{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"PAMELA   G BROWN","gend":1,"add":"54 RUFUS ROAD","city":"ROCKY MOUNT","state":"VA","zip":"24151-3315","dob":"1965-02-10","age":"","mstatus":"","insh":10054586,"cliId":"","pno":2766186660,"cno":"               ","email":"","ename":"","eno":"","pphy":"AARON, CAREN T","ppno":2766660452,"pcpadd":"319 Hospital Dr Ste 101, ","pcpcity":"Martinsville","pcpstate":"VA","pcpzip":241121928,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"54 RUFUS ROAD","madd2":"                                                            ","madd3":"","mcity":"ROCKY MOUNT","mstate":"VA","mzip":"24151-3315","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z85.21","Z92.3","J81.1","J98.4","Z48.89","E89.2","R20.0","R20.2","C32.9","E03.8","F41.0","E87.6","M51.36","Z90.02","Z98.890","M47.812","Z98.1","M54.2","M54.12","M51.24","M79.603","Z93.0","E03.9","J96.01","R13.10","Z12.31","G56.01","Z01.818","E20.9","E55.9","J39.8","K22.2","Z79.899","J44.9","Z87.891","M79.7","F32.9","F41.9","K21.9","Z08","L50.0","C44.42","R22.1","C79.89","Y83.3","J95.03","E89.0","Z51.0","C32.0","C32.8","Z01.812","Z23","R94.31","R06.02","U07.1","R91.8","I12.9","N18.1","Z85.828","A42.9","G89.29","M50.10","F11.90","L92.9","C76.0","L90.5","L90.9","Z51.11","C15.5","T82.818A","Z43.0","J12.89","E83.51","I45.81","R11.2","M79.9","Z86.19","J38.7","A42.89","A48.8","R00.0","D62","K62.5","J44.0","J10.00","G89.3","Z43.1","Z99.81","M81.0","M79.601","Z01.419","Z12.4","D49.1","L98.9","J22","Z51.12","E21.3","M50.30","R49.1","L57.0","Z12.83","K94.33","R59.0","C77.0","J43.9","G47.00","F34.1","I95.9","Z92.21","C32.1","N18.4","Z20.828","R19.7","R53.1","Z48.815","E83.42","R73.9","Z90.89","Z53.20","N72","E83.52","R49.0","K59.00","Y84.2","J38.4","E83.39","Z93.1","D34","Z90.2","Z72.0","M43.12","M43.13","M43.14","J32.3","L29.9","L50.9","Z88.8","Z85.12","M48.00","Z98.51","Z91.040","R11.0","E86.0","R09.02","Z03.89","Z51.81","R06.00","Z74.3","R45.89","E78.00","Z85.89","R07.89","R07.0","R29.2","M47.892","M79.18","Z01.810","L98.8","R11.10","R79.1","J18.9","K94.29","G62.9","Z79.891","Z79.1","M54.5","M25.511","L08.9","E78.5","N18.30","Z79.890","Z88.6","C54.2"],"date":["2021-01-26","2021-01-05","2019-01-12","2020-11-16","2019-01-12","2019-01-23","2019-02-26","2019-02-26","2021-05-10","2020-09-10","2020-11-07","2020-01-25","2019-07-31","2021-04-05","2020-04-28","2019-04-22","2020-04-28","2021-03-03","2019-07-25","2019-05-23","2019-05-23","2021-04-28","2021-01-26","2020-11-18","2020-06-02","2020-09-02","2019-09-16","2021-04-01","2019-09-30","2020-07-14","2020-02-18","2020-11-07","2021-04-05","2021-01-26","2021-01-26","2021-01-26","2020-06-02","2020-02-18","2021-01-26","2021-01-05","2020-01-25","2021-03-03","2021-01-26","2021-01-26","2020-02-18","2020-02-18","2020-11-07","2020-08-04","2020-05-05","2021-01-05","2021-01-12","2020-09-08","2020-11-09","2020-11-09","2020-12-03","2020-11-12","2021-01-26","2021-01-26","2021-01-26","2019-01-13","2020-03-10","2019-06-24","2019-06-24","2019-08-14","2020-08-24","2020-02-18","2020-02-18","2020-05-07","2020-04-24","2020-05-12","2020-10-19","2020-11-18","2020-11-11","2020-11-08","2020-11-08","2020-12-23","2020-12-23","2019-02-04","2019-01-12","2019-01-12","2019-01-13","2019-01-18","2019-01-18","2019-02-01","2019-02-01","2021-03-03","2019-02-01","2020-11-11","2020-07-17","2019-06-05","2020-01-16","2020-07-17","2020-05-27","2020-09-11","2020-11-18","2021-05-10","2020-03-10","2019-07-31","2021-04-05","2019-08-22","2019-08-22","2019-10-12","2020-01-22","2020-02-18","2020-11-07","2020-04-28","2020-07-17","2020-07-17","2020-08-04","2020-08-04","2020-09-10","2020-11-07","2020-10-29","2020-10-29","2019-01-13","2019-01-13","2019-01-13","2019-01-13","2019-04-03","2020-01-16","2020-11-07","2020-10-12","2020-11-11","2019-01-11","2019-01-11","2019-01-11","2019-01-11","2019-01-12","2019-04-02","2019-10-01","2020-01-07","2020-01-07","2020-01-07","2020-01-07","2020-01-25","2020-01-25","2020-01-25","2020-01-25","2020-01-25","2020-01-25","2020-01-25","2020-04-16","2020-04-21","2020-11-07","2019-01-17","2019-01-29","2019-02-26","2019-02-26","2019-02-26","2019-09-16","2019-02-26","2019-03-06","2019-03-06","2019-03-06","2019-04-22","2019-07-10","2019-08-21","2020-09-11","2020-10-29","2020-11-07","2020-11-07","2019-01-22","2019-09-16","2019-09-16","2019-09-16","2019-11-20","2019-12-06","2020-02-12","2020-11-07","2020-11-07","2020-11-07","2020-11-07","2020-12-01"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}},{"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":[["","62037099901","POT  