{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DARLENE   D HANNA","gend":1,"add":"3038   MELROSE AVENUE NW                                    ","city":"ROANOKE                       ","state":"VA","zip":"24017-5926","dob":"1957-07-18","age":"","mstatus":"","insh":10055225,"cliId":"","pno":5409159937,"cno":5409159937,"email":"","ename":"","eno":"","pphy":"BELL, VICTOR HOLLOWAY                                       ","ppno":"","pcpadd":"3716 Melrose Ave NW","pcpcity":"Roanoke                       ","pcpstate":"VA","pcpzip":240172716,"pcpcounty":"","pcpid":"P0060152","pcpname":"NEW HORIZONS HEALTH CARE","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"APT 602                                                     ","add3":"","madd1":"3038   MELROSE AVENUE NW                                    ","madd2":"APT 602                                                     ","madd3":"","mcity":"ROANOKE                       ","mstate":"VA","mzip":"24017-5926","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G89.29","M54.41","M54.42","M79.7","M16.9","E66.9","Z71.3","Z71.89","I10","E78.5","Z12.11","M47.816","Z79.899","M47.26","M51.16","M54.16","M51.37","Z23","M15.0","M25.562","W19.XXXA","R52","R68.89","S83.92XA","S86.912A","X50.9XXA","Y93.9","Y92.9","J45.909","K21.9","S83.242A","S83.242D","X58.XXXD","S83.232A","Z01.810","I49.9","I49.3","Z01.818","M89.49","M19.011","M25.511","M75.81","M62.81","M75.111","M75.121","S46.111A","M25.411","M75.41","S46.211A","E87.6","S43.431A","M75.21","S43.491A","M24.111","G89.18","Z71.82","Z11.4","Z11.59","M47.819","Z48.89","R26.81","M15.9","K59.03","N28.9","Z12.31","N64.89","Z51.81"],"date":["2021-08-09","2019-01-16","2019-01-16","2021-11-09","2019-02-01","2020-11-04","2020-11-04","2019-08-09","2021-10-21","2021-10-21","2021-08-03","2021-11-09","2021-08-09","2021-08-09","2019-05-07","2019-07-25","2021-08-09","2021-11-05","2020-02-11","2020-06-15","2020-05-26","2020-05-26","2020-05-26","2020-05-26","2020-05-26","2020-05-26","2020-05-26","2020-05-26","2021-10-21","2021-10-21","2020-06-15","2020-06-15","2020-06-15","2020-07-14","2020-07-07","2020-07-07","2020-07-07","2020-10-22","2021-11-09","2020-10-30","2021-01-05","2020-10-08","2021-01-05","2020-10-19","2020-10-30","2020-10-14","2020-10-14","2020-10-30","2020-10-27","2020-10-22","2020-10-27","2020-10-30","2020-10-27","2020-10-30","2020-10-27","2020-11-04","2020-11-12","2020-11-12","2021-02-10","2021-02-10","2021-05-11","2021-10-21","2021-10-21","2021-08-23","2021-11-03","2021-11-03","2021-11-09"],"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":[["","64679092402","ENALAPRIL","5MG","30","Select","Select",""],["","69097084615","CYCLOBENZAPR","10MG","90","Select","Select",""],["","55111072510","MONTELUKAST","10MG","30","Select","Select",""],["","00597007541","SPIRIVA","HANDIHLR","30","Select","Select",""],["","00574027505","POT CHLORIDE","10MEQ ER","60","Select","Select",""],["","60505017007","PRAVASTATIN","40MG","30","Select","Select",""],["","59310057922","PROAIR","","8.5","Select","Select",""],["","16729018317","HYDROCHLOROT","25MG","30","Select","Select",""],["","00085113204","PROVENTIL","HFA","6.7","Select","Select",""],["","57237001999","DULOXETINE","60MG","30","Select","Select",""],["","68001039708","FAMOTIDINE","20MG","60","Select","Select",""],["","62175061743","PANTOPRAZOLE","40MG","30","Select","Select",""],["","57664017688","HYDROCO\/APAP","10-325MG","90","Select","Select",""],["","59267100001","PFIZER","COVID-19","0.3","Select","Select",""],["","49100040015","CULTURELLE","KIDS","30","Select","Select",""],["","00185061505","HYDROXYZ","50MG","15","Select","Select",""],["","11523726503","ZEGERID","20-1100","30","Select","Select",""],["","64679092402","ENALAPRIL ","TAB 5MG","30","Select","Select",""],["","69097084615","CYCLOBENZAPR ","TAB 10MG","90","Select","Select",""],["","55111072510","MONTELUKAST ","TAB 10MG","30","Select","Select",""],["","00597007541","SPIRIVA ","CAP HANDIHLR","30","Select","Select",""],["","00574027505","POT  CHLORIDE","TAB 10MEQ ER","60","Select","Select",""],["","60505017007","PRAVASTATIN ","TAB 40MG","30","Select","Select",""],["","59310057922","PROAIR ","AER ","8.5","Select","Select",""],["","16729018317","HYDROCHLOROT ","TAB 25MG","30","Select","Select",""],["","57237001999","DULOXETINE ","CAP 60MG","30","Select","Select",""],["","49100040015","CULTURELLE ","CHW KIDS","30","Select","Select",""],["","00085113204","PROVENTIL ","AER HFA","6.7","Select","Select",""],["","68001039708","FAMOTIDINE ","TAB 20MG","60","Select","Select",""],["","62175061743","PANTOPRAZOLE ","TAB 40MG","30","Select","Select",""],["","57664017688","HYDROCO\/APAP ","TAB 10-325MG","90","Select","Select",""],["","59267100001","PFIZER ","INJ COVID-19","0.3","Select","Select",""],["","00185061505","HYDROXYZ ","CAP 50MG","15","Select","Select",""],["","11523726503","ZEGERID ","CAP 20-1100","30","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":""}]}]}