{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"AMANDA   D AYERS","gend":1,"add":"PO BOX 271","city":"GALAX                         ","state":"VA","zip":"24333-0271","dob":"1989-08-08","age":"","mstatus":"","insh":4218108,"cliId":"","pno":2762358374,"cno":"","email":"","ename":"","eno":"","pphy":"FANT, VANESSA","ppno":8007657130,"pcpadd":"400 S Independence Ave,","pcpcity":"Independence                  ","pcpstate":"VA","pcpzip":243483972,"pcpcounty":"","pcpid":"","pcpname":"OLDTOWN MEDICAL CARE LLC","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"SOUTHWEST","aligned":"","ano":"","add2":"PO BOX 271","add3":"","madd1":"PO BOX 271","madd2":"","madd3":"","mcity":"GALAX                         ","mstate":"VA","mzip":"24333-0271","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K21.9","K90.0","R10.9","K58.9","F17.200","F41.9","E03.9","E78.5","E04.2","Z13.9","F39","J45.909","Z79.899","J11.1","J30.9","M54.6","M25.562","M54.5","F43.12","R68.89","E06.3","Z01.419","Z23","Z11.3","K29.80","R13.10","K29.50","K21.0","Z72.0","E07.9","K29.90","K29.70","H04.123","D31.31","D31.22","M54.2","M54.16","M62.81","G89.4","Z3A.09","Z11.8","O26.892","R10.30","O99.332","Z3A.16","O99.280","Z36.89","Z3A.19","Z34.90","Z34.83","O24.419","O24.410","K13.79","K08.89","K02.9","I10","Z88.5","Z79.1","Z79.51","R68.84","O36.5931","O34.211","O76","O36.5930","Z37.0","Z3A.31","O36.5990","O24.420","O99.284","Z79.890","F32.A","O99.344","F17.210","Z09","M79.601","I73.00","Z39.2","E89.0","F33.1","E04.1","K29.00","R10.13","R11.0","R10.32","Z79.82","R49.9","F32.9","E04.9","G89.18","F17.220","R01.1","S29.011A","X58.XXXA","S29.012A","K04.7","K05.10"],"date":["2021-03-11","2021-03-11","2021-07-24","2021-03-11","2021-03-11","2021-11-11","2021-11-20","2021-03-11","2022-02-11","2020-01-07","2020-09-09","2020-09-23","2021-11-20","2020-02-10","2020-07-15","2021-01-04","2020-07-22","2021-03-11","2020-07-24","2021-01-27","2022-03-09","2020-08-26","2020-08-26","2021-05-18","2020-09-25","2020-09-25","2020-09-25","2020-09-25","2020-09-23","2020-09-23","2020-09-25","2020-09-25","2020-10-27","2020-10-27","2020-10-27","2021-03-11","2022-02-08","2021-01-04","2021-03-11","2021-05-18","2021-05-18","2021-07-24","2021-07-24","2021-07-24","2021-07-24","2021-07-29","2021-07-29","2021-07-29","2021-09-22","2021-10-08","2021-10-13","2021-11-01","2021-10-26","2021-10-26","2021-10-26","2021-10-26","2021-11-11","2021-10-26","2021-11-11","2021-10-26","2021-11-10","2021-11-11","2021-11-11","2021-11-11","2021-11-11","2021-11-11","2021-11-11","2021-11-11","2021-11-11","2021-11-20","2021-11-11","2021-11-11","2021-11-20","2021-11-18","2021-11-20","2021-11-20","2021-12-16","2022-02-11","2019-09-04","2019-05-14","2019-03-04","2019-03-04","2019-03-04","2019-03-04","2019-03-28","2019-05-08","2019-05-14","2019-05-14","2019-05-20","2019-05-20","2019-12-01","2019-07-12","2019-07-12","2019-07-12","2019-12-01","2019-12-01"],"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":{"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":[["","65862057490","MONTELUKAST","TAB 10MG","90","Select","Select",""],["","00378181377","LEVOTHYROXIN","TAB 125MCG","180","Select","Select",""],["","65862052305","GABAPENTIN","TAB 600MG","60","Select","Select",""],["","65862050320","AMOX\/K","TAB 875-125","10","Select","Select",""],["","60432046400","LIDOCAINE","SOL 2% VISC","100","Select","Select",""],["","65162019050","NAPROXEN","TAB 500MG","20","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","70710113908","FLUCONAZOLE","TAB 150MG","2","Select","Select",""],["","66993037083","MEDROXYPR","INJ 150MG\/ML","1.00","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","59267100001","PFIZER","INJ COVID-19","0.3","Select","Select",""],["","10702001801","OXYCODONE","TAB 5MG","12","Select","Select",""],["","49483060350","IBUPROFEN","TAB 600MG","90","Select","Select",""],["","59779045839","CVS","TAB 10MG","30","Select","Select",""],["","69315012710","FOLIC","TAB 1000MCG","30","Select","Select",""],["","00536100901","FERROUS","TAB 325MG","30","Select","Select",""],["","69097014260","ALBUTEROL","AER HFA","6.7","Select","Select",""],["","00193730850","BAYER","NE XT 50CT","50","Select","Select",""],["","00193658621","MICROLET","MIS LANCETS","30","Select","Select",""],["","58160088752","FLUARIX","INJ 2021-22","0.5","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","6","Select","Select",""],["","00093226301","AMOXICILLIN","TAB 500MG","30","Select","Select",""],["","00093081001","NORTRIPTYLIN","CAP 10MG","60","Select","Select",""],["","00173071920","FLOVENT","AER 110MCG","12","Select","Select",""],["","50111064701","FLUOXETINE","CAP 10MG","30","Select","Select",""],["","67877057505","BENZONATATE","CAP 200MG","30","Select","Select",""],["","69238126601","OSELTAMIVIR","CAP 75MG","10","Select","Select",""],["","00378395377","ATORVASTATIN","TAB 80MG","30","Select","Select",""],["","64380080438","RANITIDINE","TAB 300MG","30","Select","Select",""],["","67877025130","TRIAMCINOLON","CRE 0.001","90","Select","Select",""],["","65862086001","FAMOTIDINE","TAB 40MG","30","Select","Select",""],["","45802057178","FEXOFENADINE","TAB 180MG","30","Select","Select",""],["","45802086866","POLYETH","POW 3350 NF","28","Select","Select",""],["","51645075099","DOCUSATE","UM 100 MG TA","60","Select","Select",""],["","31722057330","ESOMEPRA","CAP 40MG DR","30","Select","Select",""],["","10370010150","BUPROPN","TAB 150MG XL","30","Select","Select",""],["","00143122701","DICYCLOMINE","TAB 20MG","24","Select","Select",""],["","59746028490","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","43547040710","CLONAZEPAM","TAB 1MG","45","Select","Select",""],["","51862032001","LIOTHYRONINE","TAB 5MCG","30","Select","Select",""],["","50428006205","SALINE","SPR 0.0065","88","Select","Select",""],["","00093221001","SUCRALFATE","TAB 1GM","56","Select","Select",""],["","42858010201","OXYCOD\/APAP","TAB 5-325MG","10","Select","Select",""],["","65862039010","ONDANSETRON","TAB 4MG ODT","12","Select","Select",""],["","00085113204","PROVENTIL","AER HFA","6.7","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":""}]}]}