CL MICRO","TAB 20MEQ ER","30","Select","Select",""],["","68462024901","RANITIDINE ","TAB 300MG","30","Select","Select",""],["","65862090801","CELECOXIB ","CAP 100MG","60","Select","Select",""],["","55111018015","TIZANIDINE ","TAB 4MG","90","Select","Select",""],["","70710122600","AMITRIPTYLIN ","TAB 25MG","90","Select","Select",""],["","69238183407","LEVOTHYROXIN ","TAB 100MCG","60","Select","Select",""],["","00904672360","DOK ","TAB 50-8.6MG","30","Select","Select",""],["","65862001305","SERTRALINE ","TAB 100MG","30","Select","Select",""],["","50111043302","TRAZODONE ","TAB 50MG","30","Select","Select",""],["","00005556719","CALTRATE ","","180","Select","Select",""],["","00406912576","FENTANYL ","DIS 25MCG\/HR","10","Select","Select",""],["","11917017174","CALC ","TAB MINERALS","60","Select","Select",""],["","59746000103","METHYLPRED ","TAB 4MG","21","Select","Select",""],["","00121076616","CALCIUM ","SUS 1250\/5ML","120","Select","Select",""],["","11523716001","CLARITIN ","TAB 10MG","30","Select","Select",""],["","10702005601","OXYCODONE ","TAB 10MG","180","Select","Select",""],["","59746011506","PROCHLORPER ","TAB 10MG","60","Select","Select",""],["","00363064534","LOPERAMIDE ","SUS 1MG\/7.5","240","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","14","Select","Select",""],["","00054312041","CALCITRIOL ","SOL 1MCG\/ML","15","Select","Select",""],["","65862032904","ALENDRONATE ","TAB 70MG","4","Select","Select",""],["","62332000131","FAMOTIDINE ","TAB 20MG","60","Select","Select",""],["","43598020453","AMOX\/K ","SUS 250\/5ML","150","Select","Select",""],["","64380080707","IBUPROFEN ","TAB 800MG","90","Select","Select",""],["","76204020025","ALBUTEROL ","NEB 0.00083","75","Select","Select",""],["","33342006807","OLANZAPINE ","TAB 5MG","20","Select","Select",""],["","00591207030","LIDO\/PRILOCN ","CRE 2.5-2.5%","30","Select","Select",""],["","59267100001","PFIZER ","INJ COVID-19","0.3","Select","Select",""],["","51224012230","AZITHROMYCIN ","TAB 500MG","5","Select","Select",""],["","00002840001","FORTEO ","SOL 600\/2.4","2.4","Select","Select",""],["","50383077504","LIDOCAINE ","SOL 2% VISC","100","Select","Select",""],["","51672406301","FLUOROURACIL ","SOL 0.05","10","Select","Select",""],["","00536124801","STIMULANT ","TAB 8.6-50MG","30","Select","Select",""],["","00115180301","HYDROXYZ ","CAP 25MG","15","Select","Select",""],["","00093031401","KETOROLAC ","TAB 10MG","9","Select","Select",""],["","00591544305","PREDNISONE ","TAB 20MG","15","Select","Select",""],["","31604001224","VIT ","CAP 400UNIT","60","Select","Select",""],["","00000000000",""," ","480","Select","Select",""],["","31604002576","MAGNESIUM ","CAP 400MG","60","Select","Select",""],["","00093314705","CEPHALEXIN ","CAP 500MG","30","Select","Select",""],["","45802065087","LORATADINE ","TAB 10MG","30","Select","Select",""],["","68462010630","ONDANSETRON ","TAB 8MG","30","Select","Select",""],["","08290320119","BD  PEN NEEDL","MIS 31GX5MM","100","Select","Select",""],["","59762040101","SUCRALFATE ","TAB 1GM","90","Select","Select",""],["","65862018601","CLINDAMYCIN ","CAP 300MG","28","Select","Select",""],["","60432053716","NYSTATIN ","SUS 100000","500","Select","Select",""],["","10702000350","PROMETHAZINE ","TAB 25MG","60","Select","Select",""],["","69452015120","VITAMIN ","CAP 50000UNT","4","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":""}]}]}