{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ANGELA   R ELLIOTT","gend":1,"add":"211   GEORGE  STREET                                        ","city":"MARTINSVILLE                  ","state":"VA","zip":"24112-2628","dob":"1984-08-09","age":"","mstatus":"","insh":10054638,"cliId":"","pno":2762266304,"cno":2762266304,"email":"","ename":"","eno":"","pphy":"FATADE, AYOKUNLE O                                          ","ppno":"","pcpadd":"1 E Market St Ste B1","pcpcity":"Martinsville                  ","pcpstate":"VA","pcpzip":241123747,"pcpcounty":"","pcpid":"P0060085","pcpname":"FATADE HEALTH AND MEDICAL CENTER PC","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"APT A                                                       ","add3":"","madd1":"211   GEORGE  STREET                                        ","madd2":"APT A                                                       ","madd3":"","mcity":"MARTINSVILLE                  ","mstate":"VA","mzip":"24112-2628","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F41.1","F31.5","M54.5","E89.40","F41.0","Z01.419","Z12.72","F31.30","J01.90","G89.4","J20.9","J30.9","J22","R05","J30.1","I10","F31.10","M25.572","S93.402D","H65.01","J40","J06.9","G43.001","G43.009","G43.909","Z88.8","Z91.040","Z91.048","F17.210","K21.0","R87.610","F91.3","M54.9","Z32.02","Z88.6","M25.511","G56.01","Z13.9","R79.89","E78.9","E07.9","E55.9","Z51.81","M25.559","R51.9","Z53.29","Z88.5","Z20.822"],"date":["2021-10-04","2020-03-17","2021-08-18","2020-02-20","2019-02-19","2020-02-20","2020-02-20","2019-02-19","2019-03-06","2021-08-18","2019-03-25","2019-03-25","2019-04-16","2019-04-16","2019-04-08","2019-12-19","2021-10-04","2019-07-28","2019-08-27","2019-09-18","2019-10-31","2021-09-10","2021-10-04","2020-02-20","2020-02-20","2020-06-13","2021-08-19","2020-02-20","2020-06-13","2020-02-20","2020-02-20","2021-11-01","2020-06-13","2020-06-13","2021-08-19","2020-07-13","2021-05-13","2020-08-18","2020-08-18","2020-08-18","2020-08-18","2020-08-18","2020-08-18","2021-10-04","2021-08-19","2021-08-19","2021-08-19","2021-09-10"],"priorHcc":[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":[["","66993001968","ALBUTEROL","HFA","18","Select","Select",""],["","64380080807","IBUPROFEN","600MG","90","Select","Select",""],["","00555088602","ESTRADIOL","1MG","30","Select","Select",""],["","52747047570","NOREL","4-10-325","20","Select","Select",""],["","69097052444","DICLOFENAC","1%","100","Select","Select",""],["","52817033200","CYCLOBENZAPR","10MG","10","Select","Select",""],["","00406012405","HYDROCO\/APAP","7.5-325","60","Select","Select",""],["","29300012510","MELOXICAM","15MG","30","Select","Select",""],["","62756052169","SUMATRIPTAN","50MG","18","Select","Select",""],["","59267100001","PFIZER","COVID-19","0.3","Select","Select",""],["","65862078430","ESOMEPRA","40MG DR","30","Select","Select",""],["","00228203150","ALPRAZOLAM","1MG","60","Select","Select",""],["","60505082901","FLUTICASONE","50MCG","16","Select","Select",""],["","69547035302","NARCAN","","2","Select","Select",""],["","60432060416","PROMETHAZINE","DM","120","Select","Select",""],["","00591544305","PREDNISONE","20MG","5","Select","Select",""],["","66993001968","ALBUTEROL ","AER HFA","18","Select","Select",""],["","64380080807","IBUPROFEN ","TAB 600MG","90","Select","Select",""],["","00555088602","ESTRADIOL ","TAB 1MG","30","Select","Select",""],["","00406012405","HYDROCO\/APAP ","TAB 7.5-325","60","Select","Select",""],["","52747047570","NOREL ","TAB 4-10-325","20","Select","Select",""],["","69097052444","DICLOFENAC ","GEL 0.01","100","Select","Select",""],["","52817033200","CYCLOBENZAPR ","TAB 10MG","10","Select","Select",""],["","59267100001","PFIZER ","INJ COVID-19","0.3","Select","Select",""],["","29300012510","MELOXICAM ","TAB 15MG","30","Select","Select",""],["","62756052169","SUMATRIPTAN ","TAB 50MG","18","Select","Select",""],["","65862078430","ESOMEPRA ","CAP 40MG DR","30","Select","Select",""],["","00228203150","ALPRAZOLAM ","TAB 1MG","60","Select","Select",""],["","60505082901","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","69547035302","NARCAN ","SPR ","2","Select","Select",""],["","60432060416","PROMETHAZINE ","SYP DM","120","Select","Select",""],["","00591544305","PREDNISONE ","TAB 20MG","5","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":""}]}]}