{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DANIEL   W BOWDEN","gend":0,"add":"916   GATEWAY DRIVE                                         ","city":"PULASKI                       ","state":"VA","zip":"24301-3714","dob":"1974-12-29","age":"","mstatus":"","insh":10054254,"cliId":"","pno":5406411930,"cno":5406411930,"email":"","ename":"","eno":"","pphy":"KAATZ, MATTHEW S                                            ","ppno":"","pcpadd":"101 1st St NW","pcpcity":"PULASKI                       ","pcpstate":"VA","pcpzip":243015603,"pcpcounty":"","pcpid":"P9058766","pcpname":"KAATZ MATTHEW S MD PC","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"916   GATEWAY DRIVE                                         ","madd2":"                                                            ","madd3":"","mcity":"PULASKI                       ","mstate":"VA","mzip":"24301-3714","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M25.562","J44.9","K21.9","F32.9","F41.9","F39","F17.200","K08.89","G47.00","F31.9","M19.019","R53.82","F41.8","K27.9","F43.10","M51.26","E55.9","M54.2","J06.9","J34.89","J45.909","Z72.0","K05.00","K05.10","R11.0","K04.7","K03.81","J30.2","F51.04","Z79.899","G47.01","K12.0","J02.0","J20.9","J40","J44.0","R05","R09.81","K25.9","S33.5XXA","R61","N39.0","R30.0","R06.02","Z76.89","M54.9","M51.36","Z87.442","Z13.220","K59.00","Z79.51","R10.9","Z12.11","M51.16","M54.10","M47.26","M51.27","M47.817","N52.9","H92.02","R82.998","Z13.31","R22.0","R68.84","R05.9","Z23"],"date":["2019-01-22","2021-11-09","2021-11-09","2020-09-18","2020-09-18","2019-07-16","2020-09-18","2021-05-12","2021-08-09","2019-05-06","2019-05-06","2019-05-06","2021-11-09","2019-05-06","2021-11-09","2020-11-11","2021-11-09","2019-05-06","2019-03-27","2019-03-27","2019-03-27","2019-11-03","2019-05-01","2019-05-01","2020-07-14","2021-05-12","2019-06-26","2019-07-16","2019-08-14","2019-10-15","2019-11-26","2019-10-15","2019-11-01","2019-11-01","2019-11-03","2019-11-03","2020-02-05","2019-11-03","2019-11-26","2020-01-02","2020-02-05","2020-05-29","2020-05-29","2020-05-29","2020-07-14","2021-08-18","2021-11-09","2020-10-22","2021-08-10","2020-10-22","2020-06-24","2020-06-24","2020-10-22","2020-11-11","2020-11-11","2020-11-11","2020-11-11","2020-11-11","2021-11-09","2021-01-21","2021-04-22","2021-11-09","2021-05-12","2021-10-02","2021-11-09","2021-11-09"],"priorHcc":["",null,null,"","","","","","","","","",null,"",null,"",null,"","","","","","","","","","","","","","","","","","","","","","","","","","","","","",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":[["","62175011843","OMEPRAZOLE","20MG","30","Select","Select",""],["","60505265301","TRAZODONE","50MG","30","Select","Select",""],["","65862001205","SERTRALINE","50MG","30","Select","Select",""],["","68382013201","TAMSULOSIN","0.4MG","30","Select","Select",""],["","00172572960","FAMOTIDINE","40MG","30","Select","Select",""],["","67877025001","QUETIAPINE","100MG","30","Select","Select",""],["","16729016901","ESCITALOPRAM","10MG","30","Select","Select",""],["","66993058597","FLUTIC\/SALME","250\/50","60","Select","Select",""],["","16729013616","CLONAZEPAM","0.5MG","30","Select","Select",""],["","68382004001","PROMETHAZINE","12.5MG","6","Select","Select",""],["","52817033010","CYCLOBENZAPR","5MG","30","Select","Select",""],["","80777027399","MODERNA","COVID-19","0.5","Select","Select",""],["","31722072690","MONTELUKAST","10MG","30","Select","Select",""],["","45802026937","PERMETHRIN","5%","60","Select","Select",""],["","65162062711","TRAMADOL","50MG","30","Select","Select",""],["","00054350049","LIDOCAINE","2% VISC","100","Select","Select",""],["","00143988915","AMOXICILLIN","250\/5ML","300","Select","Select",""],["","16571020150","DICLOFENAC","75MG