{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MICHELE A CROWDER","gend":1,"add":"4908 OLD ROBINSON TRACT RD ","city":"PULASKI  ","state":"VA","zip":"24301-9998","dob":"1971-10-25","age":"","mstatus":"","insh":11013840,"cliId":"3XK2GJ2DV12","pno":5407394167,"cno":5405772589,"email":"","ename":"","eno":"","pphy":"STEWART, KNOTRESHA F ","ppno":5408350500,"pcpadd":"28 Town Center Dr","pcpcity":"Dublin","pcpstate":"VA","pcpzip":240846069,"pcpcounty":"","pcpid":"P0124299","pcpname":"LEON J BROWN JR MD","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"ROANOKE ALLEGHANY","aligned":"Y","ano":"","add2":"","add3":"","madd1":"4908 OLD ROBINSON TRACT RD ","madd2":"","madd3":"","mcity":"PULASKI  ","mstate":"VA","mzip":"24301-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["F33.2","Z20.828","F25.0","R53.82","E03.9","Z79.899","M54.5","R30.0","R50.9","E78.5","I10","E07.9","F32.9","G89.29","F41.9","F17.200","Z79.890","F33.3","I65.22","R11.0","R42","H53.9","E11.9","G47.00","G47.30","B35.1","M79.675","M79.674","L60.3","N10","R16.0","K76.0","R00.0","Z87.442","D72.829","J44.9","F17.210","N12","R10.9","R21","B02.9","F43.10","F60.3","F41.1","F17.290","E55.9","M54.9","R51.9","Z68.41","F39","F41.0","Z72.0","Z71.6","G47.33","F90.9","R73.09","R45.851","F20.0","X50.0XXA","F25.1"],"date":["2021-11-24","2020-11-27","2021-11-04","2020-06-18","2021-11-03","2021-11-03","2020-07-13","2020-07-13","2020-07-13","2021-04-20","2021-11-03","2020-07-13","2021-01-19","2020-07-13","2020-07-13","2021-07-23","2020-07-13","2020-09-02","2020-07-29","2020-07-29","2021-04-20","2020-07-29","2021-11-16","2021-09-30","2021-07-23","2021-11-16","2021-11-16","2021-11-16","2021-11-16","2020-09-29","2020-09-29","2020-09-29","2020-09-29","2020-09-29","2020-09-29","2020-09-29","2020-09-29","2020-09-29","2021-01-19","2020-10-06","2020-10-06","2021-11-18","2021-11-18","2021-11-24","2021-01-25","2021-11-03","2021-07-23","2021-04-20","2021-07-23","2021-11-24","2021-02-04","2021-07-26","2021-07-23","2021-06-15","2021-07-22","2021-07-23","2021-08-26","2021-09-14","2020-07-13","2021-10-04"],"priorHcc":[null,"",null,"",null,null,"","","","",null,"","","","","","","","","","","",null,"","",null,null,null,null,"","","","","","","","","","","","",null,null,null,"",null,"","","",null,"","","","","","","","","",""]}},{"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":[["","51862032101","LIOTHYRONINE","TAB 25MCG","","Select","Select",""],["","69315090405","LORAZEPAM","TAB 0.5MG","","Select","Select",""],["","64764073030","TRINTELLIX","TAB 10MG","","Select","Select",""],["","115166001","PROPRANOLOL","TAB 20MG","","Select","Select",""],["","378181577","LEVOTHYROXIN","TAB 150MCG","","Select","Select",""],["","55111025960","ZIPRASIDONE","CAP 80MG","","Select","Select",""],["","69097015815","MELOXICAM","TAB 7.5MG","","Select","Select",""],["","57237001999","DULOXETINE","CAP 60MG","","Select","Select",""],["","50458002803","SPRAVATO","SOL 84MG DOS","","Select","Select",""],["","13107003205","MIRTAZAPINE","TAB 45MG","","Select","Select",""],["","68382076010","METFORMIN","TAB 1000MG","","Select","Select",""],["","6027731","JANUVIA","TAB 100MG","","Select","Select",""],["","53885024510","ONETOUCH","TES