{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DARLENE   L CROCKETT","gend":1,"add":"833 FOOTHILLS ROAD","city":"CALLAWAY                      ","state":"VA","zip":"24067-5513","dob":"1989-11-13","age":"","mstatus":"","insh":4932822,"cliId":"","pno":5404894253,"cno":"","email":"","ename":"","eno":"","pphy":"SUBUHI, TABASSUM","ppno":5407257555,"pcpadd":"180 Ferrum Mountain Rd,","pcpcity":"Ferrum                        ","pcpstate":"VA","pcpzip":240882939,"pcpcounty":"","pcpid":"","pcpname":"TRI AREA COMMUNITY HEALTH CENTER AT FERRUM","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"833 FOOTHILLS ROAD","add3":"","madd1":"833 FOOTHILLS ROAD","madd2":"","madd3":"","mcity":"CALLAWAY                      ","mstate":"VA","mzip":"24067-5513","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J02.9","H92.03","D68.52","F17.210","Z86.711","Z86.718","Z79.01","Z11.3","M79.12","M54.2","Z79.891","M54.5","G89.29","N30.00","R06.02","L29.9","R07.9","Z87.891","R00.0","F31.81","F41.9","F90.0","S09.90XA","J01.00","W10.8XXA","Y93.89","Y92.008","Y99.8","J45.909","M26.69","R51","W19.XXXA","R68.84","Z87.81","Z04.3","R10.9","E86.0","R42","H83.03","Z98.84","M62.81","R26.2","M25.60","N39.0","R30.0","R10.30","R50.9","R11.2","D50.9","Z98.51","M51.36","D64.9","Z79.899","D47.3","D68.59","Z76.89","Z82.0","F31.9","Z84.0","D50.0","D50.8","I26.99","I82.3","G43.909","R39.15","N10","N23","R16.0","K83.1","K44.9","R10.84","R93.421","R93.3","E78.00","R53.83","R25.2","Z79.02","M54.42","M54.41","H66.002","Z20.828","H66.003","G43.011","F11.20","R07.89","S29.011A","W01.0XXA","F17.200","B96.20","Z16.11","R11.0","R63.0"],"date":["2020-01-30","2021-01-02","2021-10-11","2021-08-03","2021-10-11","2021-09-09","2021-10-11","2020-07-10","2020-09-04","2020-10-01","2020-09-04","2020-12-09","2020-12-03","2020-05-28","2020-02-29","2020-02-29","2020-02-29","2021-10-11","2020-02-29","2020-03-30","2020-03-30","2020-03-30","2020-04-20","2020-04-19","2020-04-19","2020-04-19","2020-04-19","2020-04-19","2021-08-03","2020-04-20","2020-04-20","2020-04-20","2020-04-20","2020-04-20","2020-04-20","2021-10-11","2020-06-29","2020-06-29","2020-06-29","2021-08-03","2020-10-01","2020-10-01","2020-10-01","2020-10-29","2021-10-11","2020-10-11","2021-10-11","2020-10-30","2020-10-29","2020-10-11","2020-11-09","2021-07-01","2021-10-11","2021-08-03","2021-08-03","2020-11-09","2020-11-09","2020-11-29","2020-10-21","2021-08-03","2021-07-20","2021-08-03","2021-10-11","2020-10-29","2020-10-29","2020-10-30","2020-10-30","2020-10-30","2020-10-30","2020-10-30","2020-10-30","2020-10-30","2020-10-30","2021-08-03","2020-11-29","2020-11-29","2020-11-29","2020-12-03","2020-12-03","2021-01-02","2021-01-02","2021-01-02","2021-06-08","2021-10-05","2021-09-09","2021-09-09","2021-09-09","2021-09-09","2021-10-11","2021-10-11","2021-10-11","2021-10-11"],"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":[["","12496120803","SUBOXONE","MIS 8-2MG","14","Select","Select",""],["","00054018913","BUPREN\/NALOX","SUB 8-2MG","30","Select","Select",""],["","65862039010","ONDANSETRON","TAB 4MG ODT","10","Select","Select",""],["","69097014260","ALBUTEROL","AER HFA","6.7","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","14","Select","Select",""],["","75826011410","PHENAZOPYRID","TAB 100MG","15","Select","Select",""],["","57237000511","FLUCONAZOLE","TAB 150MG","1","Select","Select",""],["","50458057930","XARELTO","TAB 20MG","30","Select","Select",""],["","00093314705","CEPHALEXIN","CAP 500MG","28","Select","Select",""],["","00378064205","PREDNISONE","TAB 20MG","15","Select","Select",""],["","42806016005","HYDROXYZ","TAB 25MG","20","Select","Select",""],["","52817033200","CYCLOBENZAPR","TAB 10MG","60","Select","Select",""],["","68180016013","AZITHROMYCIN","TAB 250MG","4","Select","Select",""],["","00228212750","CLONIDINE","TAB 0.1MG","20","Select","Select",""],["","59011027160","HYSINGLA","TAB 20 MG","30","Select","Select",""],["","65862050320","AMOX\/K","TAB 875-125","14","Select","Select",""],["","69097052444","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","00555077902","MEDROXYPR","TAB 10MG","60","Select","Select",""],["","00093770198","LEVOCETIRIZI","TAB 5MG","30","Select","Select",""],["","69452015120","VITAMIN","CAP 50000UNT","4","Select","Select",""],["","00406012505","HYDROCO\/APAP","TAB 10-325MG","90","Select","Select",""],["","55111012105","ATORVASTATIN","TAB 10MG","30","Select","Select",""],["","65862001605","AMOXICILLIN","CAP 250MG","30","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","51285016288","PLAN","TAB 1.5MG","1","Select","Select",""],["","00378033401","HALOPERIDOL","TAB 10MG","30","Select","Select",""],["","65162044210","MECLIZINE","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":""}]}]}