{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MILDRED   R DAVIS","gend":1,"add":"917 ASKIN STREET","city":"MARTINSVILLE","state":"VA","zip":"24112-4111","dob":"1967-08-30","age":"","mstatus":"","insh":10054994,"cliId":"","pno":2762013420,"cno":2763408981,"email":"","ename":"","eno":"","pphy":"TURNER, WESLEY CHAD","ppno":4347914122,"pcpadd":"705 Main St, ","pcpcity":"Danville","pcpstate":"VA","pcpzip":245411803,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":5407614492,"add2":"APT C","add3":"","madd1":"917 ASKIN STREET","madd2":"APT C","madd3":"","mcity":"MARTINSVILLE","mstate":"VA","mzip":"24112-4111","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F41.9","J44.9","J45.40","B20","B02.23","S46.012A","S49.91XA","S29.9XXA","Y04.8XXA","Y92.009","S50.811A","D64.9","Z21","B19.10","Z98.51","Z90.89","Z98.890","Z88.6","Z91.041","Y04.0XXA","F22","F15.10","F31.9","M25.561","R93.7","G44.319","R51.9","W18.09XA","Y93.9","Y92.9","M54.2","R06.2","D72.819","D69.6","F17.210","S19.9XXA","X58.XXXA","R06.02","J02.9","E78.00","R68.89","M50.10","M43.10","S41.119A","Z48.02","Z12.4","R53.1","M50.30","M54.9","G89.29","F31.81","B19.20","F25.9","G40.909","R29.6","S79.911A","S30.0XXA","S79.912A","D61.818","E86.0","B18.2","J45.50","R06.09","Z71.6","M62.82","G92","F15.188","R44.3","R74.0","E80.6","I10","J44.1","B17.10","K74.60","E87.6","E83.39","L89.899","N63.0","M48.02","M54.5","R42","R87.612","D84.9","Z11.51","S92.322A","S51.812A","S90.30XA","S80.12XA","T76.11XA","N63.20","N63.10","R41.82","R87.615","W20.8XXA","R06.9","R05","S41.111D","M54.12","F10.129","M54.6","R51","F10.20","K92.1","R53.83","Z79.899","Z86.19","T14.8XXA","M79.601","Z09","M25.512","M25.511","M47.22","S41.112A","S59.912A","S50.852A","W45.8XXA","K83.8","R94.31","R49.0","K73.9","G47.33","E78.1","E87.1","M94.0","G43.009","F14.20","T43.625A","Z91.89","G81.94","Y90.1","R20.0","Z59.0","S89.82XA","S89.81XA","R13.12","M62.838","R87.619","R87.89","G44.89","R58","R00.0","J42","S99.922A","W22.8XXA","Z53.21","M50.20","S49.92XA","M79.632","T79.6XXA","R06.00","F25.0","Z81.1","Z81.8","E55.9","Z91.410","N63.12","N63.23","Z32.02","Z01.812"],"date":["2019-01-19","2021-04-28","2019-05-23","2020-12-03","2019-05-23","2019-04-26","2019-04-26","2021-04-16","2019-04-26","2020-02-14","2019-04-26","2021-04-16","2021-04-16","2020-02-14","2019-04-26","2020-02-14","2019-04-26","2021-04-28","2021-04-28","2019-04-26","2020-05-01","2020-04-30","2021-04-28","2020-11-23","2020-11-23","2021-04-16","2021-04-16","2021-04-16","2021-04-16","2021-04-16","2021-04-16","2021-04-16","2021-04-16","2021-04-16","2021-04-28","2021-04-16","2021-04-16","2019-04-18","2019-01-21","2020-07-09","2020-04-10","2019-09-26","2019-08-12","2020-03-06","2020-03-06","2020-12-15","2020-12-03","2020-09-22","2020-12-28","2020-12-03","2020-09-22","2020-09-22","2020-09-22","2020-12-03","2020-09-22","2020-11-03","2020-11-03","2020-11-03","2020-12-28","2020-12-28","2020-04-10","2019-08-02","2019-08-02","2019-08-02","2020-05-01","2020-04-30","2020-05-01","2020-04-29","2020-07-23","2020-04-29","2020-12-26","2020-07-09","2020-05-01","2020-12-03","2020-05-01","2020-05-01","2020-05-01","2020-07-09","2020-09-23","2020-09-23","2021-04-16","2020-12-15","2020-12-15","2020-12-15","2021-05-10","2020-02-14","2020-04-14","2020