{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ANGIE COMBS","gend":1,"add":"253   RIVERBEND ROAD                                        ","city":"NARROWS                       ","state":"VA","zip":"24124-2323","dob":"1979-06-30","age":"","mstatus":"","insh":10054455,"cliId":"","pno":5409227801,"cno":5409227801,"email":"","ename":"","eno":"","pphy":"FREED, ELLIOT S                                             ","ppno":"","pcpadd":"1645 N Main St","pcpcity":"Blacksburg                    ","pcpstate":"VA","pcpzip":240602554,"pcpcounty":"","pcpid":"P0149967","pcpname":"LEWIS GALE PHYSICIANS","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"253   RIVERBEND ROAD                                        ","madd2":"                                                            ","madd3":"","mcity":"NARROWS                       ","mstate":"VA","mzip":"24124-2323","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N91.5","R30.0","R68.89","R87.612","Z12.4","Z01.411","N93.9","R32","N83.202","N83.201","N83.292","N83.291","N87.1","B97.7","Z32.02","M54.42","M54.41","G89.29","E11.65","I10","Z23","G47.00","H65.91","R09.02","G47.30","G47.10","G25.81","Z01.810","E11.9","R00.0","R94.31","Z01.812","E11.8","G47.33","G47.61","J34.3","M25.561","R29.898","M17.11","E66.01","Z68.42","Z79.4","G62.9","E78.5","H35.00","J32.9","H73.893","J34.2","H70.13","J34.89","Z79.899","F41.8","E11.40","D72.829","H69.83","M95.0","H92.11","E78.00","J45.909","K21.9","F32.9","H66.93","R09.81","H69.80","N84.0","E11.319","J45.20","F17.200","Z79.1","N87.9","J01.90","B96.89","L92.9","M26.609","H70.11","H66.91","H69.81","J31.0","H61.23","H93.A3","H90.A22","H69.93","N94.6","Z86.001","N93.8","N73.6","Z87.891","R53.83","H61.21","H71.91","H69.91","Z68.43","Z79.51","B00.1","H66.90","H70.10","H90.11","H90.A31","E11.42","M25.50","Z99.89","E66.9","Z20.828","J45.30","F33.42","H90.A11","H90.3","H72.01","R13.19","Q38.8","H61.22","G35","H91.90","R13.10","H90.6","R05","B37.0","K12.0","J30.9","H73.891","H72.2X1","H92.01","H25.13","H74.20","Z01.818","R06.09","R06.02","R05.9"],"date":["2019-01-14","2019-01-11","2021-02-24","2019-04-10","2019-01-11","2019-01-11","2020-03-12","2019-01-11","2019-01-14","2019-01-14","2019-01-14","2019-01-14","2019-11-12","2019-01-29","2019-01-29","2019-02-14","2019-02-14","2019-02-14","2021-08-26","2021-08-26","2019-03-05","2021-10-21","2019-03-05","2021-10-21","2021-08-04","2019-04-15","2019-04-02","2021-07-21","2021-08-04","2019-04-10","2019-11-04","2021-07-21","2019-04-10","2020-11-06","2019-06-26","2019-10-01","2021-07-19","2019-06-28","2019-07-03","2020-11-06","2020-03-12","2021-08-04","2020-11-05","2021-08-26","2020-11-05","2019-08-20","2019-09-30","2019-10-01","2019-08-05","2019-10-01","2020-04-06","2020-11-06","2021-10-27","2019-09-10","2021-08-04","2019-09-30","2020-05-19","2019-09-30","2021-08-04","2021-08-04","2019-09-30","2019-10-01","2019-10-01","2020-05-28","2019-11-12","2020-03-12","2020-07-31","2019-11-12","2020-05-13","2019-11-12","2019-12-05","2019-12-05","2020-01-03","2020-01-03","2020-05-19","2021-05-18","2021-05-18","2020-05-12","2020-02-26","2020-02-26","2021-01-05","2020-02-26","2020-03-12","2020-03-12","2020-03-12","2020-03-12","2020-05-13","2020-04-30","2020-05-12","2021-08-04","2020-05-13","2020-05-13","2020-05-13","2020-05-19","2020-05-28","2020-05-28","2021-08-04","2021-01-05","2021-08-26","2020-11-06","2020-07-31","2021-08-04","2021-11-17","2020-11-06","2021-08-24","2021-05-18","2020-12-01","2021