{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LATEALA   T MARTIN","gend":1,"add":"701 CORN TASSEL TRAIL                                       ","city":"MARTINSVILLE                  ","state":"VA","zip":"24112-5427","dob":"1980-10-14","age":"","mstatus":"","insh":10037407,"cliId":"","pno":2768066196,"cno":2767326539,"email":"","ename":"","eno":"","pphy":"FATADE, AYOKUNLE O                                          ","ppno":"","pcpadd":"1 E Market St Ste B1","pcpcity":"Martinsville                  ","pcpstate":"VA","pcpzip":241123747,"pcpcounty":"","pcpid":"P0060085","pcpname":"FATADE HEALTH AND MEDICAL CENTER PC","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"APARTMENT 3                                                 ","add3":"","madd1":"701 CORN TASSEL TRAIL                                       ","madd2":"APARTMENT 3                                                 ","madd3":"","mcity":"MARTINSVILLE                  ","mstate":"VA","mzip":"24112-5427","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F31.5","Z91.5","Z91.81","E66.9","J44.9","M54.5","F06.4","E11.8","J06.9","R05","J45.41","J20.9","I10","E11.9","Z72.0","F17.290","R87.612","Z12.4","R87.810","Z01.411","Z30.41","N39.3","N89.8","Z11.3","A49.2","L20.84","R68.89","G89.4","R87.610","N87.0","B00.9","N87.9","Z68.41","R30.0","K52.9","R11.2","N39.0","K63.89","R16.0","R19.7","R10.13","Z32.02","F41.9","J45.909","F31.9","Z86.69","Z88.2","Z88.6","Z91.040","Z98.890","Z79.899","Z51.81","R79.89","E78.9","E55.9","E07.9","L02.511","Z79.84","Z79.4","Z79.891","Z88.8","Z87.891","J40","L20.82","L13.9","M79.602","R00.0","V89.2XXA","S33.5XXA","R10.9","V49.9XXA","R10.32","R51","X58.XXXA","M54.2","V49.50XD","S19.80XA","S00.93XA","S30.0XXA","L30.9","M19.079","L60.0","L60.2","E10.41","M79.674","M79.675","R79.0","R60.0","M25.569","L03.019","K21.9","K76.0","R10.11","R31.29","K59.00","R31.9","N20.0","N61.0","N64.4","R13.10","Z11.59","K20.9","R63.4","Z76.0","Z88.5","R74.8","L20.9","L72.3","Z01.419","B37.3","L84","L85.3","B97.7","Z68.36","Z87.410","R13.12","M25.561","Z87.442","N94.9","N76.1","Z68.37","E11.65","H53.8","R53.83","R53.1","R06.00","R78.81","B86","Z11.51","M25.562","D51.0","L29.9","N93.9","N18.9","G25.81","R82.90","R82.79","A09","E86.0","R53.81","Z12.31","N92.0","Z68.32","M25.519","R13.19","R68.81","Z13.9","M75.82","M75.102","M19.012","M75.42","L20.89","L60.8","L81.6","L29.8","M25.512","M25.78","R20.0","M79.603"],"date":["2021-05-09","2019-07-28","2019-07-28","2019-07-28","2021-05-04","2021-05-04","2021-05-04","2021-04-06","2019-02-10","2019-06-21","2019-02-10","2019-02-10","2021-04-26","2021-04-15","2021-03-01","2019-05-23","2019-03-28","2021-01-06","2021-01-06","2021-03-01","2019-02-28","2019-02-28","2019-02-28","2019-02-28","2019-03-07","2020-09-29","2020-09-29","2021-04-26","2020-10-19","2019-03-28","2020-08-11","2020-05-07","2019-12-16","2021-05-04","2019-05-19","2021-03-23","2020-09-14","2019-05-19","2020-01-08","2019-05-19","2019-05-19","2019-05-19","2020-05-15","2020-05-15","2020-05-15","2020-05-15","2021-01-02","2020-03-04","2021-01-02","2021-03-01","2020-08-12","2020-08-12","2021-04-06","2019-06-20","2021-04-26","2019-06-20","2019-06-24","2020-05-15","2020-08-14","2019-06-24","2020-03-04","2019-06-24","2020-08-12","2019-06-27","2019-06-27","2019-07-13","2019-07-13","2019-07-15","2019-07-13","2021-01-07","2019-07-13","2019-07-13","2019-07-15","2019-07-13","2021-04-29","2019-07-15","2019-07-15","2019-07-15","2019-07-15","2021-04-26","2019-08-06","2021-04-14","2020-07-10","2020-07-10","2020-07-10","2020-07-10","2019-08-12","2020-04-09","2021-04-06","2019-09-18","2021-03-23","2020-04-14","2019-10-29","2020-10-13","2019-11-04","2019-12-16","2019-11-18","2019-12-11","2019-12-11","2021-04-29","2020-07-17","2020-01-08","2020-04-14","