{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MELISSA   A BRINKLEY","gend":1,"add":"P. O. BOX 140                                               ","city":"COPPER HILL                   ","state":"VA","zip":"24079-0140","dob":"1984-01-31","age":"","mstatus":"","insh":10036591,"cliId":"","pno":5405812883,"cno":5405812883,"email":"","ename":"","eno":"","pphy":"NAZLI, AYESHA                                               ","ppno":"","pcpadd":"3716 Melrose Ave NW","pcpcity":"Roanoke                       ","pcpstate":"VA","pcpzip":240172716,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"P. O. BOX 140                                               ","madd2":"                                                            ","madd3":"","mcity":"COPPER HILL                   ","mstate":"VA","mzip":"24079-0140","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["B18.2","F11.20","F31.32","F41.1","F43.10","R76.8","R51","G43.909","R11.0","J45.909","K21.9","F17.200","Z79.51","F31.81","F17.210","L03.314","G47.00","F31.9","L02.214","N76.4","F60.3","Z48.01","Z56.0","L73.2","J04.0","J02.9","R05","J06.9","M19.90","R06.2","Z72.0","R50.9","Z53.29","J32.0","B19.20","F11.21","F41.9","E55.9","Z79.82","Z80.0","Z81.1","Z82.3","J32.9","J01.00","J01.90","R93.89","Q35.9","J32.4","Z68.36","J45.20","J34.2","J34.3","J32.8","O09.91","O99.511","O99.341","O99.321","F33.1","J45.21","Z3A.01","F19.90","Z32.01","Z36.82","O28.3","Z3A.13","Z36.89","O36.8910","O09.521","Z3A.12","O09.92","O09.522","O35.9XX0","O09.212","Z3A.17","O99.212","R06.02","R07.9","O99.89","Z3A.20","O09.892","Z3A.21","Z3A.22","Z87.51","O26.892","R10.2","O99.342","Z79.899","Z3A.26","O09.512","E66.9","O09.93","O09.213","O26.893","R10.30","Z3A.29","W10.9XXA","Y92.009","O99.343","O99.213","O09.523","O98.513","O9A.213","S39.91XA","W19.XXXA","Z71.89","Z23","O12.03","Z71.9","O09.293","Z3A.35","O47.1","Z3A.38","Z03.79","O99.513","O99.333","Z34.93","O80","Z3A.39","Z37.0","O99.324","Z34.83","O99.344","O98.42","O98.52","B00.9","O99.214","O70.0","F32.9","Z30.430","Z32.02","J20.9","B34.9","R09.81","Z20.822","F11.220","S61.210A","W26.0XXA","F15.20"],"date":["2020-12-26","2021-11-24","2021-11-18","2021-11-18","2021-10-05","2019-05-28","2020-01-19","2019-06-26","2019-06-26","2021-09-04","2021-09-04","2021-09-04","2021-09-04","2019-06-27","2020-12-19","2019-08-17","2019-12-22","2021-06-15","2019-12-09","2019-12-09","2019-12-09","2019-12-11","2019-12-11","2019-12-20","2019-12-22","2019-12-22","2020-08-17","2019-12-22","2019-12-22","2020-08-17","2021-03-14","2021-03-14","2020-01-15","2020-01-30","2020-05-27","2020-01-18","2020-10-21","2020-01-18","2020-01-18","2020-01-18","2020-01-18","2020-01-18","2020-02-26","2020-01-18","2020-01-18","2020-01-19","2020-04-01","2020-04-01","2020-04-01","2020-08-27","2020-02-21","2020-02-26","2020-02-26","2020-12-02","2020-04-29","2020-04-29","2020-04-29","2020-04-29","2020-08-17","2020-04-29","2020-05-27","2020-05-27","2020-06-24","2020-06-24","2020-06-24","2020-06-24","2020-06-24","2020-06-24","2020-06-24","2020-09-09","2020-08-24","2020-07-27","2020-07-27","2020-07-27","2020-09-28","2020-08-17","2020-08-17","2020-08-17","2020-08-17","2020-08-24","2020-08-24","2020-08-27","2020-12-19","2020-09-29","2020-09-29","2020-09-28","2020-09-28","2020-09-29","2020-09-28","2020-12-26","2020-12-18","2020-12-19","2020-10-21","2020-10-21","2020-10-21","2020-10-21","2021-09-04","2020-10-21","2020-12-19","2020-12-19","2020-10-21","2020-10-21","2020-10-21","2020-10-21","2020-10-27","2021-09-04","2020-11-05","2020-11-19","2020-12-02","2020-12-02","2020-12-19","2020-12-19","2020-12-19","2020-12-19","2020-12-19","2020-12-23","2020-12-26","2020-12-26","2020-12-26","2020-12-26","2020-12-26","2020-12-26","2020-12-26","2020-12-26","2020-12-26","2020-12-26","2020-12-26","2021-06-15","2021-02-10","2021-02-10","2021-03-14","2021-03-14","2021-03-14","2021-03-14","2021-08-10","2021-09-04","2021-09-04","2021-10-13"],"priorHcc":["",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":[]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","69547035302","NARCAN","","2","Select","Select",""],["","43547030303","ARIPIPRAZOLE","5MG","30","Select","Select",""],["","65862023060","LAMOTRIGINE","200MG","30","Select","Select",""],["","68462015713","ONDANSETRON","4MG