ULTRA","","Select","Select",""],["","13668000701","ZOLPIDEM","TAB 5MG","","Select","Select",""],["","69097084507","CYCLOBENZAPR","TAB 5MG","","Select","Select",""],["","65162019050","NAPROXEN","TAB 500MG","","Select","Select",""],["","42858010201","OXYCOD\/APAP","TAB 5-325MG","","Select","Select",""],["","50111043302","TRAZODONE","TAB 50MG","","Select","Select",""],["","69238149101","BUMETANIDE","TAB 2MG","","Select","Select",""],["","55111029236","SUMATRIPTAN","TAB 50MG","","Select","Select",""],["","60505258008","ATORVASTATIN","TAB 40MG","","Select","Select",""],["","69097094312","GABAPENTIN","CAP 300MG","","Select","Select",""],["","832003800","OXYBUTYNIN","TAB 5MG","","Select","Select",""],["","69047103","CHANTIX","PAK 0.5& 1MG","","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","","Select","Select",""],["","93031401","KETOROLAC","TAB 10MG","","Select","Select",""],["","23155022801","ACYCLOVIR","TAB 800MG","","Select","Select",""],["","53885039310","ONETOUCH US","MIS LANCETS","","Select","Select",""],["","69315090405","LORAZEPAM ","TAB 0.5MG","36","Select","Select",""],["","51862032101","LIOTHYRONINE ","TAB 25MCG","28","Select","Select",""],["","50458002803","SPRAVATO ","SOL 84MG DOS","3","Select","Select",""],["","832003800","OXYBUTYNIN ","TAB 5MG","56","Select","Select",""],["","55111025960","ZIPRASIDONE ","CAP 80MG","56","Select","Select",""],["","69097015815","MELOXICAM ","TAB 7.5MG","56","Select","Select",""],["","13107003205","MIRTAZAPINE ","TAB 45MG","28","Select","Select",""],["","69097094605","ATORVASTATIN ","TAB 40MG","28","Select","Select",""],["","57237001999","DULOXETINE ","CAP 60MG","56","Select","Select",""],["","13668000701","ZOLPIDEM ","TAB 5MG","28","Select","Select",""],["","64764072030","TRINTELLIX ","TAB 5MG","28","Select","Select",""],["","69238149101","BUMETANIDE ","TAB 2MG","28","Select","Select",""],["","6027731","JANUVIA ","TAB 100MG","28","Select","Select",""],["","115166001","PROPRANOLOL ","TAB 20MG","56","Select","Select",""],["","378181577","LEVOTHYROXIN ","TAB 150MCG","28","Select","Select",""],["","53885024510","ONETOUCH ","TES ULTRA","100","Select","Select",""],["","55111029236","SUMATRIPTAN ","TAB 50MG","9","Select","Select",""],["","68382076010","METFORMIN ","TAB 1000MG","90","Select","Select",""],["","23155022801","ACYCLOVIR ","TAB 800MG","40","Select","Select",""],["","69097094312","GABAPENTIN ","CAP 300MG","30","Select","Select",""],["","69097084507","CYCLOBENZAPR ","TAB 5MG","21","Select","Select",""],["","65162019050","NAPROXEN ","TAB 500MG","20","Select","Select",""],["","42858010201","OXYCOD\/APAP ","TAB 5-325MG","15","Select","Select",""],["","50111043302","TRAZODONE ","TAB 50MG","28","Select","Select",""],["","69047103","CHANTIX ","PAK 0.5& 1MG","53","Select","Select",""],["","68180012202","CEPHALEXIN ","500MG","40","Select","Select",""],["","93031401","KETOROLAC ","10MG","15","Select","Select",""],["","00310737020","BUDES\/FORMOT","160-4.5","10.2","Select","Select",""],["","00310737020","BUDES\/FORMOT ","AER 160-4.5","10.2","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","",""],["Yes","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":""}]}]}