{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LAURA   A LOGAN","gend":1,"add":"1554   BLUEMONT AVENUE                                      ","city":"ROANOKE                       ","state":"VA","zip":"24015-4921","dob":"1985-06-08","age":"","mstatus":"","insh":4239641,"cliId":"","pno":5404670255,"cno":"","email":"","ename":"","eno":"","pphy":"INOUYE, ALICE MASAMI                                        ","ppno":5403870441,"pcpadd":"4910 Valley View Blvd NW Ste 100,","pcpcity":"Roanoke                       ","pcpstate":"VA","pcpzip":240122022,"pcpcounty":"","pcpid":"","pcpname":"LEWIS GALE PHYSICIANS LLC","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"APT 162                                                     ","add3":"","madd1":"1554 Bluemont Ave SW Apt 162","madd2":"                                                            ","madd3":"","mcity":"Roanoke                       ","mstate":"VA","mzip":"24015-4921","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F31.62","E66.9","M79.7","R11.2","F33.1","F31.31","N39.0","R10.2","E78.5","K21.9","Z87.891","F12.10","G47.00","R06.83","F12.20","R40.0","N93.9","Z72.51","Z32.02","R30.0","N76.0","M25.572","W01.0XXA","W01.0XXD","Z01.419","Z11.51","R87.810","K12.0","Z80.1","B07.9","Z76.0","J02.0","F33.42","F31.9","A59.01"],"date":["2021-12-29","2021-04-27","2021-09-08","2021-02-15","2021-12-29","2021-06-15","2021-03-06","2021-03-06","2021-03-06","2021-09-08","2021-03-06","2021-12-29","2021-04-27","2021-04-27","2021-04-27","2021-04-27","2021-06-24","2021-09-18","2021-06-24","2021-07-24","2021-12-20","2021-08-03","2021-07-24","2021-08-03","2021-08-18","2021-08-18","2021-08-18","2021-08-31","2021-09-08","2021-10-12","2021-09-18","2021-10-11","2021-12-29","2021-12-29","2021-12-20"],"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":[["","68382079101","ACYCLOVIR","TAB 400MG","60","Select","Select",""],["","00378427677","VALACYCLOVIR","TAB 1GM","30","Select","Select",""],["","68462018905","NAPROXEN","TAB 375MG","30","Select","Select",""],["","65862052790","VENLAFAXINE","CAP 37.5 ER","30","Select","Select",""],["","00115180301","HYDROXYZ","CAP 25MG","30","Select","Select",""],["","70700015010","OMEPRAZOLE","CAP 20MG","180","Select","Select",""],["","65862001705","AMOXICILLIN","CAP 500MG","14","Select","Select",""],["","57237000511","FLUCONAZOLE","TAB 150MG","2","Select","Select",""],["","50111033402","METRONIDAZOL","TAB 500MG","21","Select","Select",""],["","62332003731","LAMOTRIGINE","TAB 25MG","60","Select","Select",""],["","59267100001","PFIZER","INJ COVID-19","0.3","Select","Select",""],["","00093314705","CEPHALEXIN","CAP 500MG","28","Select","Select",""],["","67877024201","QUETIAPINE","TAB 25MG","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":""}]}]}