLEY, BRYAN MARK","ppno":2764291410,"pcpadd":"202 TOWN SQUARE ST,","pcpcity":"Glade Spring","pcpstate":"VA","pcpzip":"24340-2924","pcpcounty":"","pcpid":"","pcpname":"TOWN SQUARE MEDICAL PLLC","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"SOUTHWEST","aligned":"","ano":"","add2":"PO BOX 966","add3":"","madd1":"PO BOX 966","madd2":"","madd3":"","mcity":"LEBANON","mstate":"VA","mzip":"24266-0966","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F43.9","K21.9","K26.7","R74.8","K44.9","K81.9","M54.17","M13.851","M13.852","J44.9","I10","R19.7","R53.83","R53.1","R68.83","K81.1","E78.2","Z13.29","M54.41","I48.0","Z12.31","G89.29","Z01.811","K81.0","Z01.818","Z20.822","J93.9","K31.6","K82.3","I48.91","Z53.31","Z79.899","Z79.51","R91.8","J93.83","D72.829","J95.811","K57.90","J90","G72.81","Z48.815","E78.5","F32.9","M54.5","M25.512","R53.81","E66.9","Z48.01","Z43.4","Z48.03","M54.31","R30.0","K65.1","K83.8","K57.10","I26.99","Z48.1","R52","R10.9","M54.9","T81.9XXA","G47.62","R25.2","M79.604","R25.3","G25.81","E87.6","K21.00","M54.16","M19.90","R00.2","K13.0","R22.0","Z79.01","L03.211","L03.221","R51.9","L08.9","Z82.49","Z80.3","L02.01","R93.3","R10.13","R00.0","I49.3","I35.1","I34.0","K22.89","K31.9","R13.14","K20.80","K31.89","K22.2","M25.551","M25.461","S82.001A","M25.569","W19.XXXA","S82.034A","W18.39XA","T14.90XA","S82.034D","T14.90XD","M25.561","M17.11","M79.671","M25.571","M23.91","M25.361","H25.13","H02.825","M16.11","F11.20","G57.63","M79.2","M54.50","R13.10","F33.0","Z79.891","Z13.89","N39.0","Z76.89","I48.20","R60.9","Z86.010","F33.8","G89.4","J02.0","J02.9","R09.82","F11.90","K22.4","R00.1","U07.1","R06.02","S33.5XXA","X58.XXXA","S39.012A","X50.9XXA","R10.84","F43.21"],"date":["2022-12-12","2022-10-26","2021-08-09","2021-08-09","2022-04-15","2021-05-03","2021-03-23","2021-01-28","2021-01-28","2021-02-25","2022-10-26","2021-02-25","2021-02-25","2021-02-25","2022-10-26","2021-04-09","2022-08-10","2021-03-23","2022-08-04","2022-08-10","2021-06-21","2022-08-04","2021-04-01","2021-04-01","2021-04-03","2023-01-25","2021-04-13","2021-04-09","2021-04-09","2023-01-28","2021-04-09","2023-01-28","2021-07-29","2021-04-11","2021-04-12","2021-04-14","2021-04-15","2021-04-18","2021-04-18","2021-05-04","2021-05-05","2022-10-26","2021-07-29","2021-04-26","2021-04-26","2021-05-05","2021-04-26","2021-05-05","2021-05-05","2021-05-05","2021-05-05","2021-05-21","2021-05-21","2021-05-19","2021-05-19","2021-08-24","2021-05-20","2021-05-20","2021-05-20","2023-03-20","2021-05-20","2021-05-23","2021-05-23","2023-03-20","2021-05-23","2022-08-04","2021-06-18","2021-06-18","2021-06-18","2021-06-18","2023-01-28","2021-07-29","2021-07-29","2021-11-11","2021-07-29","2021-07-29","2021-07-29","2021-07-29","2021-07-29","2021-07-29","2021-07-29","2021-08-09","2022-05-27","2021-09-26","2021-09-26","2021-09-26","2021-09-26","2021-10-12","2022-09-26","2021-10-12","2022-09-26","2022-09-26","2022-09-26","2022-03-12","2021-11-13","2021-11-13","2021-11-13","2021-11-13","2022-02-09","2021-11-13","2021-11-24","2022-03-03","2021-12-22","2022-01-26","2022-11-08","2022-02-09","2022-02-09","2022-03-03","2022-02-09","2022-02-28","2022-02-28","2023-03-28","2022-03-23","2022-03-28","2022-03-28","2022-04-15","2023-04-17","2022-07-28","2022-07-28","2022-07-28","2022-08-04","2022-08-04","2023-01-28","2022-08-19","2022-08-24","2022-12-12","2022-10-04","2022-10-26","2022-10-26","2022-10-26","2022-10-26","2022-12-05","2023-01-28","2023-01-28","2023-01-28","2023-03-20","2023-03-20","2023-03-20","2023-03-20","2023-04-17","2023-05-24"],"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":[["","00406012401","HYDROCO\/APAP","TAB 7.5-325","90","Select","Select",""],["","68001041103","GABAPENTIN","TAB 600MG","60","Select","Select",""],["","42571025201","CLINDAMYCIN","CAP 300MG","30","Select","Select",""],["","68462039710","OMEPRAZOLE","CAP 40MG","30","Select","Select",""],["","68001036703","POT CHLORIDE","TAB 10MEQ ER","20","Select","Select",""],["","68001033408","LISINOPRIL","TAB 10MG","180","Select","Select",""],["","24979002607","DILTIAZEM","CAP 120MG ER","90","Select","Select",""],["","39423044048","FLORAJEN","CAP DIGESTIO","30","Select","Select",""],["","00093317431","ALBUTEROL SUL","FAT E","8.5","Select","Select",""],["","62175089241","ATORVASTATIN","TAB 40MG","30","Select","Select",""],["","64380080807","IBUPROFEN","TAB 600MG","70","Select","Select",""],["","43386048024","ORPHENADRINE","TAB 100MG ER","10","Select","Select",""],["","59746017310","PREDNISONE","TAB 10MG","10","Select","Select",""],["","00406055201","OXYCODONE","TAB 5MG","18","Select","Select",""],["","00574200815","NYSTOP","POW 100000","30","Select","Select",""],["","00003089421","ELIQUIS","TAB 5MG","60","Select","Select",""],["","59267100001","PFIZER VACC","INJ COVID-19","0.3","Select","Select",""],["","13668009390","PRAMIPEXOLE","TAB 0.5MG","90","Select","Select",""],["","62332003131","ROPINIROLE","TAB 0.5MG","30","Select","Select",""],["","68180072003","AMLODIPINE","TAB 5MG","30","Select","Select",""],["","00143980350","DOXYCYCL HYC","CAP 100MG","20","Select","Select",""],["","00781261305","AMOXICILLIN","CAP 500MG","20","Select","Select",""],["","82607066026","FLOWFLEX","KIT TEST","1","Select","Select",""],["","21922000909","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","57237007530","ONDANSETRON","TAB 4MG","4","Select","Select",""],["","11845015339","VITAMIN D3","CAP 5000UNIT","30","Select","Select",""],["","52817033200","CYCLOBENZAPR","TAB 10MG","20","Select","Select",""],["","68001041405","DULOXETINE","CAP 30MG","60","Select","Select",""],["","70010075405","METHOCARBAM","TAB 500MG","20","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":""}]}]}