{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LATOVA   D ORTIZ","gend":1,"add":"21 SHADY REST COURT","city":"RIDGEWAY","state":"VA","zip":"24148-5509","dob":"1990-03-01","age":"","mstatus":"","insh":4550480,"cliId":"","pno":2766348131,"cno":"","email":"","ename":"","eno":"","pphy":"TRIVEDI, RAJENDRA S","ppno":4347923730,"pcpadd":"501 Rison St, Ste 120","pcpcity":"Danville","pcpstate":"VA","pcpzip":245412426,"pcpcounty":"","pcpid":"","pcpname":"MEMORIAL FAMILY CARE INC","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"APT 3","add3":"","madd1":"21 SHADY REST COURT","madd2":"APT 3","madd3":"","mcity":"RIDGEWAY","mstate":"VA","mzip":"24148-5509","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F33.2","N93.9","N94.6","D59.9","N83.202","Z30.9","R68.89","Z30.2","N39.0","R31.9","R35.0","H65.03","L03.211","R10.9","F41.1","Z53.29","Z11.59","F33.1","R10.31","R10.84","Q50.1","Z72.0","F32.9","H60.391","K04.7","L50.0","R21","R51","O02.1","O99.341","O26.841","Z3A.08","Z36.89","F32.2","O02.0","F17.210","Z79.899","F31.30","O02.89","R10.2","R63.4","N73.9","Z02.1","O26.891","R82.90","Z01.411","Z11.3","Z32.00","O21.9","R11.2","R94.6","U07.1","R06.00","J20.9","J01.90","R05","M54.5","F33.9","F31.12","R03.0","G47.00","F41.9","R20.2","Z30.40","Z79.3","Z01.419","Z30.42","Z32.02","F31.62","H00.011","N89.8","Z20.2","Z72.51"],"date":["2022-02-28","2020-01-22","2020-01-08","2020-01-08","2020-01-08","2020-01-08","2020-04-30","2020-02-11","2021-12-27","2020-03-26","2020-03-26","2020-03-26","2020-03-26","2020-07-17","2021-10-16","2020-06-12","2020-09-24","2020-07-02","2021-03-18","2020-07-17","2020-07-17","2020-07-17","2021-12-27","2020-08-19","2020-09-18","2020-08-21","2020-08-21","2020-09-18","2020-09-28","2020-09-22","2020-09-22","2021-04-01","2020-09-22","2020-09-22","2020-09-28","2020-09-24","2020-09-24","2020-09-25","2020-09-28","2020-12-22","2020-12-23","2020-12-22","2021-01-22","2021-04-01","2021-03-18","2021-03-18","2021-03-18","2021-03-18","2021-04-01","2021-04-01","2021-07-09","2021-09-01","2021-09-01","2021-09-01","2021-09-01","2021-09-01","2021-09-01","2021-10-16","2021-11-04","2021-12-27","2021-12-27","2019-01-31","2019-01-31","2019-03-11","2019-03-11","2019-04-05","2019-04-05","2019-04-22","2019-04-10","2019-05-01","2019-09-24","2019-09-24","2019-09-24"],"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":[["","50111033402","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","43547028810","BUPROPION","TAB 100MG SR","30","Select","Select",""],["","00536440601","VITAMIN","TAB 25MG","90","Select","Select",""],["","00904531346","PRENATAL","TAB 27-0.8MG","30","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","14","Select","Select",""],["","57237000511","FLUCONAZOLE","TAB 150MG","2","Select","Select",""],["","00143992801","CIPROFLOXACN","TAB 500MG","20","Select","Select",""],["","63402030230","LATUDA","TAB 20MG","30","Select","Select",""],["","13811071910","NITROFURANTN","CAP 100MG","14","Select","Select",""],["","29300011101","LAMOTRIGINE","TAB 25MG","60","Select","Select",""],["","57237007710","ONDANSETRON","TAB 4MG ODT","12","Select","Select",""],["","57237000830","MIRTAZAPINE","TAB 15MG","30","Select","Select",""],["","68462019005","NAPROXEN","TAB 500MG","30","Select","Select",""],["","65862001501","AMOXICILLIN","TAB 875MG","20","Select","Select",""],["","57237004105","PENICILLN","TAB 500MG","30","Select","Select",""],["","51293081001","PHENAZOPYRID","TAB 100MG","6","Select","Select",""],["","50111043301","TRAZODONE","TAB 50MG","15","Select","Select",""],["","65862018601","CLINDAMYCIN","CAP 300MG","20","Select","Select",""],["","00093101042","MUPIROCIN","OIN 0.02","22","Select","Select",""],["","00172572860","FAMOTIDINE","TAB 20MG","20","Select","Select",""],["","00591544305","PREDNISONE","TAB 20MG","6","Select","Select",""],["","43598081115","CETIRIZINE","TAB 10MG","10","Select","Select",""],["","00093031401","KETOROLAC","TAB 10MG","15","Select","Select",""],["","52817033200","CYCLOBENZAPR","TAB 10MG","20","Select","Select",""],["","00093314705","CEPHALEXIN","CAP 500MG","14","Select","Select",""],["","69097084805","ESCITALOPRAM","TAB 10MG","30","Select","Select",""],["","59762453701","MEDROXYPR","INJ 150MG\/ML","1","Select","Select",""],["","00904759080","FEROSUL","TAB 325MG","60","Select","Select",""],["","13925011701","SE-NATAL","CHW ","30","Select","Select",""],["","74312002060","ZINC","TAB 50MG","60","Select","Select",""],["","51224012230","AZITHROMYCIN","TAB 500MG","2","Select","Select",""],["","00406012305","HYDROCO\/APAP","TAB 5-325MG","32","Select","Select",""],["","00115180301","HYDROXYZ","CAP 25MG","21","Select","Select",""],["","65862044890","VALACYCLOVIR","TAB 500MG","30","Select","Select",""],["","51672130406","TERCONAZOLE","CRE 0.004","45","Select","Select",""],["","65862001305","SERTRALINE","TAB 100MG","30","Select","Select",""],["","24208091055","ERYTHROMYCIN","OIN OP","3.5","Select","Select",""],["","00143980305","DOXYCYCL","CAP 100MG","20","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":""}]}]}