{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"D NOSAJRETSEH ","gend":0,"add":"SERC911EVA TNE","city":"MARION","state":"VA","zip":"24354-3029","dob":"1987-11-09","age":"","mstatus":"","insh":"50015769","cliId":"","pno":"8767285610","cno":"","email":"","ename":"","eno":"","pphy":"LACY, KIMBERLY K","ppno":2766864007,"pcpadd":"306 S MAIN ST","pcpcity":"Rural Retreat","pcpstate":"VA","pcpzip":"24368-3269","pcpcounty":"","pcpid":"","pcpname":"BLUE RIDGE FAMILY MEDICINE","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"SOUTHWEST","aligned":"","ano":"","add2":"119CRESENT AVE","add3":"","madd1":"119CRESENT AVE","madd2":"","madd3":"","mcity":"MARION","mstate":"VA","mzip":"24354-3029","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K58.9","R11.2","R10.13","I10","K52.9","R10.9","F41.8","K21.9","F12.90","Z79.899","R10.84","R11.10","Z09","F41.1","F33.1","J30.9","F51.01","Z01.89","K29.70","B96.81","R73.01","E78.5","R53.83","G89.29","R00.0","E05.80","F42.2","Z68.26","R11.15","K29.50","K44.9","E78.70","F32.9","F41.9","Z86.19","K29.30","F12.288","K58.8","E66.9","Z68.28","E05.90","S16.1XXA","M54.2","X58.XXXA","X50.9XXA","Z87.898","F12.988","E07.9","R19.7","R45.4","F42.9","R11.0","K92.0","R10.817","R94.6","Z68.22","R10.816","F12.188","R11.14","S60.479A","S60.511A","S61.451A","W55.01XA","Y92.009","S60.871A","S60.571A","S50.871A","Z23","W55.03XA","Z53.21","F63.81","R45.850","R45.851","Z20.822","K64.9","K62.89","R60.0","R60.9","M25.472","M25.471","R07.9","F17.210","K76.0","F25.0","F50.2","F31.12","R63.4","R03.0","F33.0","Z78.9","E53.8","R42","Z87.19","F32.A","Z74.3","R18.8","N40.0","R06.02","R00.2","F15.20","F31.9","F25.9","F15.10","F10.10","F12.10","G80.9","Z13.30","F19.10","S05.02XA","S05.02XD","G47.9","S61.210A","W26.0XXA","J06.9","R09.81","R05.9","R06.2","E78.2","F60.2"],"date":["2021-02-14","2022-05-14","2021-11-07","2022-11-08","2021-02-16","2022-05-14","2021-08-10","2022-11-08","2022-03-17","2022-10-08","2022-01-28","2022-05-14","2021-03-03","2022-11-08","2022-11-08","2022-08-26","2021-03-29","2021-03-03","2021-03-18","2021-03-18","2021-04-07","2021-08-23","2021-03-29","2021-04-01","2022-06-23","2021-04-07","2021-04-07","2021-05-20","2022-01-03","2021-04-16","2021-04-16","2021-04-16","2021-08-20","2022-09-09","2021-04-16","2021-04-26","2021-08-26","2021-04-29","2021-04-29","2021-04-29","2022-11-08","2021-05-16","2021-05-16","2021-05-16","2021-05-16","2021-05-20","2021-07-02","2022-09-09","2021-11-25","2021-08-26","2022-11-08","2022-03-17","2021-08-20","2021-08-21","2021-08-26","2021-08-26","2021-09-11","2021-10-25","2021-11-07","2021-11-13","2021-11-13","2021-11-13","2021-11-13","2021-11-13","2021-11-13","2021-11-13","2021-11-13","2021-11-13","2021-11-13","2021-11-24","2022-12-06","2021-12-13","2022-07-09","2022-10-08","2021-12-22","2021-12-22","2021-12-27","2021-12-27","2021-12-27","2021-12-27","2022-06-23","2022-10-08","2022-01-28","2022-01-29","2022-01-29","2022-01-29","2022-03-02","2022-03-02","2022-03-02","2022-03-02","2022-02-03","2022-06-23","2022-03-17","2022-09-09","2022-05-14","2022-05-15","2022-05-15","2022-06-23","2022-06-23","2022-08-24","2022-07-10","2022-07-15","2022-07-09","2022-07-09","2022-07-09","2022-09-09","2022-07-09","2022-07-10","2022-07-28","2022-07-29","2022-08-24","2022-09-09","2022-09-09","2022-10-08","2022-10-08","2022-10-08","2022-10-08","2022-11-08","2022-12-01"],"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":[["","68645055154","LISINOPRIL","TAB 