{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TINA   G ANDERSON","gend":1,"add":"MEADOW HILLS ALF                                            ","city":"ROANOKE                       ","state":"VA","zip":"24012-1736","dob":"1973-10-02","age":"","mstatus":"","insh":10051233,"cliId":"","pno":4342090005,"cno":5402912301,"email":"","ename":"","eno":"","pphy":"DELL, PATRICIA TAYLOR                                       ","ppno":"","pcpadd":"1906 Belleview Ave SE","pcpcity":"Roanoke                       ","pcpstate":"VA","pcpzip":240141838,"pcpcounty":"","pcpid":"P0060152","pcpname":"NEW HORIZONS HEALTH CARE","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"5046   WILLIAMSON  ROAD                                     ","add3":"","madd1":"MEADOW HILLS ALF                                            ","madd2":"5046   WILLIAMSON  ROAD                                     ","madd3":"","mcity":"ROANOKE                       ","mstate":"VA","mzip":"24012-1736","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F25.0","E11.65","I10","K08.89","J30.2","K11.20","F20.0","J40","H50.17","Z01.818","H53.003","H50.10","E11.9","Z79.84","E78.5","E55.9","F31.9","F20.9","F17.200","K59.00","H61.22","Z00.00","Z71.3","Z23","Z11.1","F20.89","Z76.89","S06.9X9A","Z12.39","K21.9","Z87.891","D64.9","R94.6","D51.9","E03.9","B37.0","F17.210","F41.1","F43.10","F25.1","F32.9","F25.9","E11.69","Z79.899","J45.40","B35.1","Z87.820","Z12.11","Z12.31","M25.519","M61.9","M79.601","M79.89","R22.31","J45.909","Z79.51","N91.2","Z11.3","Z12.4","E78.2","G47.9","S90.122A","L60.3","G93.89","E22.1","Z01.89","Z68.30","B37.3","R35.0","R81","Z11.4","Z11.59","N76.0","E23.6","Z13.820","E28.319"],"date":["2020-02-05","2020-01-02","2021-08-31","2019-09-18","2019-05-03","2019-01-22","2020-03-25","2019-05-03","2019-08-16","2019-07-30","2019-07-30","2019-08-16","2021-10-15","2021-05-31","2020-02-21","2021-05-18","2019-08-16","2019-08-16","2019-08-16","2020-01-02","2020-01-02","2020-02-19","2020-02-19","2020-10-22","2021-05-18","2021-05-10","2020-05-05","2020-05-05","2020-06-10","2021-05-31","2020-05-05","2020-05-13","2020-05-13","2020-05-13","2020-05-13","2020-06-10","2020-06-10","2021-09-07","2021-09-07","2021-11-24","2021-09-08","2021-09-08","2021-08-31","2021-08-31","2021-05-18","2021-05-18","2021-05-18","2021-05-18","2021-05-18","2021-05-31","2021-05-31","2021-05-31","2021-06-01","2021-05-31","2021-05-31","2021-05-31","2021-07-02","2021-06-17","2021-06-17","2021-08-31","2021-06-17","2021-07-01","2021-07-01","2021-07-02","2021-08-31","2021-07-02","2021-07-22","2021-08-10","2021-08-10","2021-08-10","2021-08-31","2021-08-31","2021-08-31","2021-09-28","2021-11-05","2021-11-05"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",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":[]},{"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":[["","65862000601","CITALOPRAM","20MG","30","Select","Select",""],["","69315013810","BENZTROPINE","2MG","30","Select","Select",""],["","00378306677","FENOFIBRATE","145MG","30","Select","Select",""],["","57664039753","METFORMIN","500MG","30","Select","Select",""],["","55111046701","METOPROL","50MG ER","30","Select","Select",""],["","16729011917","MONTELUKAST","10MG","30","Select","Select",""],["","65862056099","PANTOPRAZOLE","40MG","30","Select","Select",""],["","10370051150","DIVALPROEX","500MG ER","30","Select","Select",""],["","00193707025","CONTOUR","BLD