ODT","10","Select","Select",""],["","16729020216","BUSPIRONE","10MG","90","Select","Select",""],["","59651000305","OMEPRAZOLE","40MG","90","Select","Select",""],["","12496120803","SUBOXONE","8-2MG","60","Select","Select",""],["","64011030103","MAKENA","275MG","4.4","Select","Select",""],["","66993001968","ALBUTEROL","HFA","18","Select","Select",""],["","50428067309","CVS","1000UNIT","60","Select","Select",""],["","61874014530","VRAYLAR","4.5MG","30","Select","Select",""],["","65162036111","FOLIC","1MG","30","Select","Select",""],["","69842000003","FLUTICASONE","50MCG","9.9","Select","Select",""],["","69097081507","GABAPENTIN","400MG","90","Select","Select",""],["","45802091987","CETIRIZINE","10MG","90","Select","Select",""],["","69842093108","ACETAMINOPHN","500MG","60","Select","Select",""],["","67877032005","IBUPROFEN","600MG","60","Select","Select",""],["","50428317683","STOOL","100MG","30","Select","Select",""],["","00536589688","NICOTINE","21MG\/24H","28","Select","Select",""],["","65862050320","AMOX\/K","875-125","20","Select","Select",""],["","31722070430","VALACYCLOVIR","500MG","6","Select","Select",""],["","63824000832","MUCINEX","600MG ER","60","Select","Select",""],["","50580072636","ZYRTEC","10MG","30","Select","Select",""],["","00186037020","SYMBICORT","160-4.5","10.2","Select","Select",""],["","65862057490","MONTELUKAST","10MG","30","Select","Select",""],["","69097083412","SERTRALINE","50MG","30","Select","Select",""],["","00603533715","PREDNISONE","5MG","21","Select","Select",""],["","68180071160","CEFDINIR","300MG","20","Select","Select",""],["","67877057505","BENZONATATE","200MG","30","Select","Select",""],["","16571020106","DICLOFENAC","75MG DR","20","Select","Select",""],["","00536440601","VITAMIN","25MG","30","Select","Select",""],["","00069047103","CHANTIX","0.5& 1MG","53","Select","Select",""],["","69547035302","NARCAN ","SPR ","2","Select","Select",""],["","43547030303","ARIPIPRAZOLE ","TAB 5MG","30","Select","Select",""],["","65862023060","LAMOTRIGINE ","TAB 200MG","30","Select","Select",""],["","68462015713","ONDANSETRON ","TAB 4MG ODT","10","Select","Select",""],["","16729020216","BUSPIRONE ","TAB 10MG","90","Select","Select",""],["","59651000305","OMEPRAZOLE ","CAP 40MG","90","Select","Select",""],["","12496120803","SUBOXONE ","MIS 8-2MG","60","Select","Select",""],["","64011030103","MAKENA ","INJ 275MG","4.4","Select","Select",""],["","66993001968","ALBUTEROL ","AER HFA","18","Select","Select",""],["","50428067309","CVS ","CAP 1000UNIT","60","Select","Select",""],["","61874014530","VRAYLAR ","CAP 4.5MG","30","Select","Select",""],["","65162036111","FOLIC ","TAB 1MG","30","Select","Select",""],["","69842000003","FLUTICASONE ","SPR 50MCG","9.9","Select","Select",""],["","69097081507","GABAPENTIN ","CAP 400MG","90","Select","Select",""],["","45802091987","CETIRIZINE ","TAB 10MG","90","Select","Select",""],["","69842093108","ACETAMINOPHN ","TAB 500MG","60","Select","Select",""],["","67877032005","IBUPROFEN ","TAB 600MG","60","Select","Select",""],["","50428317683","STOOL ","CAP 100MG","30","Select","Select",""],["","00536589688","NICOTINE ","DIS 21MG\/24H","28","Select","Select",""],["","65862050320","AMOX\/K ","TAB 875-125","20","Select","Select",""],["","31722070430","VALACYCLOVIR ","TAB 500MG","6","Select","Select",""],["","63824000832","MUCINEX ","TAB 600MG ER","60","Select","Select",""],["","50580072636","ZYRTEC ","TAB 10MG","30","Select","Select",""],["","00186037020","SYMBICORT ","AER 160-4.5","10.2","Select","Select",""],["","65862057490","MONTELUKAST ","TAB 10MG","30","Select","Select",""],["","69097083412","SERTRALINE ","TAB 50MG","30","Select","Select",""],["","00603533715","PREDNISONE ","PAK 5MG","21","Select","Select",""],["","68180071160","CEFDINIR ","CAP 300MG","20","Select","Select",""],["","67877057505","BENZONATATE ","CAP 200MG","30","Select","Select",""],["","16571020106","DICLOFENAC ","TAB 75MG DR","20","Select","Select",""],["","00536440601","VITAMIN ","TAB 25MG","30","Select","Select",""],["","00069047103","CHANTIX ","PAK 0.5& 1MG","53","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","",""],["N\/A","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","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":""}]}]}