5MG","30","Select","Select",""],["","80777027398","MODERNA VAC","INJ COVID-19","0.5","Select","Select",""],["","68462015713","ONDANSETRON","TAB 4MG ODT","20","Select","Select",""],["","29300022019","MONTELUKAST","TAB 10MG","30","Select","Select",""],["","23155007001","METHIMAZOLE","TAB 5MG","15","Select","Select",""],["","62332002431","FLUOXETINE","CAP 40MG","30","Select","Select",""],["","00832153011","HALOPERIDOL","TAB 2MG","12","Select","Select",""],["","00172572960","FAMOTIDINE","TAB 40MG","30","Select","Select",""],["","31722071390","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","59746011506","PROCHLORPER","TAB 10MG","10","Select","Select",""],["","16729017217","AMITRIPTYLIN","TAB 25MG","60","Select","Select",""],["","55111016830","OLANZAPINE","TAB 20MG","30","Select","Select",""],["","00143122701","DICYCLOMINE","TAB 20MG","20","Select","Select",""],["","00143924920","AMOX\/K CLAV","TAB 875-125","14","Select","Select",""],["","51293069601","CHLORD\/CLIDI","CAP 5-2.5MG","90","Select","Select",""],["","50111056001","TRAZODONE","TAB 50MG","60","Select","Select",""],["","42806054701","VITAMIN D","CAP 1.25MG","12","Select","Select",""],["","49281072110","FLUBLOK QUAD","INJ 2021-22","0.5","Select","Select",""],["","70010075401","METHOCARBAM","TAB 500MG","20","Select","Select",""],["","70069000510","CYANOCOBALAM","INJ 1000MCG","1","Select","Select",""],["","43199001301","HYOSCYAMINE","TAB 0.125MG","28","Select","Select",""],["","68382011414","RISPERIDONE","TAB 1MG","60","Select","Select",""],["","13668001001","CITALOPRAM","TAB 20MG","30","Select","Select",""],["","70010010810","GABAPENTIN","CAP 100MG","60","Select","Select",""],["","67877021905","CEPHALEXIN","CAP 500MG","6","Select","Select",""],["","67877043103","ARIPIPRAZOLE","TAB 5MG","30","Select","Select",""],["","68180044501","QUETIAPINE","TAB 25MG","14","Select","Select",""],["","45802075930","PROMETHAZINE","SUP 25MG","12","Select","Select",""],["","00555032302","HYDROXYZ PAM","CAP 25MG","30","Select","Select",""],["","61874011530","VRAYLAR","CAP 1.5MG","30","Select","Select",""],["","60505024701","MIRTAZAPINE","TAB 15MG","30","Select","Select",""],["","69315030805","CIPROFLOXACN","SOL 0.3% OP","5","Select","Select",""],["","69238110002","DOXYCYCL HYC","CAP 100MG","20","Select","Select",""],["","68180096301","ALBUTEROL","AER HFA","8.5","Select","Select",""],["","00603533815","PREDNISONE","PAK 10MG","21","Select","Select",""],["","24208038555","MURO 128","OIN 5% OP","3.5","Select","Select",""],["","16714079904","CETIRIZINE","TAB 10MG","30","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":""}]}]}