2020-01-08","2021-01-02","2020-01-14","2020-01-28","2020-07-10","2020-02-28","2020-03-13","2020-03-04","2020-03-04","2020-03-13","2020-03-13","2021-01-06","2020-12-02","2021-03-08","2020-04-20","2020-04-30","2021-03-01","2020-05-07","2021-04-06","2020-05-15","2020-05-15","2020-05-15","2020-05-15","2020-06-15","2020-09-14","2021-01-06","2020-08-12","2021-02-03","2020-09-29","2020-10-05","2021-04-26","2020-11-10","2020-11-10","2020-11-10","2021-01-02","2021-01-02","2021-01-02","2021-04-12","2021-03-01","2021-03-01","2021-03-08","2021-03-23","2021-03-23","2021-04-06","2021-04-26","2021-04-26","2021-04-15","2021-04-15","2021-04-21","2021-04-21","2021-04-21","2021-04-21","2021-04-26","2021-04-29","2021-04-29","2021-04-29"],"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":[]},{"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":[["","00093075210","ATENOLOL","50MG","30","Select","Select",""],["","65862066330","ARIPIPRAZOLE","10MG","30","Select","Select",""],["","70710122901","AMITRIPTYLIN","100MG","30","Select","Select",""],["","11534016503","FOLIC","1MG","30","Select","Select",""],["","65862056090","PANTOPRAZOLE","40MG","60","Select","Select",""],["","50742062101","NIFEDIPINE","60MG ER","30","Select","Select",""],["","00378729189","NORETHIN","5MG","60","Select","Select",""],["","65862086001","FAMOTIDINE","40MG","30","Select","Select",""],["","00088221905","LANTUS","100\/ML","6","Select","Select",""],["","51862094105","DIAZEPAM","2MG","60","Select","Select",""],["","00193709021","CONTOUR","BLD GLUC","100","Select","Select",""],["","57599000101","FREESTYLE KIT SENSOR","SENSOR","2","Select","Select",""],["","51672129403","CLOBETASOL","0.05%","60","Select","Select",""],["","51224000760","METFORMIN","500MG ER","60","Select","Select",""],["","00169406013","VICTOZA","18MG\/3ML","3","Select","Select",""],["","51672128901","NYSTATIN","100000","30","Select","Select",""],["","00006027731","JANUVIA","100MG","15","Select","Select",""],["","57237000511","FLUCONAZOLE","150MG","14","Select","Select",""],["","69238117009","DOXEPIN","25MG","30","Select","Select",""],["","08290320122","BD PEN NEEDL","32GX4MM","100","Select","Select",""],["","60505014202","GLIPIZIDE","10MG","60","Select","Select",""],["","65162010250","GABAPENTIN","300MG","30","Select","Select",""],["","00193658621","MICROLET","LANCETS","100","Select","Select",""],["","00574200830","NYSTOP","100000","30","Select","Select",""],["","55111012205","ATORVASTATIN","20MG","90","Select","Select",""],["","45802088014","NYSTAT\/TRIAM","","15","Select","Select",""],["","57599000200","FREESTYLE MIS READER","READER","1","Select","Select",""],["","00378427577","VALACYCLOVIR","500MG","20","Select","Select",""],["","59267100001","PFIZER","COVID-19","0.3","Select","Select",""],["","64380071206","BENZONATATE","100MG","30","Select","Select",""],["","65862053750","LEVOFLOXACIN","500MG","5","Select","Select",""],["","00781808926","AZITHROMYCIN","250MG","6","Select","Select",""],["","69547035302","NARCAN","","2","Select","Select",""],["","69452015120","VITAMIN","50000UNT","4","Select","Select",""],["","42799080601","IVERMECTIN","3MG","25","Select","Select",""],["","45802026937","PERMETHRIN","5%","60","Select","Select",""],["","00406851501","OXYCODONE","15MG","120","Select","Select",""],["","00185012201","NITROFURANTN","100MG","14","Select","Select",""],["","00591544210","PREDNISONE","10MG","21","Select","Select",""],["","00555057202","METHOTREXATE","2.5MG","16","Select","Select",""],["","65862007601","CIPROFLOXACN","250MG","6","Select","Select",""],["","69543025216","VIRTUSSIN","100-10\/5","120","Select","Select",""],["","16729042112","TACROLIMUS","0.03%","60","Select","Select",""],["","68462025401","ROPINIROLE","0.5MG","30","Select","Select",""],["","00024591502","DUPIXENT","300\/2ML","4","Select","Select",""],["","29300012810","HYDROCHLOROT","25MG","30","Select","Select",""],["","68462010530","ONDANSETRON","4MG","30","Select","Select",""],["","00168008031","HYDROCORT","2.50%","30","Select","Select",""],["","00093075210","ATENOLOL ","TAB 50MG","30","Select","Select",""],["","65862066330","ARIPIPRAZOLE ","TAB 10MG","30","Select","Select",""],["","70710122901","AMITRIPTYLIN ","TAB 100MG","30","Select","Select",""],["","11534016503","FOLIC ","TAB 1MG","30","Select","Select",""],["","65862056090","PANTOPRAZOLE ","TAB 40MG","60","Select","Select",""],["","50742062101","NIFEDIPINE ","TAB 60MG ER","30","Select","Select",""],["","00378729189","NORETHIN ","TAB 5MG","60","Select","Select",""],["","65862086001","FAMOTIDINE ","TAB 40MG","30","Select","Select",""],["","00088221905","LANTUS ","INJ 100\/ML","6","Select","Select",""],["","51862094105","DIAZEPAM ","TAB 2MG","60","Select","Select",""],["","00193709021","CONTOUR ","TES BLD GLUC","100","Select","Select",""],["","57599000101","FREESTYLE    KIT SENSOR","KIT SENSOR","2","Select","Select",""],["","51672129403","CLOBETASOL ","GEL 0.0005","60","Select","Select",""],["","51224000760","METFORMIN ","TAB 500MG ER","60","Select","Select",""],["","00169406013","VICTOZA ","INJ 18MG\/3ML","3","Select","Select",""],["","51672128901","NYSTATIN ","CRE 100000","30","Select","Select",""],["","00006027731","JANUVIA ","TAB 100MG","15","Select","Select",""],["","57237000511","FLUCONAZOLE ","TAB 150MG","14","Select","Select",""],["","69238117009","DOXEPIN ","CAP 25MG","30","Select","Select",""],["","08290320122","BD  PEN NEEDL","MIS 32GX4MM","100","Select","Select",""],["","60505014202","GLIPIZIDE ","TAB 10MG","60","Select","Select",""],["","65162010250","GABAPENTIN ","CAP 300MG","30","Select","Select",""],["","00193658621","MICROLET ","MIS LANCETS","100","Select","Select",""],["","00574200830","NYSTOP ","POW 100000","30","Select","Select",""],["","55111012205","ATORVASTATIN ","TAB 20MG","90","Select","Select",""],["","45802088014","NYSTAT\/TRIAM ","CRE ","15","Select","Select",""],["","57599000200","FREESTYLE    MIS READER","MIS READER","1","Select","Select",""],["","00378427577","VALACYCLOVIR ","TAB 500MG","20","Select","Select",""],["","59267100001","PFIZER ","INJ COVID-19","0.3","Select","Select",""],["","64380071206","BENZONATATE ","CAP 100MG","30","Select","Select",""],["","65862053750","LEVOFLOXACIN ","TAB 500MG","5","Select","Select",""],["","00781808926","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","69547035302","NARCAN ","SPR ","2","Select","Select",""],["","69452015120","VITAMIN ","CAP 50000UNT","4","Select","Select",""],["","42799080601","IVERMECTIN ","TAB 3MG","25","Select","Select",""],["","45802026937","PERMETHRIN ","CRE 0.05","60","Select","Select",""],["","00406851501","OXYCODONE ","TAB 15MG","120","Select","Select",""],["","00185012201","NITROFURANTN ","CAP 100MG","14","Select","Select",""],["","00591544210","PREDNISONE ","TAB 10MG","21","Select","Select",""],["","00555057202","METHOTREXATE ","TAB 2.5MG","16","Select","Select",""],["","65862007601","CIPROFLOXACN ","TAB 250MG","6","Select","Select",""],["","69543025216","VIRTUSSIN ","SOL 100-10\/5","120","Select","Select",""],["","16729042112","TACROLIMUS ","OIN 0.0003","60","Select","Select",""],["","68462025401","ROPINIROLE ","TAB 0.5MG","30","Select","Select",""],["","00024591502","DUPIXENT ","INJ 300\/2ML","4","Select","Select",""],["","29300012810","HYDROCHLOROT ","TAB 25MG","30","Select","Select",""],["","68462010530","ONDANSETRON ","TAB 4MG","30","Select","Select",""],["","00168008031","HYDROCORT ","CRE 0.025","30","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","",""],["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":""}]}]}