{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KEVIN   A BARRERA","gend":0,"add":"1328 IRISBURG ROAD                                          ","city":"AXTON                         ","state":"VA","zip":"24054-2390","dob":"2000-04-14","age":"","mstatus":"","insh":10054243,"cliId":"","pno":2762263179,"cno":"","email":"","ename":"","eno":"","pphy":"CLARK, KENNETH A                                            ","ppno":"","pcpadd":"1107 Brookdale St","pcpcity":"Martinsville                  ","pcpstate":"VA","pcpzip":241124501,"pcpcounty":"","pcpid":"P0117816","pcpname":"CARILION MEDICAL ASSOCIATES GALAX FAMILY","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"1328 IRISBURG ROAD                                          ","madd2":"                                                            ","madd3":"","mcity":"AXTON                         ","mstate":"VA","mzip":"24054-2390","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z00.00","Z01.00","H10.45","H52.00","H52.209","F41.9","J01.90","F33.8","H60.331","T16.2XXA","F29","F70","R10.9","K59.00","F20.9","F43.8","H52.03","H90.A22","Z97.4","H61.22","H92.11","H90.A31","R29.6","Z87.76","L98.9","R44.0","R51","F25.9","L02.811","L21.8","L73.2","L70.0","Z79.899","G71.00","R51.9","R26.9","R26.89","M62.81","R14.0","E53.8","R11.2","R68.83","F20.1","K13.0","R68.89","R63.5","R11.0","L02.411","D22.5","D48.5","R58","L53.8","R20.8","L29.8","Z03.818","H66.11"],"date":["2020-11-16","2019-02-18","2020-03-25","2019-03-02","2020-03-25","2019-09-10","2019-05-08","2019-06-10","2019-06-20","2019-06-20","2020-04-15","2020-02-13","2019-09-13","2019-09-13","2019-12-04","2020-06-16","2020-03-25","2021-09-16","2021-09-16","2020-04-07","2021-11-04","2020-05-28","2021-06-14","2020-11-16","2020-06-23","2020-06-23","2020-06-23","2021-10-26","2020-09-16","2021-05-03","2021-07-26","2021-07-26","2021-07-26","2020-10-12","2021-06-14","2020-10-12","2020-12-01","2020-12-01","2020-11-16","2020-11-20","2021-01-29","2021-01-29","2021-04-27","2021-07-26","2021-06-14","2021-06-14","2021-06-14","2021-07-01","2021-07-26","2021-07-26","2021-07-26","2021-07-26","2021-07-26","2021-07-26","2021-08-06","2021-11-11"],"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":[["","43547030203","ARIPIPRAZOLE","2MG","1","Select","Select",""],["","50111064801","FLUOXETINE","20MG","30","Select","Select",""],["","14539067401","HYDROXYZ","25MG","30","Select","Select",""],["","65862042005","SMZ\/TMP","800-160","14","Select","Select",""],["","00555105786","CLARAVIS","40MG","60","Select","Select",""],["","45802091987","CETIRIZINE","10MG","30","Select","Select",""],["","00054327099","FLUTICASONE","50MCG","16","Select","Select",""],["","67877057305","BENZONATATE","100MG","15","Select","Select",""],["","59148007280","ABILIFY","400MG","1","Select","Select",""],["","50428057523","VITAMIN","5000UNIT","30","Select","Select",""],["","61748030313","MYORISAN","30MG","60","Select","Select",""],["","51991083675","EPINASTINE","0.05%","5","Select","Select",""],["","69315030805","CIPROFLOXACN","0.3% OP","5","Select","Select",""],["","24208063562","NEO\/POLY\/HC","1% OTIC","10","Select","Select",""],["","49483060350","IBUPROFEN","600MG","60","Select","Select",""],["","68180065208","DOXYCYC","100MG","60","Select","Select",""],["","45802046564","KETOCONAZOLE","2%","120","Select","Select",""],["","50428016183","CVS","2000UNIT","30","Select","Select",""],["","43547030203","ARIPIPRAZOLE ","TAB 2MG","1","Select","Select",""],["","67877057305","BENZONATATE ","CAP 100MG","15","Select","Select",""],["","50111064801","FLUOXETINE ","CAP 20MG","30","Select","Select",""],["","14539067401","HYDROXYZ ","CAP 25MG","30","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","14","Select","Select",""],["","00555105786","CLARAVIS ","CAP 40MG","60","Select","Select",""],["","45802091987","CETIRIZINE ","TAB 10MG","30","Select","Select",""],["","00054327099","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","59148007280","ABILIFY ","INJ 400MG","1","Select","Select",""],["","50428057523","VITAMIN ","TAB 5000UNIT","30","Select","Select",""],["","61748030313","MYORISAN ","CAP 30MG","60","Select","Select",""],["","51991083675","EPINASTINE ","DRO 0.0005","5","Select","Select",""],["","69315030805","CIPROFLOXACN ","SOL 0.3% OP","5","Select","Select",""],["","24208063562","NEO\/POLY\/HC ","SUS 1% OTIC","10","Select","Select",""],["","49483060350","IBUPROFEN ","TAB 600MG","60","Select","Select",""],["","68180065208","DOXYCYC ","CAP 100MG","60","Select","Select",""],["","45802046564","KETOCONAZOLE ","SHA 0.02","120","Select","Select",""],["","50428016183","CVS ","CAP 2000UNIT","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","",""],["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":""}]}]}