{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MATRISHA T GWYNN","gend":1,"add":"559 AHART RIDGE ROAD ","city":"ARARAT","state":"VA","zip":"24053-3691","dob":"1987-09-04","age":"","mstatus":"","insh":11000669,"cliId":"3K48UF5VU50","pno":2762511209,"cno":3367566782,"email":"","ename":"","eno":"","pphy":"TATE, GLEN E","ppno":2763982292,"pcpadd":"40 Wiley Dr","pcpcity":"Ferrum","pcpstate":"VA","pcpzip":240881100,"pcpcounty":"","pcpid":"P0114064","pcpname":"TRI AREA COMMUNITY HEALTH CENTER","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"ROANOKE ALLEGHANY","aligned":"Y","ano":"","add2":"","add3":"","madd1":"559 AHART RIDGE ROAD ","madd2":"","madd3":"","mcity":"ARARAT","mstate":"VA","mzip":"24053-3691","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["F32.0","N39.0","R10.31","F31.9","Z79.899","F17.210","M26.621","R07.2","R06.02","R07.9","F17.200","E66.01","R06.09","E78.2","E88.81","R11.2","M79.671","K21.9","F41.9","E55.9","R94.39","I25.9","I50.30","I51.7","I31.3","E78.5","Z82.49","B07.0","G89.29","E66.9","E03.9","Z28.21","R07.89","I10","R06.00","Z01.818","I20.8","M79.672","M54.5","M54.42","M54.41","M54.9","B07.8","M51.27","M72.2","K76.0","N39.46","R11.0","Z11.59","Z20.828","K20.90","K29.70","R10.9","K31.89","N30.00","R30.0","Z12.31","N63.20","R92.8","J45.20","J45.901","J20.8","R05","R06.2","J20.9","Z03.818","K62.5","K59.00","R53.83","R06.83","Z11.52","G47.33","G47.30","Z71.3","Z87.891","Z68.43","R63.5","E63.9","Z86.2","Z87.19","R73.09","Z98.890","F43.20","S91.301A","L02.611","L08.9","B99.9","Z71.9","L08.89","M79.5","L97.411","F33.2","R35.0","F90.2","N32.81","N39.41","Z01.812","F25.0","Z01.810","J45.909","B34.9","R50.9","Z20.822","R09.81","R22.41","S99.921A","J30.2","R63.1"],"date":["2021-04-23","2018-01-12","2018-01-12","2020-10-01","2020-12-04","2021-04-17","2018-05-03","2020-08-21","2021-08-24","2020-12-04","2021-07-22","2021-08-18","2021-08-18","2020-08-21","2019-07-31","2019-10-22","2021-10-02","2019-07-09","2019-07-09","2019-07-31","2020-08-07","2019-07-11","2019-07-11","2019-07-11","2019-07-11","2019-07-31","2019-07-11","2020-07-13","2020-07-13","2021-08-04","2021-10-19","2021-10-19","2020-07-28","2020-07-31","2020-08-21","2021-08-13","2020-08-07","2019-09-06","2018-08-21","2018-08-27","2018-08-27","2018-08-22","2021-02-24","2018-09-05","2021-10-02","2020-09-21","2021-08-18","2020-09-15","2020-09-24","2021-08-24","2020-10-01","2020-10-01","2020-10-01","2020-10-01","2019-10-15","2021-05-14","2020-10-22","2020-11-09","2020-11-09","2020-11-30","2020-11-30","2020-11-30","2021-08-24","2020-12-04","2020-12-04","2020-12-04","2020-12-14","2020-12-14","2021-01-05","2021-01-05","2021-01-14","2021-08-18","2021-08-18","2021-02-16","2021-02-23","2021-10-19","2021-02-23","2021-02-16","2021-02-23","2021-02-23","2021-02-23","2021-05-07","2021-06-01","2021-04-17","2021-04-19","2021-04-19","2021-04-19","2021-10-04","2021-04-17","2021-04-19","2021-04-19","2021-09-09","2021-05-14","2021-05-05","2021-08-18","2021-08-18","2021-06-07","2021-06-01","2021-07-22","2021-08-18","2021-10-04","2021-08-24","2021-10-04","2021-10-04","2021-10-02","2021-10-02","2021-10-04","2021-10-19"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}},{"a":[]}]},{"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":{"indx":["","",""],"comment":["","",""],"sub":[]}},{"a":{"indx":["","",""],"comment":["","",""],"sub":[]}}]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","68180032002","BUPROPN HCL","TAB 300MG XL","","Select","Select",""],["","228255111","DICLOFENAC","TAB 75MG DR","","Select","Select",""],["","781107710","ALPRAZOLAM","TAB 