{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" EERANAHSTNARG M  ","gend":1,"add":"B YBGUR 93017 TPA WN DVL","city":"ROANOKE","state":"VA","zip":"24017-9998","dob":"2002-09-22","age":"","mstatus":"","insh":"3735110*67","cliId":"","pno":"94\/0450245-4","cno":"","email":"","ename":"","eno":"","pphy":"ROYALL, SABRINA FNP","ppno":"540\/362-0360","pcpadd":"3716 MELROSE AVE NW","pcpcity":"ROANOKE","pcpstate":"VA","pcpzip":24017,"pcpcounty":"","pcpid":"","pcpname":"KUUMBA COMMUNITY HEALTH AND WELLNESS CENTER INC","plan":"OHP","program":"MEDICAID","lob":"M4","region":"ROANOKE ALLEGHANY","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F32.81","N94.6","N89.8","N30.01","F33.2","U07.1","Z76.0","R45.6","V62.84","Z30.09","F32.9","F43.9","F31.89","R30.9","R10.30","N73.9","A59.9","L29.3","Z20.822","M25.572","N92.0","D64.9","Z11.3","R53.1","R55.","A59.01","N73.0","R10.2","Z72.51","F43.25","R06.02","Z20.828","Z30.013","R50.9","S60.912A","N39.0","D50.0","N92.4","Z11.1","N93.8","N93.9","Z79.3","Z79.2","J06.9","R10.13","R10.9","Z30.016","R11.2","J93.83","D72.829","D50.9","N94.89","N70.93","N76.0","Z46.82","R05.9","K46.0","K42.0","Z00.00","Z71.82","Z71.3","Z13.1","Z13.6","Z11.4","Z11.59","Z86.2","N83.299","N70.03","Z86.16","J93.82","D72.823","K52.9","R63.0","Z88.8","Z68.51","Z79.891","Z79.899","R63.4","R53.83","F41.9","J93.11","R19.7","R82.81","K42.9","Z46.59","R30.0","R76.12","J93.9","N80.9","R52.","Z01.419","M54.2","R51.9","M54.9"],"date":["2020-07-17","2022-04-12","2021-12-11","2021-01-27","2021-05-05","2021-08-25","2021-12-11","2020-03-03","2020-03-03","2020-12-10","2022-04-04","2020-07-17","2020-07-17","2020-08-31","2021-12-08","2022-04-12","2020-08-31","2021-06-24","2022-10-19","2021-09-14","2022-01-27","2021-12-16","2021-09-09","2021-11-17","2021-11-17","2020-03-09","2020-10-19","2022-02-24","2020-10-19","2021-05-10","2021-08-25","2020-06-08","2020-12-10","2021-12-08","2021-05-02","2020-01-22","2021-11-25","2021-11-25","2020-06-09","2021-01-28","2021-01-28","2021-01-28","2021-01-28","2022-10-19","2019-05-31","2022-03-11","2019-06-17","2022-01-01","2022-01-18","2022-01-18","2022-01-18","2022-01-13","2022-01-18","2022-03-05","2022-01-08","2022-01-10","2022-03-29","2022-04-04","2022-08-16","2022-08-16","2022-08-16","2022-08-16","2022-08-16","2022-08-16","2022-08-16","2022-08-16","2022-02-24","2022-01-02","2022-01-02","2022-01-02","2022-01-02","2022-01-02","2022-01-02","2022-01-02","2022-01-02","2022-01-02","2022-01-02","2022-01-02","2022-01-18","2022-04-04","2022-01-01","2022-01-01","2022-01-01","2022-03-11","2022-01-18","2022-01-27","2022-05-20","2022-01-14","2022-08-16","2022-10-19","2022-08-16","2022-11-03","2022-11-03","2022-11-03"],"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":{"indx":[false,false],"comment":["",""],"score":["",""]}},{"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":[["","00536100901","FERROUS","TAB 325MG","60","Select","Select",""],["","00378334053","XULANE","DIS 150-35","3","Select","Select",""],["","67877021660","CEFUROXIME","TAB 500MG","28","Select","Select",""],["","68180065208","DOXYCYC","CAP 100MG","28","Select","Select",""],["","","FLUCONAZOLE","TAB 150MG","","Select","Select",""],["","29300035505","TRAMADOL","TAB 50MG","28","Select","Select",""],["","45802043262","PSEUDOEPHEDR","TAB 30MG","24","Select","Select",""],["","76385012450","METHOCARBAM","TAB 750MG","40","Select","Select",""],["","00603188016","LIDOCAINE","PAD 0.05","5","Select","Select",""],["","69784050001","EC-NAPROXEN","TAB 500MG","10","Select","Select",""],["","50428038612","ACETAMINOPHN","TAB 500MG","20","Select","Select",""],["","","AZITHROMYCIN","TAB 250MG","","Select","Select",""],["","","DOXYCYCL","CAP 100MG","","Select","Select",""],["","47781030301","NITROFURANTN","CAP 100MG","20","Select","Select",""],["","45802091987","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","50111064701","FLUOXETINE","CAP 10MG","30","Select","Select",""],["","","METRONIDAZOL","TAB 500MG","","Select","Select",""],["","00054418425","DEXAMETHASON","TAB 4MG","4","Select","Select",""],["","65162052110","PROMETHAZINE","TAB 25MG","12","Select","Select",""],["","00093031401","KETOROLAC","TAB 10MG","10","Select","Select",""],["","16571020106","DICLOFENAC","TAB 75MG DR","10","Select","Select",""],["","","SMZ\/TMP","TAB 800-160","","Select","Select",""],["","45802065078","LORATADINE","TAB 10MG","30","Select","Select",""],["","","CONDOMS","MIS LUBRICAT","","Select","Select",""],["","64380080307","RANITIDINE","TAB 150MG","60","Select","Select",""],["","65862039010","ONDANSETRON","TAB 4MG ODT","10","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":""}]}]}