{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"AMY   R ALLEN","gend":1,"add":"2229   MOUNTAIN VIEW TERRACE SW                             ","city":"ROANOKE                       ","state":"VA","zip":"24015-5539","dob":"1973-03-22","age":"","mstatus":"","insh":10053496,"cliId":"","pno":5406764718,"cno":5406764718,"email":"","ename":"","eno":"","pphy":"NGUYEN, SON H                                               ","ppno":"","pcpadd":"1802 Braeburn Dr,Ste 1","pcpcity":"Salem                         ","pcpstate":"VA","pcpzip":241537357,"pcpcounty":"","pcpid":"P0123923","pcpname":"LEWIS GALE PHYSICIANS LLC","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"APT 12                                                      ","add3":"","madd1":"2229   MOUNTAIN VIEW TERRACE SW                             ","madd2":"APT 12                                                      ","madd3":"","mcity":"ROANOKE                       ","mstate":"VA","mzip":"24015-5539","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F31.30","N92.6","E11.9","K21.9","Z23","F43.12","G56.01","N60.01","J30.1","K14.0","Z96.1","D49.6","H49.12","H26.493","M77.9","L30.9","L98.9","L70.0","R42","K11.20","K05.6","M25.532","K06.1","R23.2","R53.83","Z78.9","Z12.31","M19.131","R51","Z85.841","R22.0","C71.7","Z92.21","Z11.3","N95.1","N90.89","D07.1","N76.0","N93.9","B96.89","N92.4","Z12.4","N72","N90.3","R87.619","N88.2","Z79.84","I10","F17.210","E78.5","G43.909","F31.9","F41.9","Z92.3","Z88.8","Z01.810","A60.00","R30.0","C71.9","G91.1","J02.9","Z76.89","Z98.2","R19.5","Z01.419","K14.6","B37.0","R60.0","K13.79","K13.0","G93.89","Z87.2","Z98.890","R07.89","R68.89","E11.42","M79.671","M79.672","R26.81","M62.81","G60.9","I11.9","S89.92XA","S83.207A","M25.561","S83.512A","E11.40","Z00.00","B00.9","R87.610","Z32.02","R87.810","R51.9"],"date":["2021-08-06","2019-01-16","2021-08-02","2020-01-10","2019-01-23","2021-10-25","2019-04-12","2019-04-12","2019-05-07","2019-05-07","2019-06-13","2020-11-05","2020-11-05","2020-11-05","2019-06-19","2021-08-30","2019-07-15","2019-07-15","2019-07-15","2020-09-16","2019-07-18","2019-08-14","2019-08-16","2019-08-16","2019-08-16","2019-08-16","2021-10-26","2019-09-06","2019-09-16","2019-10-10","2019-09-19","2019-10-10","2020-01-10","2020-08-11","2019-10-23","2019-11-20","2020-01-15","2019-11-20","2020-01-24","2019-11-20","2019-11-25","2021-08-30","2019-12-03","2021-08-30","2019-12-19","2020-01-10","2020-01-10","2021-05-12","2020-05-11","2021-08-02","2020-01-10","2020-05-11","2021-08-02","2020-01-10","2020-01-10","2020-01-10","2020-01-15","2021-08-30","2021-11-23","2020-02-06","2020-03-06","2020-05-11","2020-11-04","2020-08-05","2020-08-11","2020-08-22","2020-08-22","2020-10-02","2020-10-02","2020-10-02","2020-11-04","2020-11-04","2020-11-04","2021-02-10","2021-02-10","2021-02-12","2021-02-12","2021-02-12","2021-02-12","2021-02-12","2021-02-12","2021-04-17","2021-04-19","2021-04-19","2021-04-19","2021-06-04","2021-05-12","2021-08-30","2021-08-30","2021-10-21","2021-10-21","2021-10-21","2021-11-23"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",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":[["","00093010901","CARBAMAZEPIN","200MG","60","Select","Select",""],["","68180051401","LISINOPRIL","10MG","30","Select","Select",""],["","49483062310","METFORMIN","500MG ER","60","Select","Select",""],["","49100040007","CULTURELLE","","30","Select","Select",""],["","00378615093","OMEPRAZOLE","20MG","30","Select","Select",""],["","00093321201","CLONAZEPAM","1MG","40","Select","Select",""],["","45802057178","FEXOFENADINE","180MG","34","Select","Select",""],["","00904026013","TOTAL","","30","Select","Select",""],["","60505317007","OMEGA-3-ACID","1GM","120","Select","Select",""],["","54629090970","VITAMIN","2000UNIT","30","Select","Select",""],["","00168000315","TRIAMCINOLON","0.03%","15","Select","Select",""],["","00378427577","VALACYCLOVIR","500MG","7","Select","Select",""],["","00406055201","OXYCODONE","5MG","5","Select","Select",""],["","29033004630","VENLAFAXINE","225MG