0.5MG","","Select","Select",""],["","69238116609","DOXEPIN HCL","CAP 10MG","","Select","Select",""],["","67877043403","ARIPIPRAZOLE","TAB 20MG","","Select","Select",""],["","69097084905","ESCITALOPRAM","TAB 20MG","","Select","Select",""],["","16729021816","CLOPIDOGREL","TAB 75MG","","Select","Select",""],["","70710113908","FLUCONAZOLE","TAB 150MG","","Select","Select",""],["","57237023305","SMZ-TMP DS","TAB 800-160","","Select","Select",""],["","76204060030","IPRATROPIUM\/","SOL ALBUTER","","Select","Select",""],["","54418325","DEXAMETHASON","TAB 2MG","","Select","Select",""],["","68382004101","PROMETHAZINE","TAB 25MG","","Select","Select",""],["","51224002230","AZITHROMYCIN","TAB 250MG","","Select","Select",""],["","68462019005","NAPROXEN","TAB 500MG","","Select","Select",""],["","31722071390","PANTOPRAZOLE","TAB 40MG","","Select","Select",""],["","70461041910","FLUCLVX QUAD","INJ 2019-20","","Select","Select",""],["","65862056090","PANTOPRAZOLE ","TAB 40MG","90","Select","Select",""],["","67877043403","ARIPIPRAZOLE ","TAB 20MG","30","Select","Select",""],["","69238116609","DOXEPIN ","CAP 10MG","270","Select","Select",""],["","70710113908","FLUCONAZOLE ","TAB 150MG","1","Select","Select",""],["","57237023305","SMZ-TMP ","TAB 800-160","14","Select","Select",""],["","228202996","ALPRAZOLAM ","TAB 0.5MG","60","Select","Select",""],["","68180032002","BUPROPN ","TAB 300MG XL","30","Select","Select",""],["","69097084905","ESCITALOPRAM ","TAB 20MG","30","Select","Select",""],["","228255111","DICLOFENAC ","TAB 75MG DR","60","Select","Select",""],["","16729021816","CLOPIDOGREL ","TAB 75MG","8","Select","Select",""],["","65862018601","CLINDAMYCIN ","CAP 300MG","30","Select","Select",""],["","54418325","DEXAMETHASON ","TAB 2MG","15","Select","Select",""],["","51224002230","AZITHROMYCIN ","TAB 250MG","8","Select","Select",""],["","76204060030","IPRATROPIUM\/ ","SOL ALBUTER","90","Select","Select",""],["","68382004101","PROMETHAZINE ","TAB 25MG","10","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","20","Select","Select",""],["","406012305","HYDROCO\/APAP ","TAB 5-325MG","10","Select","Select",""],["","93314705","CEPHALEXIN ","CAP 500MG","14","Select","Select",""],["","93101042","MUPIROCIN ","OIN 0.02","22","Select","Select",""],["","68462019005","NAPROXEN ","TAB 500MG","60","Select","Select",""],["","70461041910","FLUCLVX ","2019-20","0.5","Select","Select",""],["","68180032002","BUPROPN","300MG XL","30","Select","Select",""],["","67877032005","IBUPROFEN","600MG","30","Select","Select",""],["","68180012201","CEPHALEXIN","500MG","28","Select","Select",""],["","42858000101","OXYCODONE","5MG","5","Select","Select",""],["","69238116609","DOXEPIN","10MG","270","Select","Select",""],["","57237023305","SMZ-TMP","800-160","14","Select","Select",""],["","65862018601","CLINDAMYCIN","300MG","30","Select","Select",""],["","65862042005","SMZ\/TMP","800-160","20","Select","Select",""],["","00093101042","MUPIROCIN","0.02","22","Select","Select",""],["","70461041910","FLUCLVX","2019-20","0.5","Select","Select",""],["","00406012305","HYDROCO\/APAP","5-325MG","10","Select","Select",""],["","67877032005","IBUPROFEN ","TAB 600MG","30","Select","Select",""],["","42858000101","OXYCODONE ","TAB 5MG","5","Select","Select",""],["","00169413212","OZEMPIC ","INJ 2\/1.5ML","4.5","Select","Select",""]]}},{"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":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[[["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""]]]},{"t":"Mini-Cog","q":[{"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":""}]}]}