{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ELINDA   K BOWDEN","gend":1,"add":"916 GATEWAY DRIVE                                           ","city":"PULASKI                       ","state":"VA","zip":"24301-3714","dob":"1969-03-09","age":"","mstatus":"","insh":10054312,"cliId":"","pno":5406411930,"cno":5406411930,"email":"","ename":"","eno":"","pphy":"STEWART, KNOTRESHA F                                        ","ppno":"","pcpadd":"28 Town Center Dr","pcpcity":"Dublin                        ","pcpstate":"VA","pcpzip":240846069,"pcpcounty":"","pcpid":"P0124296","pcpname":"RIVER VALLEY HEALTHCARE ASSOCIATES 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":["J02.0","J02.9","R05","J45.909","E07.9","F32.9","F39","Z79.51","R30.0","B37.3","R10.9","R19.7","R11.0","K21.9","F17.200","J39.8","R53.1","R50.9","B34.9","J98.9","Z72.0","R91.8","J06.9","R52","R09.81","Z79.890","J44.9","E03.9","E78.00","R73.09","R09.02","J45.998","M17.12","R60.9","J45.901","R60.0","E66.01","Z68.44","E78.6","R06.02","R58","R94.5","X58.XXXA","S80.12XA","S80.11XA","R79.89","R06.09","I50.9","E87.6","R73.03","G47.33","F31.9","Z12.31","J20.9","R09.89","J44.1","R74.0","I10","E78.5","K08.89","F41.9","L72.3","M25.569","M25.562","S80.02XA","B86","M79.89","M19.90","Z83.3","Z68.43","Z86.59","Z82.49","K76.0","Z90.09","Z12.11","G47.00","F41.1","J43.9","R53.83","E11.9","R74.8","F43.10","Z68.42","F25.8","E66.9","F51.04","Z71.6","K04.7","Z79.899","M17.11","M25.561","M17.0","S80.01XA","W18.30XA","R53.82","E55.9","Z20.822","R03.0","R22.0"],"date":["2019-01-04","2019-01-04","2019-11-07","2021-10-01","2021-05-12","2021-08-26","2019-02-20","2021-05-12","2020-10-08","2019-05-13","2019-02-02","2019-02-04","2019-02-02","2020-11-14","2021-03-01","2019-02-16","2019-02-16","2019-02-16","2019-02-16","2019-02-16","2020-01-06","2019-02-16","2021-10-08","2021-11-11","2019-10-31","2021-05-12","2019-02-25","2021-10-29","2021-08-23","2021-02-05","2019-09-06","2019-09-06","2019-04-10","2019-07-02","2019-05-13","2019-07-02","2020-09-29","2019-06-02","2019-06-06","2021-10-01","2019-07-02","2019-11-21","2020-01-19","2019-07-02","2019-07-02","2019-07-02","2019-07-02","2021-05-12","2019-08-13","2020-04-09","2020-01-06","2020-01-06","2019-10-28","2019-10-31","2019-10-31","2019-11-07","2019-11-21","2021-10-29","2021-08-26","2019-12-26","2021-05-14","2020-01-06","2021-08-26","2021-05-12","2021-05-12","2020-01-19","2021-05-12","2021-03-01","2020-03-11","2020-03-11","2020-03-11","2020-03-11","2020-06-15","2020-03-11","2020-03-11","2021-05-14","2021-08-26","2021-10-29","2020-09-29","2021-10-29","2021-08-26","2020-07-23","2020-08-13","2021-09-02","2021-10-08","2021-09-02","2021-08-26","2021-11-11","2021-10-29","2021-03-19","2021-05-12","2021-05-12","2021-05-12","2021-05-12","2021-10-29","2021-10-29","2021-10-08","2021-10-08","2021-11-11"],"priorHcc":["","","",null,"","","","","","","","","","","","","","","","","","","",null,"","","",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":[["","64380080707","IBUPROFEN","800MG","90","Select","Select",""],["","00054429731","FUROSEMIDE","20MG","15","Select","Select",""],["","00006033530","BELSOMRA","20MG","28","Select","Select",""],["","00006011231","JANUVIA","50MG","30","Select","Select",""],["","00186037020","SYMBICORT","160-4.5","10.2","Select","Select",""],["","99073013001","FREESTYLE MIS LANCETS","LANCETS","100","Select","Select",""],["","69238184001","LEVOTHYROXIN","200MCG","30","Select","Select",""],["","65862066630","ARIPIPRAZOLE","30MG","30","Select","Select",""],["","31722088390","ROSUVASTATIN","10MG","30","Select","Select",""],["","55111032001","GLIMEPIRIDE","1MG","60","Select","Select",""],["","00228203150","ALPRAZOLAM","1MG","30","Select","Select",""],["","16729009712","QUETIAPINE","400MG ER","30","Select","Select",""],["","00378230201","PRAZOSIN","2MG","30","Select","Select",""],["","99073070822","FREESTYLE TES