{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"WENDY   L LIPPINCOTT","gend":1,"add":"520 E MARSHALL STREET","city":"WYTHEVILLE","state":"VA","zip":"24382-3227","dob":"1982-02-15","age":"","mstatus":"","insh":4650572,"cliId":"","pno":2769200634,"cno":"","email":"","ename":"","eno":"","pphy":"GRIFFIN, SUSAN R","ppno":2762286499,"pcpadd":"1785 W Lee Hwy, ","pcpcity":"Wytheville","pcpstate":"VA","pcpzip":243821437,"pcpcounty":"","pcpid":"","pcpname":"FOREST FAMILY CARE","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"","add3":"","madd1":"520 E MARSHALL STREET","madd2":"","madd3":"","mcity":"WYTHEVILLE","mstate":"VA","mzip":"24382-3227","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K76.0","R10.11","R11.0","R07.89","R07.9","F32.9","M06.9","E78.00","Z79.899","E03.9","E78.5","I31.9","R00.2","R06.02","I26.99","R55","K57.30","K57.90","G43.019","F41.9","R56.9","G43.719","R51","R60.0","Z23","I82.419","Z91.09","K21.9","E78.49","M79.671","I10","R42","R11.2","Z88.5","Z88.8","Z79.02","Z79.1","M10.9","G43.909","Z86.711","J06.9","R05","J02.9","Z20.822","Z90.710","Z79.01","R05.9","R09.89","F32.A","E66.9","Z79.52","R07.2","G89.29","R00.0","I45.19","I45.81","R94.31","R16.0","J98.11","Z86.718","M25.572","M94.0","R07.81","E03.8","M54.5","I73.9","M54.16","M54.31","M54.40","M54.2","E04.9"],"date":["2020-03-11","2020-03-24","2021-11-29","2020-01-27","2021-08-03","2021-09-24","2020-01-27","2021-11-29","2021-09-24","2021-12-27","2021-12-15","2020-07-16","2021-04-19","2021-08-25","2021-08-20","2021-12-15","2020-03-11","2020-03-11","2020-04-23","2020-12-21","2020-04-23","2022-01-05","2020-09-23","2020-07-21","2020-10-01","2021-12-15","2020-12-21","2021-11-29","2021-06-21","2021-08-03","2021-11-29","2021-08-03","2021-08-03","2021-09-24","2021-09-24","2021-08-03","2021-11-29","2021-11-29","2021-11-29","2021-08-03","2021-11-29","2021-09-24","2021-09-24","2021-11-29","2021-09-24","2021-11-29","2021-11-29","2021-11-29","2021-11-29","2021-11-29","2021-11-29","2019-06-08","2019-02-09","2019-02-10","2019-02-10","2019-02-10","2019-02-10","2019-02-10","2019-02-10","2019-06-08","2019-05-02","2019-06-22","2019-06-23","2019-08-07","2019-10-09","2019-10-10","2019-10-10","2019-10-15","2019-10-10","2019-10-10","2019-11-01"],"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":[["","00185067401","HYDROXYZ","CAP 25MG","120","Select","Select",""],["","00172409680","BACLOFEN","TAB 10MG","90","Select","Select",""],["","65862047605","RAMIPRIL","CAP 5MG","30","Select","Select",""],["","00172572970","FAMOTIDINE","TAB 40MG","30","Select","Select",""],["","80777027399","MODERNA","INJ COVID-19","0.5","Select","Select",""],["","62175013643","OMEPRAZOLE","CAP 40MG","60","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","65862056090","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","58160088752","FLUARIX","INJ 2021-22","0.5","Select","Select",""],["","16714074002","FENOFIBRATE","CAP 134MG","30","Select","Select",""],["","00536641208","MELATONIN","TAB 3MG","30","Select","Select",""],["","10006073038","MAG","TAB 400MG","30","Select","Select",""],["","50458057930","XARELTO","TAB 20MG","30","Select","Select",""],["","00115703301","FLUDROCORT","TAB 0.1MG","180","Select","Select",""],["","69097012503","TOPIRAMATE","TAB 200MG","60","Select","Select",""],["","00378623205","CITALOPRAM","TAB 20MG","30","Select","Select",""],["","64380080438","RANITIDINE","TAB 300MG","60","Select","Select",""],["","43547027310","ROPINIROLE","TAB 4MG","30","Select","Select",""],["","27241009990","DULOXETINE","CAP 60MG","60","Select","Select",""],["","00378182377","LEVOTHYROXIN","TAB 137MCG","60","Select","Select",""],["","00023114501","BOTOX","INJ 100UNIT","2","Select","Select",""],["","16714089802","LORATADINE","TAB 10MG","30","Select","Select",""],["","61442012710","MELOXICAM","TAB 15MG","30","Select","Select",""],["","00832532515","POT  CL MICRO","TAB 20MEQ ER","60","Select","Select",""],["","72205002799","ROSUVASTATIN","TAB 5MG","30","Select","Select",""],["","62037083301","METOPROL","TAB 200MG ER","30","Select","Select",""],["","61314027105","OLOPATADINE","CL 0.1% OPTH","5","Select","Select",""],["","51660052605","ALLERGY","TAB 10MG","30","Select","Select",""],["","65162052111","PROMETHAZINE","TAB 25MG","12","Select","Select",""],["","69238106901","POT  CHLORIDE","TAB 20MEQ ER","180","Select","Select",""],["","43547036050","LOSARTAN","TAB 25MG","30","Select","Select",""],["","00591079510","DICYCLOMINE","TAB 20MG","20","Select","Select",""],["","59746017310","PREDNISONE","TAB 10MG","35","Select","Select",""],["","57664050318","TIZANIDINE","TAB 4MG","180","Select","Select",""],["","17478071710","KETOTIF","DRO 0.025%OP","5","Select","Select",""],["","70010075405","METHOCARBAM","TAB 500MG","90","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":""}]}]}