{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JORDAN   C WADE","gend":1,"add":"PO BOX 214                                                  ","city":"RURAL RETREAT                 ","state":"VA","zip":"24368-0214","dob":"1998-10-10","age":"","mstatus":"","insh":4312889,"cliId":"","pno":2766200168,"cno":2766201047,"email":"","ename":"","eno":"","pphy":"ROGERS, RACHEL M                                            ","ppno":2767832511,"pcpadd":"1204 N Main St                                              ,                                                            ","pcpcity":"MARION                        ","pcpstate":"VA","pcpzip":243544312,"pcpcounty":"","pcpid":"","pcpname":"MOUNTAINVIEW PEDIATRICS PC&","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"PO BOX 214                                                  ","add3":"","madd1":"PO BOX 214                                                  ","madd2":"                                                            ","madd3":"","mcity":"RURAL RETREAT                 ","mstate":"VA","mzip":"24368-0214","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z30.431","G37.9","G43.709","N83.201","K22.4","R51","G97.1","G43.909","H91.90","E66.9","Z68.32","G43.009","G35","T67.5XXA","K59.09","M21.41","M21.42","K59.00","M79.671","M76.821","M79.672","M76.822","Z01.812","Z20.828","R12","R13.19","K63.5","G89.29","K21.9","E55.9","M54.6","K22.2","R05","R11.10","R13.10","R20.2","R20.0","R07.9","H91.92","Z68.34","Z79.899","Z98.890","R47.9","R20.1","Z86.69","Z03.89","R13.12","J38.7","Z01.411","Z12.4","R10.2","Z97.5","K58.9","R41.3","R53.82","Z13.0","Z13.1","Z13.21","Z13.220","Z13.228","R29.818","R44.8","R29.898","J37.0","H90.12","J30.89","H93.13","R42","H90.5","R29.2","J31.0","D80.8","R10.13","K21.00","R10.32","R19.8","R90.89","H69.93","M54.50","W19.XXXA","R00.2","U07.1","R50.9","H92.02","R94.02","R56.9","R07.89","Z20.822","E04.9","E24.9","R63.5","R13.11","G47.33","F43.9","F41.9","E88.81","L65.9","M25.561","Z83.3","M25.50","E06.3"],"date":["2020-01-16","2022-11-29","2022-09-09","2020-04-06","2020-01-30","2020-02-05","2020-02-06","2021-02-10","2020-11-13","2020-12-29","2020-02-06","2022-11-29","2022-07-20","2020-09-03","2022-11-29","2020-10-06","2020-10-06","2022-10-07","2020-10-20","2021-10-29","2020-10-20","2021-10-29","2022-09-14","2020-12-29","2022-11-29","2020-11-13","2020-11-13","2020-12-29","2022-10-20","2022-11-10","2020-11-20","2020-12-29","2021-04-06","2020-12-29","2021-01-14","2020-12-29","2020-12-30","2022-09-14","2020-12-29","2020-12-29","2022-09-14","2020-12-29","2020-12-30","2020-12-30","2020-12-30","2020-12-30","2021-01-05","2021-04-06","2021-01-20","2021-01-20","2021-04-14","2021-04-14","2021-02-10","2021-02-10","2021-02-10","2021-02-10","2021-02-10","2021-02-10","2021-02-10","2021-02-10","2021-02-19","2021-02-19","2021-02-19","2021-12-01","2021-06-02","2021-06-02","2021-06-02","2021-06-02","2021-06-02","2021-06-02","2021-06-03","2021-06-03","2022-09-27","2021-11-16","2021-11-18","2021-11-18","2022-07-20","2022-02-08","2022-05-02","2022-05-02","2022-10-20","2022-06-17","2022-06-17","2022-06-17","2022-07-20","2022-10-03","2022-10-20","2022-09-14","2022-11-10","2022-11-02","2022-11-10","2022-10-07","2022-10-20","2022-11-29","2022-11-29","2022-11-29","2022-11-10","2022-11-29","2022-11-29","2022-11-29","2022-11-29"],"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":[["","65649000330","TRULANCE","TAB 3MG","30","Select","Select",""],["","68645014059","FAMOTIDINE","TAB 20MG","60","Select","Select",""],["","00002143611","EMGALITY","INJ 120MG\/ML","1","Select","Select",""],["","72618300002","NURTEC","TAB 75MG ODT","16","Select","Select",""],["","16714066202","GABAPENTIN","CAP 300MG","90","Select","Select",""],["","64764024060","AMITIZA","CAP 24MCG","60","Select","Select",""],["","70700015010","OMEPRAZOLE","CAP 20MG","90","Select","Select",""],["","64380074108","BUSPIRONE","TAB 5MG","90","Select","Select",""],["","64380073706","VITAMIN","CAP 50000UNT","4","Select","Select",""],["","16714008502","SPIRONOLACT","TAB 50MG","30","Select","Select",""],["","10702000709","CYCLOBENZAPR","TAB 10MG","30","Select","Select",""],["","45802005935","NYSTATIN","CRE 100000","15","Select","Select",""],["","57237008734","RIZATRIPTAN","TAB 5MG","10","Select","Select",""],["","57237003005","AMOXICILLIN","CAP 250MG","30","Select","Select",""],["","16729017117","AMITRIPTYLIN","TAB 10MG","90","Select","Select",""],["","16714079801","SUMATRIPTAN","TAB 100MG","9","Select","Select",""],["","51224002218","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","00456120130","LINZESS","CAP 145MCG","30","Select","Select",""],["","29300011616","TOPIRAMATE","TAB 50MG","30","Select","Select",""],["","65162019011","NAPROXEN","TAB 500MG","15","Select","Select",""],["","70461031903","FLUCLVX","INJ 2019-20","0.5","Select","Select",""],["","64380076921","PEG-3350\/KCL","SOL \/SODIUM","4,000.00","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","59746011506","PROCHLORPER","TAB 10MG","30","Select","Select",""],["","16571020150","DICLOFENAC","TAB 75MG DR","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":""}]}]}