{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KRISTA   A DENOYER","gend":1,"add":"1227 MELROSE AVENUE NW","city":"ROANOKE","state":"VA","zip":"24017-6321","dob":"1989-09-25","age":"","mstatus":"","insh":10054945,"cliId":"","pno":5407950489,"cno":5407950489,"email":"","ename":"","eno":"","pphy":"SAKS, JONATHAN C","ppno":5408282634,"pcpadd":"282 Westlake Rd, ","pcpcity":"Hardy","pcpstate":"VA","pcpzip":241013967,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":5406093144,"add2":"                                                            ","add3":"","madd1":"1227 MELROSE AVENUE NW","madd2":"                                                            ","madd3":"","mcity":"ROANOKE","mstate":"VA","mzip":"24017-6321","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R20.8","R06.02","M79.641","M79.642","R70.0","I10","M32.9","Z90.49","F17.210","Z79.899","R00.0","R94.31","A41.9","J18.1","R65.21","E87.2","M34.1","E87.6","E43","E88.09","K21.9","Z87.09","E83.51","R13.10","Z93.1","D64.9","R63.4","R74.8","L03.818","E46","R52","T85.848A","K75.4","K21.0","K22.2","K31.9","K92.2","K44.9","T18.2XXA","K91.61","I27.21","G47.36","Z87.891","R10.9","K94.29","D62","K22.4","M35.1","I27.20","K20.9","J18.9","I08.1","R09.02","R06.89","J47.9","M60.9","J98.4","Z87.01","M35.8","M34.9","M35.00","J84.9","E44.0","R07.89","K20.80","J44.9","R50.9","K14.0","R05","R91.8","K74.60","K86.89","K22.11","I27.23","R10.32","K92.1","R62.7","Z87.39","Z87.19","K29.01","M32.19","Z79.51","Z83.3","Z80.3","M34.0","K29.60","M32.8","D50.9","S68.119S","K20.90","K22.8","J47.0","D63.8","Z43.1","K94.23","K59.00","Z43.8","R07.9","Z00.00","I73.00","E61.1","Z01.818","K29.70","K21.00","J16.8","L94.0","I27.0","M33.20","F17.200","L53.9","R93.2","K76.9","K31.811","S68.129S","Z79.52","F11.20","Z68.1","J96.01","L03.311","K94.20","Y83.3","Y92.9","T81.83XA","K31.6","T18.128A","Z11.59","R07.2","D50.0","K25.9","K29.50","I95.9","N17.9","E63.9","R68.89","R07.81","K76.6","K31.89","I28.8","D50.8","M79.18","K94.22","R74.0","L93.2","G89.29","E64.8","R64","D89.9","B37.0","Z78.9","L03.319","K20.8","Z98.890","J69.0","Y83.8","J96.21","I27.29","I50.30","Z23","L93.0","I34.0","R53.1","M79.10","Z99.81","D64.89","R10.84","R06.00"],"date":["2019-01-30","2019-12-02","2019-01-30","2019-01-30","2019-01-30","2019-05-15","2020-10-21","2019-07-29","2020-12-30","2020-11-10","2020-07-01","2020-10-20","2019-02-20","2019-11-10","2019-02-20","2020-10-20","2020-12-30","2019-11-10","2020-04-23","2019-02-20","2020-10-21","2019-02-14","2019-02-14","2019-05-15","2020-07-09","2020-10-21","2019-05-15","2019-06-06","2020-03-18","2019-11-24","2019-09-09","2020-03-18","2020-10-21","2019-11-13","2020-12-30","2020-12-30","2020-10-22","2020-12-30","2020-07-23","2019-08-13","2020-12-30","2019-08-13","2020-10-20","2019-09-10","2020-04-23","2020-10-22","2020-03-18","2019-11-27","2020-11-10","2020-07-23","2019-09-16","2019-11-11","2019-11-27","2019-11-27","2020-10-21","2019-11-24","2020-10-20","2019-11-24","2019-11-27","2020-10-22","2019-11-27","2019-11-27","2019-11-27","2020-10-22","2020-10-23","2020-12-30","2019-02-15","2019-02-15","2019-11-10","2020-10-22","2019-11-27","2019-05-23","2019-11-10","2019-06-12","2019-06-12","2019-06-13","2019-06-12","2019-06-12","2020-10-21","2019-09-09","2019-09-09","2019-09-09","2019-09-09","2019-09-09","2020-01-01","2020-01-01","2020-11-10","2020-11-18","2020-11-10","2020-10-23","2020-12-30","2019-02-19","2019-11-27","2019-05-15","2020-07-23","2019-11-12","2020-07-01","2020-10-21","2020-11-10","2020-11-10","2020-11-11","2020-12-24","2020-12-30","2020-12-30","2019-02-13","2019-03-01","2019-03-01","2019-03-01","2019-03-01","2019-06-12","2019-07-29","2019-07-29","2019-11-12","2019-11-12","2019-11-12","2019-11-25","2019-11-24","2019-11-25","2020-03-18","2020-07-01","2020-07-23","2020-07-23","2020-07-23","2020-07-23","2020-07-23","2020-07-23","2020-10-21","2020-10-22","2020-12-30","2020-12-30","2019-02-13","2019-02-13","2019-02-18","2019-04-16","2019-05-15","2019-11-27","2020-07-23","2020-10-21","2020-10-22","2019-01-30","2019-06-13","2019-05-23","2019-06-06","2019-11-25","2019-11-13","2019-02-13","2019-02-13","2019-02-13","2019-06-13","2019-06-13","2020-07-09","2019-09-16","2019-11-10","2019-11-10","2019-11-10","2019-11-10","2019-11-10","2020-10-20","2020-10-20","2020-10-21","2019-01-30","2019-01-30","2019-06-12","2019-09-09","2019-09-09","2019-11-11"],"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":[["","53746010901","HYDROCO\/APAP ","TAB 5-325MG","42","Select","Select",""],["","65162077810","BUDESONIDE ","CAP 3MG DR","30","Select","Select",""],["","68462018117","CLOTRIMAZOLE ","CRE 0.01","15","Select","Select",""],["","62175061743","PANTOPRAZOLE ","TAB 40MG","60","Select","Select",""],["","68180016006","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","00054016325","MYCOPHENOLAT ","CAP 250MG","60","Select","Select",""],["","00378020810","FUROSEMIDE ","TAB 20MG","30","Select","Select",""],["","65862068890","SILDENAFIL ","TAB 20MG","90","Select","Select",""],["","24658031205","DOXYCYCL ","TAB 100MG","10","Select","Select",""],["","00093005805","TRAMADOL ","TAB 50MG","90","Select","Select",""],["","43598072101","HYDROXYCHLOR ","TAB 200MG","30","Select","Select",""],["","00591240530","AMBRISENTAN ","TAB 5MG","30","Select","Select",""],["","58914017014","CARAFATE ","SUS 1GM\/10ML","400","Select","Select",""],["","50428027915","CVS ","TAB 8.6MG","30","Select","Select",""],["","65862050320","AMOX\/K ","TAB 875-125","6","Select","Select",""],["","65862053820","LEVOFLOXACIN ","TAB 750MG","7","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","",""],["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":""}]}]}