DR","60","Select","Select",""],["","68462024805","RANITIDINE","150MG","60","Select","Select",""],["","00591544305","PREDNISONE","20MG","20","Select","Select",""],["","45802086802","POLYETH","3350 NF","238","Select","Select",""],["","67618012012","SENOKOT","17.2MG","40","Select","Select",""],["","70461032003","FLUCLVX","2020-21","0.5","Select","Select",""],["","66993001968","ALBUTEROL","HFA","18","Select","Select",""],["","51293081101","PHENAZOPYRID","200MG","6","Select","Select",""],["","68180044102","CEPHALEXIN","250\/5ML","400","Select","Select",""],["","00143980305","DOXYCYCL","100MG","20","Select","Select",""],["","62542030117","HYD","10-8\/5ML","120","Select","Select",""],["","62175011843","OMEPRAZOLE ","CAP 20MG","30","Select","Select",""],["","60505265301","TRAZODONE ","TAB 50MG","30","Select","Select",""],["","65862001205","SERTRALINE ","TAB 50MG","30","Select","Select",""],["","68382013201","TAMSULOSIN ","CAP 0.4MG","30","Select","Select",""],["","00172572960","FAMOTIDINE ","TAB 40MG","30","Select","Select",""],["","67877025001","QUETIAPINE ","TAB 100MG","30","Select","Select",""],["","16729016901","ESCITALOPRAM ","TAB 10MG","30","Select","Select",""],["","66993058597","FLUTIC\/SALME ","AER 250\/50","60","Select","Select",""],["","16729013616","CLONAZEPAM ","TAB 0.5MG","30","Select","Select",""],["","42806071401","BENZONATATE ","CAP 100MG","30","Select","Select",""],["","68382004001","PROMETHAZINE ","TAB 12.5MG","6","Select","Select",""],["","52817033010","CYCLOBENZAPR ","TAB 5MG","30","Select","Select",""],["","80777027399","MODERNA ","INJ COVID-19","0.5","Select","Select",""],["","31722072690","MONTELUKAST ","TAB 10MG","30","Select","Select",""],["","45802026937","PERMETHRIN ","CRE 0.05","60","Select","Select",""],["","65162062711","TRAMADOL ","TAB 50MG","30","Select","Select",""],["","00054350049","LIDOCAINE ","SOL 2% VISC","100","Select","Select",""],["","00143988915","AMOXICILLIN ","SUS 250\/5ML","300","Select","Select",""],["","16571020150","DICLOFENAC ","TAB 75MG DR","60","Select","Select",""],["","68462024805","RANITIDINE ","TAB 150MG","60","Select","Select",""],["","00591544305","PREDNISONE ","TAB 20MG","20","Select","Select",""],["","45802086802","POLYETH ","POW 3350 NF","238","Select","Select",""],["","67618012012","SENOKOT ","TAB 17.2MG","40","Select","Select",""],["","70461032003","FLUCLVX ","INJ 2020-21","0.5","Select","Select",""],["","66993001968","ALBUTEROL ","AER HFA","18","Select","Select",""],["","51293081101","PHENAZOPYRID ","TAB 200MG","6","Select","Select",""],["","68180044102","CEPHALEXIN ","SUS 250\/5ML","400","Select","Select",""],["","00143980305","DOXYCYCL ","CAP 100MG","20","Select","Select",""],["","62542030117","HYD ","SUS 10-8\/5ML","120","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","",""],["No","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":""}]}]}