{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ARAYNEKLERUD ","gend":1,"add":"LLIHPEH 73132 TPA RD ","city":"BASSETT","state":"VA","zip":"24055-9998","dob":"2002-10-14","age":"","mstatus":"","insh":"4591110*49","cliId":"","pno":"33\/7065600-1","cno":"","email":"","ename":"","eno":"","pphy":"MCBRIDE, FELECIA NP","ppno":"276\/629-1076","pcpadd":"324 TB STANLEY HWY SUITES B & C","pcpcity":"BASSETT","pcpstate":"VA","pcpzip":24055,"pcpcounty":"","pcpid":"","pcpname":"MARTINSVILLE HENRY COUNTY COALITION FOR HEALTH AND WELLNESS","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":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F90.0","F41.1","Z68.53","T78.3XXA","F41.9","F32.9","F90.9","M32.9","D84.1","R76.8","Z32.01","T39.1X2A","T43.292A","E87.2","I45.81","T50.905A","J00.","R05.","R94.31","R01.1","T65.892A","T50.901A","V62.84","F33.2","Z68.54","F43.10","F34.81","M35.00","L50.9","Z88.9","Z86.39","E55.9","Z79.899","F43.25","F43.20","J45.909","L50.1","R40.4","R42.","M13.0","Z28.21","H93.11","H93.25","R94.120","H93.293","H69.93","H90.41","H93.231","R30.0","R35.0","R35.1"],"date":["2020-01-14","2020-01-14","2020-01-14","2021-03-24","2021-03-24","2021-03-24","2021-03-24","2021-03-24","2021-04-13","2021-04-13","2021-11-11","2019-02-01","2019-02-01","2019-02-01","2019-02-01","2019-02-01","2019-04-02","2019-04-02","2019-12-20","2019-12-20","2019-01-31","2019-02-06","2019-02-06","2019-08-08","2019-08-08","2019-08-08","2019-08-08","2019-10-29","2019-10-29","2019-10-29","2019-10-29","2019-10-29","2019-10-29","2019-02-01","2019-01-31","2019-01-31","2019-03-06","2019-01-30","2019-01-30","2019-02-07","2019-02-22","2019-05-16","2019-05-16","2019-11-08","2019-11-08","2019-11-08","2019-05-08","2019-05-08","2019-11-26","2019-11-26","2019-11-26"],"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":[["","00054001829","PREDNISONE","TAB 20MG","5","Select","Select",""],["","31604002766","PRENATAL","","30","Select","Select",""],["","42192032130","PNV-DHA","CAP ","30","Select","Select",""],["","00093598627","EPINEPHRINE","INJ 0.3MG","2","Select","Select",""],["","00065427325","PAZEO","DRO 0.007","2","Select","Select",""],["","50458058801","CONCERTA","TAB 27MG","30","Select","Select",""],["","13811070710","METHYLPHENID","TAB 27MG ER","30","Select","Select",""],["","64380080307","RANITIDINE","TAB 150MG","30","Select","Select",""],["","45802065078","LORATADINE","TAB 10MG","60","Select","Select",""],["","10702001250","HYDROXYZ","TAB 50MG","30","Select","Select",""],["","00093742698","MONTELUKAST","TAB 10MG","30","Select","Select",""],["","","NITROFURANTN","CAP 100MG","","Select","Select",""],["","75834002001","VITAMIN","CAP 50000UNT","4","Select","Select",""],["","50111064801","FLUOXETINE","CAP 20MG","30","Select","Select",""],["","65862022701","LAMOTRIGINE","TAB 25MG","90","Select","Select",""],["","67877057305","BENZONATATE","CAP 100MG","30","Select","Select",""],["","50428054089","CVS","CAP 5000UNIT","30","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","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":""}]}]}