{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ALESHIA   G THOMASON","gend":1,"add":"4090 ROCKINGHAM BOULEVARD                                   ","city":"ROANOKE                       ","state":"VA","zip":"24014-6726","dob":"1979-08-15","age":"","mstatus":"","insh":4390610,"cliId":"","pno":5405217394,"cno":"","email":"","ename":"","eno":"","pphy":"KEILMAN, DAVID A                                            ","ppno":5402651607,"pcpadd":"4910 Valley View Blvd Nw Ste 10                             ,                                                            ","pcpcity":"Roanoke                       ","pcpstate":"VA","pcpzip":240122040,"pcpcounty":"","pcpid":"","pcpname":"LEWIS GALE PHYSICIANS LLC","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"4090 ROCKINGHAM BOULEVARD                                   ","add3":"","madd1":"4090 ROCKINGHAM BOULEVARD                                   ","madd2":"                                                            ","madd3":"","mcity":"ROANOKE                       ","mstate":"VA","mzip":"24014-6726","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E03.9","R74.8","Z78.9","R51.9","R41.3","R10.11","R11.0","Z87.42","W55.49XA","R13.10","R27.0","R42","R20.0","H53.8","T42.6X5A","R00.0","R94.31","R26.0","R29.818","G40.909","G43.909","Z87.39","R47.9","R29.90","G25.3","G93.40","R26.81","Z86.69","I06.8","I08.8","D72.829","R11.2","F41.9","R47.01","R47.1","R41.1","H53.9","R09.89","M32.9","F41.1","G40.A09","G43.719","G31.84","M06.9","R10.10","R19.7","Z86.73","R10.9","R30.0","Z01.419","N80.9","K52.9","R53.1","R03.0","Z09","G43.109","Z53.21","M54.50","R10.30","G45.9","F44.5","G43.709","K92.1","Z20.822","K50.90","F19.10","F68.10","Z79.890","Z87.442","F68.13","R41.0","R40.4","K62.5","R10.13","K64.4","M79.7","Z87.891","Z79.899","Z83.2","Z80.9","N93.9","N94.6","Z32.02","R10.2","F52.6","N92.0","Z30.42","N12","R10.31","F32.9","R35.0","R32","N94.10","G62.9","R82.90","R73.9","K31.89","K63.5","K51.40","K29.80","K29.30","K29.70","F17.210","R56.9","K27.9","E66.9","Z68.35","B37.0","R53.81","M06.00","G89.29"],"date":["2022-10-25","2021-10-04","2021-10-04","2021-10-15","2021-10-04","2021-12-01","2022-11-30","2021-10-04","2021-10-04","2022-11-09","2021-11-16","2021-12-13","2021-12-13","2021-10-14","2021-10-14","2021-10-15","2021-12-16","2021-10-15","2021-12-13","2021-11-16","2021-12-13","2021-10-15","2021-12-13","2021-10-17","2021-10-16","2021-10-16","2021-10-16","2021-10-16","2021-10-16","2021-10-16","2021-10-17","2021-12-13","2021-10-17","2021-10-17","2021-12-13","2021-10-17","2021-10-17","2021-10-18","2021-12-16","2021-11-16","2021-10-18","2021-11-16","2021-11-16","2022-10-25","2021-11-16","2022-10-25","2021-12-13","2022-11-30","2022-08-11","2021-10-25","2021-10-25","2022-09-14","2021-12-13","2021-10-26","2021-10-26","2021-10-26","2021-10-30","2021-11-07","2021-11-07","2021-11-07","2021-12-13","2021-11-18","2021-11-30","2021-12-13","2021-12-16","2021-12-13","2021-12-13","2022-08-18","2021-12-13","2021-12-14","2021-12-13","2021-12-13","2021-12-16","2022-10-25","2021-12-16","2022-10-25","2021-12-16","2021-12-16","2021-12-16","2021-12-16","2022-02-28","2022-02-07","2022-11-17","2022-08-22","2022-02-07","2022-02-28","2022-11-17","2022-08-18","2022-08-18","2022-08-22","2022-08-22","2022-08-22","2022-08-22","2022-08-29","2022-08-29","2022-09-14","2022-10-25","2022-10-25","2022-10-25","2022-10-25","2022-10-25","2022-10-25","2022-10-25","2022-10-25","2022-10-25","2022-10-25","2022-10-25","2022-11-30","2022-11-30","2022-11-30","2022-11-30"],"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":[["","69238183607","LEVOTHYROXIN","TAB 125MCG","30","Select","Select",""],["","66993037083","MEDROXYPR","INJ 150MG\/ML","1","Select","Select",""],["","65162052110","PROMETHAZINE","TAB 25MG","20","Select","Select",""],["","65862042001","SMZ\/TMP","TAB 800-160","14","Select","Select",""],["","68462015713","ONDANSETRON","TAB 4MG ODT","10","Select","Select",""],["","65162068110","PHENAZOPYRID","TAB 100MG","20","Select","Select",""],["","72578005505","DOXYCYCL","CAP 100MG","20","Select","Select",""],["","00527058601","DICYCLOMINE","CAP 10MG","20","Select","Select",""],["","42806026695","CHOLESTYRAM","POW 4GM","60","Select","Select",""],["","68382072001","BUDESONIDE","CAP 3MG","60","Select","Select",""],["","57896048930","POLYETH","POW 3350 NF","510","Select","Select",""],["","68382000514","TOPIRAMATE","CAP 25MG","240","Select","Select",""],["","10702025350","BUT\/APAP\/CAF","TAB ","20","Select","Select",""],["","59762040105","SUCRALFATE","TAB 1GM","60","Select","Select",""],["","69315012710","FOLIC","TAB 1000MCG","30","Select","Select",""],["","57896010201","ACETAMINOPHE","TAB 325MG","20","Select","Select",""],["","40985022368","THERAPEUTIC-","TAB M\/LUTEIN","30","Select","Select",""],["","55111015834","OMEPRAZOLE","CAP 20MG","60","Select","Select",""],["","73796027104","BLOOD","KIT 3 SERIES","1","Select","Select",""],["","50111056001","TRAZODONE","TAB 50MG","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":""}]}]}