{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TAMMY L HICKS","gend":1,"add":"805 BURGESS ","city":"MARTINSVILLE","state":"VA","zip":"24112-9998","dob":"1980-11-30","age":"","mstatus":"","insh":11007913,"cliId":"7T55H28RE57","pno":2763361131,"cno":2763361131,"email":"","ename":"","eno":"","pphy":"WATERS, MICHAEL G ","ppno":4346562224,"pcpadd":"305 N Main St","pcpcity":"Gretna","pcpstate":"VA","pcpzip":245574176,"pcpcounty":"","pcpid":"P0110944","pcpname":"BASSETT FAMILY PRACTICE","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"ROANOKE ALLEGHANY","aligned":"Y","ano":"","add2":"","add3":"","madd1":"805 BURGESS ","madd2":"","madd3":"","mcity":"MARTINSVILLE","mstate":"VA","mzip":"24112-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["S16.1XXA","M54.2","M43.6","E11.9","Z87.19","Z88.1","Z88.0","G43.919","F32.9","M54.06","M46.1","M51.36","M79.18","R10.10","R10.9","F17.210","E78.5","K21.9","M54.5","F39","M51.37","J02.9","Z71.89","Z71.3","M54.31","Z86.69","M54.41","S33.5XXA","X50.0XXA","Y92.9","Z32.02","M25.512","T14.90XA","S43.421A","S46.012A","S93.402A","M79.672","W01.0XXA","S99.912A","M79.89","M25.572","S99.922A","S93.602A","M26.601","J45.909","E78.00","F41.9","F17.200","Z79.899","Z79.84","G57.01","M62.830","M79.10","R68.84","K02.9","G89.29","M54.9","Z79.4","Z88.8","R51.9","E86.0","E87.6"],"date":["2020-02-16","2020-02-16","2020-02-16","2021-05-20","2020-02-16","2021-05-20","2021-05-20","2020-04-23","2020-12-22","2021-04-14","2021-04-14","2021-04-14","2021-04-14","2020-07-22","2020-07-22","2021-05-06","2020-12-28","2020-09-05","2021-05-06","2020-08-04","2020-12-22","2019-09-05","2019-09-05","2019-09-05","2020-09-05","2020-09-05","2020-09-05","2019-10-24","2019-11-26","2019-12-10","2019-10-24","2019-11-26","2019-11-26","2019-11-26","2019-11-26","2019-12-10","2019-12-10","2019-12-10","2019-12-10","2019-12-10","2019-12-10","2019-12-10","2019-12-16","2021-01-03","2021-01-03","2021-01-03","2021-01-03","2021-01-03","2021-05-20","2021-01-03","2021-04-14","2021-02-17","2020-12-22","2020-12-28","2020-12-28","2021-05-06","2021-05-06","2021-05-06","2021-05-06","2021-05-20","2021-05-20","2021-05-20"],"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":[["","52817033200","CYCLOBENZAPR","TAB 10MG","","Select","Select",""],["","29300012510","MELOXICAM","TAB 15MG","","Select","Select",""],["","65862018501","CLINDAMYCIN","CAP 150MG","","Select","Select",""],["","16571020210","DICLOFENAC","TAB 50MG DR","","Select","Select",""],["","115174801","METAXALONE","TAB 800MG","","Select","Select",""],["","527133001","BACLOFEN","TAB 10MG","","Select","Select",""],["","68382004001","PROMETHAZINE","TAB 12.5MG","","Select","Select",""],["","64764073030","TRINTELLIX","TAB 10MG","","Select","Select",""],["","781577626","AZITHROMYCIN","TAB 250MG","","Select","Select",""],["","65862056090","PANTOPRAZOLE","TAB 40MG","","Select","Select",""],["","62756052269","SUMATRIPTAN","TAB 100MG","","Select","Select",""],["","93031401","KETOROLAC","TAB 10MG","","Select","Select",""],["","51862001601","NORTRIPTYLIN","CAP 25MG","","Select","Select",""],["","52817033200","CYCLOBENZAPR ","TAB 10MG","90","Select","Select",""],["","29300012510","MELOXICAM ","TAB 15MG","90","Select","Select",""],["","65862018501","CLINDAMYCIN ","CAP 150MG","28","Select","Select",""],["","16571020210","DICLOFENAC ","TAB 50MG DR","30","Select","Select",""],["","527133001","BACLOFEN ","TAB 10MG","12","Select","Select",""],["","65162062711","TRAMADOL ","TAB 50MG","15","Select","Select",""],["","115174801","METAXALONE ","TAB 800MG","30","Select","Select",""],["","93031401","KETOROLAC ","TAB 10MG","10","Select","Select",""],["","68382004001","PROMETHAZINE ","TAB 12.5MG","120","Select","Select",""],["","51862001601","NORTRIPTYLIN ","CAP 25MG","90","Select","Select",""],["","64764073030","TRINTELLIX ","TAB 10MG","30","Select","Select",""],["","65862056090","PANTOPRAZOLE ","TAB 40MG","30","Select","Select",""],["","781577626","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","62756052269","SUMATRIPTAN ","TAB 100MG","9","Select","Select",""],["","591264001","BUT\/APAP\/CAF ","","20","Select","Select",""],["","00591264001","BUT\/APAP\/CAF","","20","Select","Select",""],["","65162062711","TRAMADOL","50MG","15","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":[[["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["Yes","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":""}]}]}