-05-18","2021-05-18","2021-05-18","2020-12-01","2020-12-30","2020-12-30","2020-12-30","2021-05-18","2021-02-15","2021-03-15","2021-03-15","2021-03-15","2021-08-04","2021-08-04","2021-06-10","2021-07-08","2021-08-04","2021-07-30","2021-08-04","2021-08-04","2021-11-15"],"priorHcc":["","","","","","","","","","","","","","","","","","","",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":[["","00378427677","VALACYCLOVIR","1GM","10","Select","Select",""],["","72205001590","PREGABALIN","150MG","60","Select","Select",""],["","08290320122","BD PEN NEEDL","32GX4MM","200","Select","Select",""],["","31722099601","HYDROCO\/APAP","5-325MG","20","Select","Select",""],["","65862039010","ONDANSETRON","4MG ODT","5","Select","Select",""],["","68180071160","CEFDINIR","300MG","20","Select","Select",""],["","00310737220","BUDES\/FORMOT","80-4.5","10.2","Select","Select",""],["","00310653004","BYDUREON","2MG","4","Select","Select",""],["","57599080300","FREESTY","2 READER","1","Select","Select",""],["","00002771559","BASAGLAR","100UNIT","30","Select","Select",""],["","73070010315","INSULIN","FLEXPEN","45","Select","Select",""],["","45802086803","POLYETH","3350 NF","510","Select","Select",""],["","68180096301","ALBUTEROL","HFA","17","Select","Select",""],["","68001043897","LORATADINE","10MG","30","Select","Select",""],["","67877024910","QUETIAPINE","50MG","45","Select","Select",""],["","65862056090","PANTOPRAZOLE","40MG","30","Select","Select",""],["","27241009810","DULOXETINE","30MG","30","Select","Select",""],["","68001039803","FAMOTIDINE","40MG","30","Select","Select",""],["","70710128505","BACLOFEN","10MG","90","Select","Select",""],["","27808015801","ROSUVASTATIN","40MG","30","Select","Select",""],["","68382005005","MELOXICAM","7.5MG","30","Select","Select",""],["","16729020216","BUSPIRONE","10MG","90","Select","Select",""],["","68180052002","LISINOP\/HCTZ","20-25MG","30","Select","Select",""],["","16729017217","AMITRIPTYLIN","25MG","30","Select","Select",""],["","00597015390","JARDIANCE","25MG","30","Select","Select",""],["","17478071310","OFLOXACIN","0.3% OP","5","Select","Select",""],["","00186037220","SYMBICORT","80-4.5","10.2","Select","Select",""],["","68645056259","IBUPROFEN","600MG","30","Select","Select",""],["","42858010201","OXYCOD\/APAP","5-325MG","20","Select","Select",""],["","00085461001","DULERA","200-5MCG","13","Select","Select",""],["","24208072002","DEXAMETH","0.1% OP","20","Select","Select",""],["","80777027399","MODERNA","COVID-19","0.5","Select","Select",""],["","60505082901","FLUTICASONE","50MCG","16","Select","Select",""],["","57599000101","FREESTYLE KIT SENSOR","SENSOR","2","Select","Select",""],["","49035053112","EQ","500MG","28","Select","Select",""],["","61314064511","NEO\/POLY\/HC","1% OTIC","10","Select","Select",""],["","00591570801","CLINDAMYCIN","150MG","80","Select","Select",""],["","49035098410","PAIN","500MG","28","Select","Select",""],["","00065853302","CIPRODEX","0.3-0.1%","7.5","Select","Select",""],["","64980032005","TRIAMCINOLON","DEN 0.1%","5","Select","Select",""],["","00527512170","NYSTATIN","100000","480","Select","Select",""],["","43598032675","CIPRO\/DEXA","0.3-0.1%","7.5","Select","Select",""],["","00603533715","PREDNISONE","5MG","21","Select","Select",""],["","16729000301","GLIMEPIRIDE","4MG","30","Select","Select",""],["","00169280015","SAXENDA","18MG\/3ML","15","Select","Select",""],["","00781214501","AMPICILLIN","500MG","56","Select","Select",""],["","00378427677","VALACYCLOVIR ","TAB 1GM","10","Select","Select",""],["","57599080000","FREESTY ","KIT 2 SENSOR","2","Select","Select",""],["","00085461001","DULERA ","AER 200-5MCG","13","Select","Select",""],["","68180096301","ALBUTEROL ","AER HFA","17","Select","Select",""],["","72205001590","PREGABALIN ","CAP 150MG","60","Select","Select",""],["","08290320122","BD  PEN NEEDL","MIS 32GX4MM","200","Select","Select",""],["","31722099601","HYDROCO\/APAP ","TAB 5-325MG","20","Select","Select",""],["","65862039010","ONDANSETRON ","TAB 4MG ODT","5","Select","Select",""],["","68180071160","CEFDINIR ","CAP 300MG","20","Select","Select",""],["","00310737220","BUDES\/FORMOT ","AER 80-4.5","10.2","Select","Select",""],["","00310653004","BYDUREON ","INJ 2MG","4","Select","Select",""],["","00002771559","BASAGLAR ","INJ 100UNIT","30","Select","Select",""],["","73070010315","INSULIN ","INJ FLEXPEN","45","Select","Select",""],["","45802086803","POLYETH ","POW 3350 NF","510","Select","Select",""],["","68001043897","LORATADINE ","TAB 10MG","30","Select","Select",""],["","67877024910","QUETIAPINE ","TAB 50MG","45","Select","Select",""],["","65862056090","PANTOPRAZOLE ","TAB 40MG","30","Select","Select",""],["","27241009810","DULOXETINE ","CAP 30MG","30","Select","Select",""],["","68001039803","FAMOTIDINE ","TAB 40MG","30","Select","Select",""],["","70710128505","BACLOFEN ","TAB 10MG","90","Select","Select",""],["","27808015801","ROSUVASTATIN ","TAB 40MG","30","Select","Select",""],["","68382005005","MELOXICAM ","TAB 7.5MG","30","Select","Select",""],["","16729020216","BUSPIRONE ","TAB 10MG","90","Select","Select",""],["","68180052002","LISINOP\/HCTZ ","TAB 20-25MG","30","Select","Select",""],["","16729017217","AMITRIPTYLIN ","TAB 25MG","30","Select","Select",""],["","00597015390","JARDIANCE ","TAB 25MG","30","Select","Select",""],["","17478071310","OFLOXACIN ","DRO 0.3% OP","5","Select","Select",""],["","00186037220","SYMBICORT ","AER 80-4.5","10.2","Select","Select",""],["","68645056259","IBUPROFEN ","TAB 600MG","30","Select","Select",""],["","42858010201","OXYCOD\/APAP ","TAB 5-325MG","20","Select","Select",""],["","24208072002","DEXAMETH ","SOL 0.1% OP","20","Select","Select",""],["","50111078751","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","00121092616","PROMETH ","SYP 6.25-5\/5","140","Select","Select",""],["","80777027399","MODERNA ","INJ COVID-19","0.5","Select","Select",""],["","60505082901","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","57599000101","FREESTYLE    KIT SENSOR","KIT SENSOR","2","Select","Select",""],["","49035053112","EQ ","TAB 500MG","28","Select","Select",""],["","61314064511","NEO\/POLY\/HC ","SUS 1% OTIC","10","Select","Select",""],["","00591570801","CLINDAMYCIN ","CAP 150MG","80","Select","Select",""],["","49035098410","PAIN ","TAB 500MG","28","Select","Select",""],["","00065853302","CIPRODEX ","SUS 0.3-0.1%","7.5","Select","Select",""],["","64980032005","TRIAMCINOLON ","PST DEN 0.1%","5","Select","Select",""],["","00527512170","NYSTATIN ","SUS 100000","480","Select","Select",""],["","43598032675","CIPRO\/DEXA ","SUS 0.3-0.1%","7.5","Select","Select",""],["","00169280015","SAXENDA ","INJ 18MG\/3ML","15","Select","Select",""],["","00603533715","PREDNISONE ","PAK 5MG","21","Select","Select",""],["","16729000301","GLIMEPIRIDE ","TAB 4MG","30","Select","Select",""],["","00781214501","AMPICILLIN ","CAP 500MG","56","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":""}]}]}