{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"J EILLIBNOSLEN ","gend":1,"add":"C FLOG4692DAOR ESRUO","city":"SPENCER","state":"VA","zip":"24165-3496","dob":"1994-03-22","age":"","mstatus":"","insh":"7014644","cliId":"","pno":"9667247262","cno":2762245617,"email":"","ename":"","eno":"","pphy":"COLE, RICHARD C","ppno":2766944466,"pcpadd":"18877 JEB STUART HWY,","pcpcity":"Stuart","pcpstate":"VA","pcpzip":"24171-5223","pcpcounty":"","pcpid":"","pcpname":"PATRICK COUNTY FAMILY PRACTICE","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"ROANOKE ALLEGHANY","aligned":"","ano":"","add2":"2964GOLF COURSE ROAD","add3":"","madd1":"2964GOLF COURSE ROAD","madd2":"","madd3":"","mcity":"SPENCER","mstate":"VA","mzip":"24165-3496","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z20.828","R11.2","F31.2","J06.9","Z03.818","F31.9","R45.851","F17.210","F32.9","I10","Z79.899","Z88.5","Z20.822","M54.5","F31.5","G89.4","R44.0","R39.9","F41.9","M48.061","M54.16","Z79.891","Z00.01","Z51.81","E78.2","M46.1","N39.0","F51.01","N61.1","G89.29","N64.4","Z48.00","M54.9","M51.36","F90.8","R20.9","M25.569","J20.9","E06.9","K02.7","K08.89","R50.9","J04.0","M25.561","M25.562","N30.10","F31.89","B37.0","R30.0"],"date":["2021-10-13","2021-02-24","2022-01-20","2021-03-31","2021-03-31","2021-10-26","2021-06-11","2022-01-25","2021-06-11","2022-03-09","2021-05-23","2021-05-23","2021-06-11","2021-05-27","2021-06-11","2022-01-31","2021-06-11","2021-09-01","2021-10-26","2022-01-10","2022-01-10","2022-01-31","2022-01-19","2022-02-18","2022-01-19","2022-01-19","2022-09-07","2022-01-19","2022-01-21","2022-01-21","2022-01-21","2022-01-25","2022-09-07","2022-01-31","2022-03-09","2022-03-09","2022-03-09","2022-03-09","2022-04-04","2022-04-14","2022-04-14","2022-04-23","2022-04-23","2022-05-02","2022-05-02","2022-05-02","2022-05-02","2022-05-02","2022-09-07"],"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":[["","29300014001","DIVALPROEX","TAB 500MG DR","60","Select","Select",""],["","49035020696","EQ NICOTINE","GUM 2MG MINT","160","Select","Select",""],["","59417010410","VYVANSE","CAP 40MG","30","Select","Select",""],["","00093101042","MUPIROCIN","OIN 0.02","22","Select","Select",""],["","42806031250","DOXYCYCL HYC","TAB 100MG","20","Select","Select",""],["","60432045516","HYDROCOD\/HOM","SYP 5-1.5\/5","300","Select","Select",""],["","47781030301","NITROFURANTN","CAP 100MG","14","Select","Select",""],["","00555030202","HYDROXYZ PAM","CAP 50MG","120","Select","Select",""],["","43598065530","BUPROPN HCL","TAB 150MG XL","30","Select","Select",""],["","68382005005","MELOXICAM","TAB 7.5MG","42","Select","Select",""],["","68382007901","HALOPERIDOL","TAB 5MG","30","Select","Select",""],["","00832030300","CHLORPROMAZ","TAB 100MG","30","Select","Select",""],["","69315013601","BENZTROPINE","TAB 0.5MG","42","Select","Select",""],["","69097052444","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","00781261305","AMOXICILLIN","CAP 500MG","21","Select","Select",""],["","16729017217","AMITRIPTYLIN","TAB 25MG","60","Select","Select",""],["","65862018601","CLINDAMYCIN","CAP 300MG","14","Select","Select",""],["","42858010201","OXYCOD\/APAP","TAB 5-325MG","30","Select","Select",""],["","69547035302","NARCAN","SPR","2","Select","Select",""],["","50111056001","TRAZODONE","TAB 50MG","21","Select","Select",""],["","00093505698","ATORVASTATIN","TAB 10MG","30","Select","Select",""],["","60258017101","MAG OXIDE","TAB 400MG","42","Select","Select",""],["","00143924920","AMOX\/K CLAV","TAB 875-125","20","Select","Select",""],["","00115164501","NITROFUR MAC","CAP 100MG","30","Select","Select",""],["","65162027250","SMZ\/TMP DS","TAB 800-160","14","Select","Select",""],["","59746017509","PREDNISONE","TAB 20MG","5","Select","Select",""],["","57237001830","DULOXETINE","CAP 30MG","30","Select","Select",""],["","49035091530","OMEPRAZOLE","TAB 20MG","30","Select","Select",""],["","57664050658","METOPROL TAR","TAB 25MG","60","Select","Select",""],["","11877001140","BINAXNOW COV","KIT HOME TES","2","Select","Select",""],["","67877021905","CEPHALEXIN","CAP 500MG","20","Select","Select",""],["","55111014512","FLUCONAZOLE","TAB 150MG","7","Select","Select",""],["","59385002160","BELBUCA","MIS 75MCG","60","Select","Select",""],["","00069108530","PAXLOVID","TAB 300-100","30","Select","Select",""],["","31722071730","ATOMOXETINE","CAP 40MG","30","Select","Select",""],["","68180096301","ALBUTEROL","AER HFA","8.5","Select","Select",""],["","57237004101","PENICILLN VK","TAB 500MG","40","Select","Select",""],["","65162010211","GABAPENTIN","CAP 300MG","30","Select","Select",""],["","68462030205","INDOMETHACIN","CAP 50MG","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":""}]}]}