GLUC","25","Select","Select",""],["","54295030815","UREA","40%","28.35","Select","Select",""],["","13668000705","ZOLPIDEM","5MG","30","Select","Select",""],["","00904615760","VITAMIN","2000UNIT","30","Select","Select",""],["","00093317431","ALBUTEROL","E","8.5","Select","Select",""],["","16714008212","HYDROXYZ","25MG","30","Select","Select",""],["","16729020216","BUSPIRONE","10MG","57","Select","Select",""],["","50458060901","INVEGA","819MG","2.63","Select","Select",""],["","45802065087","LORATADINE","10MG","28","Select","Select",""],["","49502010202","EPINEPHRINE","0.3MG","2","Select","Select",""],["","54629092910","MELATONIN","10MG","30","Select","Select",""],["","00574010770","CLOTRIMAZOLE","10MG","70","Select","Select",""],["","00597015230","JARDIANCE","10MG","28","Select","Select",""],["","00002143480","TRULICITY","1.5\/0.5","2","Select","Select",""],["","00186037220","SYMBICORT","80-4.5","10.2","Select","Select",""],["","70710113908","FLUCONAZOLE","150MG","2","Select","Select",""],["","53746046405","IBUPROFEN","400MG","30","Select","Select",""],["","00065143105","SYSTANE","","10","Select","Select",""],["","16729028715","ROSUVASTATIN","40MG","28","Select","Select",""],["","00904662735","EAR","6.50%","15","Select","Select",""],["","43386031214","GAVILAX","","510","Select","Select",""],["","29300022701","METRONIDAZOL","500MG","14","Select","Select",""],["","00904671980","ACETAMINOPHEN","B 325","100","Select","Select",""],["","59267100002","PFIZER","COVID-19","0.3","Select","Select",""],["","00186037220","SYMBICORT ","AER 80-4.5","10.2","Select","Select",""],["","65862000601","CITALOPRAM ","TAB 20MG","30","Select","Select",""],["","69315013810","BENZTROPINE ","TAB 2MG","30","Select","Select",""],["","00378306677","FENOFIBRATE ","TAB 145MG","30","Select","Select",""],["","57664039753","METFORMIN ","TAB 500MG","30","Select","Select",""],["","55111046701","METOPROL ","TAB 50MG ER","30","Select","Select",""],["","16729011917","MONTELUKAST ","TAB 10MG","30","Select","Select",""],["","65862056099","PANTOPRAZOLE ","TAB 40MG","30","Select","Select",""],["","10370051150","DIVALPROEX ","TAB 500MG ER","30","Select","Select",""],["","00193707025","CONTOUR ","TES BLD GLUC","25","Select","Select",""],["","54295030815","UREA ","CRE 0.4","28.35","Select","Select",""],["","00002223680","TRULICITY ","INJ 3\/0.5","2","Select","Select",""],["","13668000705","ZOLPIDEM ","TAB 5MG","30","Select","Select",""],["","00904615760","VITAMIN ","TAB 2000UNIT","30","Select","Select",""],["","70710113908","FLUCONAZOLE ","TAB 150MG","1","Select","Select",""],["","00093317431","ALBUTEROL ","FAT E","8.5","Select","Select",""],["","16714008212","HYDROXYZ ","TAB 25MG","30","Select","Select",""],["","16729020216","BUSPIRONE ","TAB 10MG","57","Select","Select",""],["","50458060901","INVEGA ","INJ 819MG","2.63","Select","Select",""],["","45802065087","LORATADINE ","TAB 10MG","28","Select","Select",""],["","58160088752","FLUARIX ","INJ 2021-22","0.5","Select","Select",""],["","49502010202","EPINEPHRINE ","INJ 0.3MG","2","Select","Select",""],["","54629092910","MELATONIN ","SUB 10MG","30","Select","Select",""],["","00574010770","CLOTRIMAZOLE ","LOZ 10MG","70","Select","Select",""],["","00597015230","JARDIANCE ","TAB 10MG","28","Select","Select",""],["","53746046405","IBUPROFEN ","TAB 400MG","30","Select","Select",""],["","00065143105","SYSTANE ","SOL ","10","Select","Select",""],["","16729028715","ROSUVASTATIN ","TAB 40MG","28","Select","Select",""],["","00904662735","EAR ","DRO 0.065","15","Select","Select",""],["","43386031214","GAVILAX ","POW ","510","Select","Select",""],["","29300022701","METRONIDAZOL ","TAB 500MG","14","Select","Select",""],["","00904671980","ACETAMINOPHEN ","TA B 325","100","Select","Select",""],["","59267100002","PFIZER ","INJ COVID-19","0.3","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":""}]}]}