{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KEVIN   L BROWN","gend":0,"add":"MARQUITA  SCRUGGS                                           ","city":"PROSPECT                      ","state":"VA","zip":"23960-0194","dob":"1971-07-17","age":"","mstatus":"","insh":10048465,"cliId":"","pno":4345476165,"cno":4345476165,"email":"","ename":"","eno":"","pphy":"CORBETT SR, TIMOTHY W","ppno":"","pcpadd":"324 Commerce Rd","pcpcity":"FARMVILLE                     ","pcpstate":"VA","pcpzip":239012794,"pcpcounty":"","pcpid":"P9059075","pcpname":"SOUTHSIDE AREA FAMILY MEDICINE INC","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"CENTRAL","aligned":"","ano":"","add2":"P O BOX 194                                                 ","add3":"","madd1":"70 Holiday Hill Dr                                          ","madd2":"                                                            ","madd3":"","mcity":"PAMPLIN                       ","mstate":"VA","mzip":"23958-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F33.41","Q15.8","S00.03XA","S19.9XXA","M50.322","S09.93XA","S01.01XA","F10.929","Z72.0","W19.XXXA","Y93.9","Y92.9","I10","F17.210","R68.89","R10.32","Z79.899","R10.9","F41.8","E78.00","Z68.25","F05","Z74.3","F10.10","F33.2","R45.851","F10.20","J45.909","H54.61","F33.1","H54.7","J39.9","R51","F10.129","F10.121","J06.9","R05","R06.89","T50.995A","S92.415A","S92.425A","F32.9","Z79.1","M79.675","Z87.891","F48.9","Y90.6","R45.850","F14.90","T43.206A","F41.9","F14.10","H54.40","F79","E78.5","Z82.49","S20.219A","S29.8XXA","W51.XXXA","Y93.72","S29.9XXA","J98.11","K76.0","F14.21","S30.0XXA","W10.9XXA","M54.5","S39.93XA","M16.0","S39.92XA","M47.816","J90","U07.1","R43.0","R43.2","Z20.9","R07.9","R06.9","R06.02","R09.82","H17.9"],"date":["2019-07-12","2019-02-05","2019-02-05","2019-02-05","2019-02-05","2019-02-05","2019-02-05","2019-02-05","2020-04-07","2019-02-05","2019-02-05","2019-02-05","2021-03-18","2021-03-18","2020-04-10","2019-05-31","2021-03-18","2019-05-31","2020-08-04","2021-01-20","2021-01-20","2019-07-12","2019-07-12","2020-04-06","2019-07-12","2020-04-07","2020-04-07","2019-07-12","2020-04-07","2021-10-26","2019-07-13","2019-07-17","2019-08-20","2019-08-20","2019-08-20","2019-10-18","2021-03-18","2019-10-18","2019-10-25","2019-12-26","2019-12-26","2020-06-15","2019-12-26","2019-12-26","2019-12-26","2020-04-06","2020-04-06","2020-04-07","2020-04-06","2020-04-06","2020-04-06","2020-04-07","2020-04-07","2020-04-07","2021-03-18","2020-06-15","2020-06-15","2020-06-15","2020-06-15","2020-06-15","2020-06-15","2020-06-15","2020-06-15","2021-09-29","2020-08-04","2020-08-04","2020-08-04","2020-08-04","2020-08-04","2020-08-04","2020-08-04","2021-01-20","2021-01-20","2021-01-20","2021-01-20","2021-01-20","2021-01-20","2021-01-20","2021-03-18","2021-03-18","2021-09-17"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","",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":[["","00054418325","DEXAMETHASON","2MG","27","Select","Select",""],["","65162068090","PROMETHAZINE","DM","120","Select","Select",""],["","67877057305","BENZONATATE","100MG","30","Select","Select",""],["","68180016106","AZITHROMYCIN","500MG","5","Select","Select",""],["","59267100002","PFIZER","COVID-19","0.3","Select","Select",""],["","42806008301","BUSPIRONE","7.5MG","60","Select","Select",""],["","50111043401","TRAZODONE","100MG","30","Select","Select",""],["","16729008110","NALTREXONE","50MG","15","Select","Select",""],["","70436001102","BUPROPN","300MG XL","30","Select","Select",""],["","13668013601","ESCITALOPRAM","10MG","30","Select","Select",""],["","69097094312","GABAPENTIN","300MG","90","Select","Select",""],["","71093014105","METHOCARBAM","750MG","20","Select","Select",""],["","65162019050","NAPROXEN","500MG","20","Select","Select",""],["","00054327099","FLUTICASONE","50MCG","16","Select","Select",""],["","45802091987","CETIRIZINE","10MG","30","Select","Select",""],["","00054418325","DEXAMETHASON ","TAB 2MG","27","Select","Select",""],["","65162068090","PROMETHAZINE ","SOL DM","120","Select","Select",""],["","67877057305","BENZONATATE ","CAP 100MG","30","Select","Select",""],["","68180016106","AZITHROMYCIN ","TAB 500MG","5","Select","Select",""],["","59267100002","PFIZER ","INJ COVID-19","0.3","Select","Select",""],["","42806008301","BUSPIRONE ","TAB 7.5MG","60","Select","Select",""],["","50111043401","TRAZODONE ","TAB 100MG","30","Select","Select",""],["","16729008110","NALTREXONE ","TAB 50MG","15","Select","Select",""],["","70436001102","BUPROPN ","TAB 300MG XL","30","Select","Select",""],["","13668013601","ESCITALOPRAM ","TAB 10MG","30","Select","Select",""],["","69097094312","GABAPENTIN ","CAP 300MG","90","Select","Select",""],["","71093014105","METHOCARBAM ","TAB 750MG","20","Select","Select",""],["","65162019050","NAPROXEN ","TAB 500MG","20","Select","Select",""],["","00054327099","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","45802091987","CETIRIZINE ","TAB 10MG","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":[[["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","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":""}]}]}