ER","30","Select","Select",""],["","55111032001","GLIMEPIRIDE","1MG","30","Select","Select",""],["","00093720210","PRAVASTATIN","40MG","90","Select","Select",""],["","11917009245","OMEGA-3","1000MG","60","Select","Select",""],["","00115552202","FENOFIBRATE","160MG","15","Select","Select",""],["","60505082901","FLUTICASONE","50MCG","16","Select","Select",""],["","70461032003","FLUCLVX","2020-21","0.5","Select","Select",""],["","00005197102","PREVNAR","","0.5","Select","Select",""],["","50428037587","CVS","COMPLX\/C","30","Select","Select",""],["","74312000190","B-COMP\/B-12","","30","Select","Select",""],["","30768000601","B-COMPLEX","","30","Select","Select",""],["","00054414622","CLOTRIMAZOLE","10MG","70","Select","Select",""],["","40985022668","B","","30","Select","Select",""],["","00378875006","DICLOFENAC","1%","100","Select","Select",""],["","60505263308","CETIRIZINE","10MG","30","Select","Select",""],["","66689000816","NYSTATIN","100000","140","Select","Select",""],["","60505011201","GABAPENTIN","100MG","120","Select","Select",""],["","45802086803","POLYETH","3350 NF","510","Select","Select",""],["","49348098310","SM","25MG RLF","1","Select","Select",""],["","47781019601","OXYCOD\/APAP","5-325MG","1","Select","Select",""],["","00093010901","CARBAMAZEPIN ","TAB 200MG","60","Select","Select",""],["","68180051401","LISINOPRIL ","TAB 10MG","30","Select","Select",""],["","49483062310","METFORMIN ","TAB 500MG ER","60","Select","Select",""],["","49100040007","CULTURELLE ","CAP ","30","Select","Select",""],["","00378615093","OMEPRAZOLE ","CAP 20MG","30","Select","Select",""],["","00093321201","CLONAZEPAM ","TAB 1MG","40","Select","Select",""],["","45802057178","FEXOFENADINE ","TAB 180MG","34","Select","Select",""],["","00904026013","TOTAL ","TAB ","30","Select","Select",""],["","60505317007","OMEGA-3-ACID ","CAP 1GM","120","Select","Select",""],["","54629090970","VITAMIN ","CAP 2000UNIT","30","Select","Select",""],["","00168000315","TRIAMCINOLON ","CRE 0.00025","15","Select","Select",""],["","00378427577","VALACYCLOVIR ","TAB 500MG","7","Select","Select",""],["","00406055201","OXYCODONE ","TAB 5MG","5","Select","Select",""],["","29033004630","VENLAFAXINE ","TAB 225MG ER","30","Select","Select",""],["","55111032001","GLIMEPIRIDE ","TAB 1MG","30","Select","Select",""],["","00093720210","PRAVASTATIN ","TAB 40MG","90","Select","Select",""],["","11917009245","OMEGA-3 ","CAP 1000MG","60","Select","Select",""],["","00115552202","FENOFIBRATE ","TAB 160MG","15","Select","Select",""],["","60505082901","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","70461032003","FLUCLVX ","INJ 2020-21","0.5","Select","Select",""],["","00005197102","PREVNAR ","INJ ","0.5","Select","Select",""],["","50428037587","CVS ","TAB COMPLX\/C","30","Select","Select",""],["","74312000190","B-COMP\/B-12 ","TAB ","30","Select","Select",""],["","30768000601","B-COMPLEX ","TAB ","30","Select","Select",""],["","00054414622","CLOTRIMAZOLE ","TRO 10MG","70","Select","Select",""],["","40985022668","B ","TAB ","30","Select","Select",""],["","49483061701","NAPROXEN ","TAB 375MG","30","Select","Select",""],["","00378875006","DICLOFENAC ","GEL 0.01","100","Select","Select",""],["","60505263308","CETIRIZINE ","TAB 10MG","30","Select","Select",""],["","66689000816","NYSTATIN ","SUS 100000","140","Select","Select",""],["","60505011201","GABAPENTIN ","CAP 100MG","120","Select","Select",""],["","45802086803","POLYETH ","POW 3350 NF","510","Select","Select",""],["","49348098310","SM ","TAB 25MG RLF","1","Select","Select",""],["","47781019601","OXYCOD\/APAP ","TAB 5-325MG","1","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":""}]}]}