{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KAITLYN   N GREEN","gend":1,"add":"1501 SANDY LEVEL ROAD","city":"GOODVIEW                      ","state":"VA","zip":"24095-2961","dob":"2003-08-21","age":"","mstatus":"","insh":4224819,"cliId":"","pno":5402386099,"cno":5407930193,"email":"","ename":"","eno":"","pphy":"NEVIN, MARC G","ppno":5402970023,"pcpadd":"1308 W Main St,","pcpcity":"Salem                         ","pcpstate":"VA","pcpzip":241534708,"pcpcounty":"","pcpid":"","pcpname":"LONG TERM CARE OF AMERICA VIRGINIA INC","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"1501 SANDY LEVEL ROAD","add3":"","madd1":"1501 SANDY LEVEL ROAD","madd2":"LOT 6","madd3":"","mcity":"GOODVIEW                      ","mstate":"VA","mzip":"24095-2961","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K50.019","E55.9","R63.5","J02.9","R53.81","Z20.828","G43.009","F41.9","F32.9","L70.0","L73.0","Z00.3","L03.012","I89.1","L03.022","M79.645","M79.89","Z77.22","L03.011","S05.11XA","J45.909","Z79.899","W01.0XXA","Y92.89","S09.90XA","M25.572","M54.5","M54.9","Z91.030","Z91.018","Z88.8","R11.0","W57.XXXA","R51.9","M25.511","S46.001A","R20.0","Z88.6","X50.1XXA","Y93.66","S49.91XA","R10.9","K21.9","Z13.0","Z23","K50.90","Z71.9","K29.70","D84.9","R11.2","R10.13","K92.1","Z20.822","R11.10","K50.80","R01.1","K64.4","U07.1","R05","Z79.52","Z87.09","F41.1","L50.2","T78.1XXA","L50.1","T78.1XXD","J45.20"],"date":["2021-11-04","2021-11-22","2020-05-07","2021-01-06","2020-06-02","2020-06-02","2021-03-08","2021-09-14","2021-03-08","2020-08-24","2020-08-24","2020-10-02","2020-10-30","2020-10-30","2020-10-30","2020-10-30","2020-10-30","2020-10-30","2020-11-09","2021-01-31","2021-08-28","2021-09-21","2021-01-31","2021-06-10","2021-01-31","2021-02-10","2021-03-19","2021-03-19","2021-09-21","2021-09-21","2021-09-21","2021-04-20","2021-04-20","2021-04-20","2021-06-10","2021-06-10","2021-06-10","2021-09-21","2021-06-10","2021-06-10","2021-06-10","2021-08-28","2021-11-22","2021-08-12","2021-08-12","2021-11-22","2021-11-22","2021-08-28","2021-08-28","2021-08-28","2021-08-28","2021-08-28","2021-08-28","2021-08-28","2021-09-14","2021-09-14","2021-09-14","2021-09-21","2021-09-21","2021-09-21","2021-09-21","2021-12-13","2021-11-22","2021-12-09","2021-12-30","2021-12-09","2021-12-09"],"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":[["","65162083366","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","68462015713","ONDANSETRON","TAB 4MG ODT","30","Select","Select",""],["","45802057178","FEXOFENADINE","TAB 180MG","30","Select","Select",""],["","65162006205","SUCRALFATE","SUS 1GM\/10ML","1,000.00","Select","Select",""],["","68382072001","BUDESONIDE","CAP 3MG","147","Select","Select",""],["","65862056090","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","40093010231","VIT","CAP 2000UNIT","30","Select","Select",""],["","37205034672","LORATADINE","TAB 10MG","30","Select","Select",""],["","45802008801","ALBUTEROL","AER HFA","8.5","Select","Select",""],["","62756052069","SUMATRIPTAN","TAB 25MG","18","Select","Select",""],["","49100040009","CULTURELLE","CAP ","30","Select","Select",""],["","49483000301","BISACODYL","TAB 5MG EC","2","Select","Select",""],["","70000041503","CLEARLAX","POW ","510","Select","Select",""],["","00172572960","FAMOTIDINE","TAB 40MG","60","Select","Select",""],["","00904671772","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","51660052601","ALLERGY","TAB 10MG","30","Select","Select",""],["","00378100501","AZATHIOPRINE","TAB 50MG","60","Select","Select",""],["","68382066201","SPIRONOLACT","TAB 100MG","30","Select","Select",""],["","67877022305","GABAPENTIN","CAP 300MG","30","Select","Select",""],["","74312005535","MAGNESIUM","TAB 500MG","60","Select","Select",""],["","67877057305","BENZONATATE","CAP 100MG","21","Select","Select",""],["","54458032334","VITAMIN","CAP 1000UNIT","30","Select","Select",""],["","00781261305","AMOXICILLIN","CAP 500MG","20","Select","Select",""],["","00115169449","EPINEPHRINE","INJ 0.3MG","2","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","00054458127","MERCAPTOPUR","TAB 50MG","60","Select","Select",""],["","00143980305","DOXYCYCL","CAP 100MG","14","Select","Select",""],["","00378064110","PREDNISONE","TAB 10MG","70","Select","Select",""],["","65162052110","PROMETHAZINE","TAB 25MG","20","Select","Select",""],["","37205074685","D3","CAP 1000UNIT","30","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","00116200116","CHLORHEX","SOL 0.0012","473","Select","Select",""],["","00591293201","CLINDAMYCIN","CAP 300MG","28","Select","Select",""],["","47781019605","OXYCOD\/APAP","TAB 5-325MG","16","Select","Select",""],["","53746027205","SMZ\/TMP","TAB 800-160","14","Select","Select",""],["","00574222545","TRETINOIN","CRE 0.00025","45","Select","Select",""],["","49035007841","EQ","CAP SOFTENER","60","Select","Select",""],["","00603015021","DOCQLACE","CAP 100MG","60","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":""}]}]}