LITE","LITE","50","Select","Select",""],["","55111012305","ATORVASTATIN","40MG","30","Select","Select",""],["","80777027399","MODERNA","COVID-19","0.5","Select","Select",""],["","29300011201","LAMOTRIGINE","100MG","30","Select","Select",""],["","65862001205","SERTRALINE","50MG","30","Select","Select",""],["","65862076990","FENOFIBRATE","145MG","30","Select","Select",""],["","00115180301","HYDROXYZ","25MG","60","Select","Select",""],["","50111043302","TRAZODONE","50MG","30","Select","Select",""],["","00143962125","CYANOCOBALAM","1000MCG","2","Select","Select",""],["","45802026937","PERMETHRIN","5%","60","Select","Select",""],["","13668000701","ZOLPIDEM","5MG","30","Select","Select",""],["","68462010530","ONDANSETRON","4MG","21","Select","Select",""],["","65862090801","CELECOXIB","100MG","30","Select","Select",""],["","29300012410","MELOXICAM","7.5MG","30","Select","Select",""],["","66685100100","AMOX\/K","875-125","10","Select","Select",""],["","11917010573","PROBIOTIC","SUPER","30","Select","Select",""],["","00406012305","HYDROCO\/APAP","5-325MG","56","Select","Select",""],["","65162062711","TRAMADOL","50MG","21","Select","Select",""],["","69452015120","VITAMIN","50000UNT","8","Select","Select",""],["","31604002678","D3","2000UNIT","180","Select","Select",""],["","65862001501","AMOXICILLIN","875MG","20","Select","Select",""],["","16571020150","DICLOFENAC","75MG DR","14","Select","Select",""],["","68462019005","NAPROXEN","500MG","30","Select","Select",""],["","00378718505","METFORMIN","500MG","60","Select","Select",""],["","00093005401","BUSPIRONE","10MG","60","Select","Select",""],["","99073070805","FREESTYLE MIS LITE","LITE","1","Select","Select",""],["","70461032003","FLUCLVX","2020-21","0.5","Select","Select",""],["","52817033010","CYCLOBENZAPR","5MG","60","Select","Select",""],["","66993068130","OLANZAPINE","5MG","30","Select","Select",""],["","64380080707","IBUPROFEN ","TAB 800MG","90","Select","Select",""],["","00054429731","FUROSEMIDE ","TAB 20MG","15","Select","Select",""],["","00006033530","BELSOMRA ","TAB 20MG","28","Select","Select",""],["","00006011231","JANUVIA ","TAB 50MG","30","Select","Select",""],["","00186037020","SYMBICORT ","AER 160-4.5","10.2","Select","Select",""],["","99073013001","FREESTYLE    MIS LANCETS","MIS LANCETS","100","Select","Select",""],["","69238184001","LEVOTHYROXIN ","TAB 200MCG","30","Select","Select",""],["","65862066630","ARIPIPRAZOLE ","TAB 30MG","30","Select","Select",""],["","65862090801","CELECOXIB ","CAP 100MG","30","Select","Select",""],["","31722088390","ROSUVASTATIN ","TAB 10MG","30","Select","Select",""],["","55111032001","GLIMEPIRIDE ","TAB 1MG","60","Select","Select",""],["","00228203150","ALPRAZOLAM ","TAB 1MG","30","Select","Select",""],["","16729009712","QUETIAPINE ","TAB 400MG ER","30","Select","Select",""],["","00378230201","PRAZOSIN ","CAP 2MG","30","Select","Select",""],["","00781808926","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","99073070822","FREESTYLE    TES LITE","TES LITE","50","Select","Select",""],["","55111012305","ATORVASTATIN ","TAB 40MG","30","Select","Select",""],["","65862050220","AMOX\/K ","TAB 500-125","14","Select","Select",""],["","11917010573","PROBIOTIC ","CAP SUPER","30","Select","Select",""],["","80777027399","MODERNA ","INJ COVID-19","0.5","Select","Select",""],["","29300011201","LAMOTRIGINE ","TAB 100MG","30","Select","Select",""],["","65862001205","SERTRALINE ","TAB 50MG","30","Select","Select",""],["","65862076990","FENOFIBRATE ","TAB 145MG","30","Select","Select",""],["","00115180301","HYDROXYZ ","CAP 25MG","60","Select","Select",""],["","50111043302","TRAZODONE ","TAB 50MG","30","Select","Select",""],["","00143962125","CYANOCOBALAM ","INJ 1000MCG","2","Select","Select",""],["","45802026937","PERMETHRIN ","CRE 0.05","60","Select","Select",""],["","13668000701","ZOLPIDEM ","TAB 5MG","30","Select","Select",""],["","68462010530","ONDANSETRON ","TAB 4MG","21","Select","Select",""],["","29300012410","MELOXICAM ","TAB 7.5MG","30","Select","Select",""],["","00406012305","HYDROCO\/APAP ","TAB 5-325MG","56","Select","Select",""],["","65162062711","TRAMADOL ","TAB 50MG","21","Select","Select",""],["","69452015120","VITAMIN ","CAP 50000UNT","8","Select","Select",""],["","31604002678","D3 ","CAP 2000UNIT","180","Select","Select",""],["","65862001501","AMOXICILLIN ","TAB 875MG","20","Select","Select",""],["","16571020150","DICLOFENAC ","TAB 75MG DR","14","Select","Select",""],["","68462019005","NAPROXEN ","TAB 500MG","30","Select","Select",""],["","00378718505","METFORMIN ","TAB 500MG","60","Select","Select",""],["","00093005401","BUSPIRONE ","TAB 10MG","60","Select","Select",""],["","99073070805","FREESTYLE    MIS LITE","MIS LITE","1","Select","Select",""],["","70461032003","FLUCLVX ","INJ 2020-21","0.5","Select","Select",""],["","52817033010","CYCLOBENZAPR ","TAB 5MG","60","Select","Select",""],["","66993068130","OLANZAPINE ","TAB 5MG","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":[[["Yes","Select","","","","","Select","",""],["Yes","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":""}]}]}