-04-21","2020-04-30","2020-08-20","2020-08-20","2020-09-07","2020-12-15","2021-04-28","2019-01-19","2019-04-18","2020-02-15","2020-08-11","2020-09-07","2020-09-23","2020-09-23","2020-12-03","2020-12-03","2020-12-03","2020-12-03","2019-04-18","2019-04-26","2019-04-26","2019-04-29","2019-06-07","2019-06-07","2019-08-30","2020-02-14","2020-02-14","2020-02-14","2020-02-14","2020-04-30","2021-04-16","2019-01-21","2019-01-21","2020-04-30","2019-01-21","2019-01-21","2019-01-21","2019-01-21","2019-01-21","2020-04-29","2020-07-23","2020-09-07","2020-09-07","2020-09-07","2020-09-07","2020-11-03","2020-11-03","2020-11-10","2020-11-10","2020-11-10","2020-12-15","2020-12-26","2020-12-26","2020-12-26","2021-04-16","2021-04-28","2021-04-28","2019-01-19","2019-06-20","2020-02-14","2020-02-14","2020-04-30","2020-04-30","2020-04-30","2020-04-30","2020-04-30","2020-04-30","2020-04-30","2020-08-20","2020-08-20","2020-12-15","2020-12-15"],"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":[["","29300013601","CLONIDINE ","TAB 0.2MG","30","Select","Select",""],["","65162010150","GABAPENTIN ","CAP 100MG","90","Select","Select",""],["","00406012305","HYDROCO\/APAP ","TAB 5-325MG","10","Select","Select",""],["","00713022580","TRIAMCINOLON ","CRE 0.001","80","Select","Select",""],["","49702022813","TIVICAY ","TAB 50MG","30","Select","Select",""],["","65862068730","RITONAVIR ","TAB 100MG","30","Select","Select",""],["","00254100752","ALBUTEROL ","AER HFA","6.7","Select","Select",""],["","00591544210","PREDNISONE ","TAB 10MG","14","Select","Select",""],["","59676056630","PREZISTA ","TAB 800MG","30","Select","Select",""],["","49702023113","TRIUMEQ ","TAB ","30","Select","Select",""],["","69097052444","DICLOFENAC ","GEL 0.01","200","Select","Select",""],["","63824007235","MUCINEX ","TAB 60-1200","60","Select","Select",""],["","00074333330","NORVIR ","TAB 100MG","30","Select","Select",""],["","64380080807","IBUPROFEN ","TAB 600MG","30","Select","Select",""],["","64380071206","BENZONATATE ","CAP 100MG","10","Select","Select",""],["","00143980305","DOXYCYCL ","CAP 100MG","10","Select","Select",""],["","00310460012","BEVESPI ","AER 9-4.8MCG","10.7","Select","Select",""],["","68462018905","NAPROXEN ","TAB 375MG","30","Select","Select",""],["","64679096101","AZITHROMYCIN ","TAB 250MG","15","Select","Select",""],["","43547034150","RISPERIDONE ","TAB 1MG","30","Select","Select",""],["","00766165460","OS-CAL ","TAB 500-200","60","Select","Select",""],["","69452015120","VITAMIN ","CAP 50000UNT","6","Select","Select",""],["","00093314705","CEPHALEXIN ","CAP 500MG","20","Select","Select",""],["","00591352530","LIDOCAINE ","PAD 0.05","30","Select","Select",""],["","60432060816","PROMETHAZINE ","SYP 6.25\/5ML","140","Select","Select",""],["","00143992801","CIPROFLOXACN ","500MG","20","Select","Select",""],["","00185012201","NITROFURANTN ","100MG","20","Select","Select",""],["","59676057530","PREZCOBIX ","800-150","30","Select","Select",""],["","49702024213","JULUCA ","50-25MG","30","Select","Select",""],["","52817033200","CYCLOBENZAPR ","10MG","30","Select","Select",""],["","59267100001","PFIZER ","COVID-19","0.3","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","",""],["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":""}]}]}