{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ELIJAH   D GOODMAN","gend":0,"add":"1330 WOODBINE ST SE","city":"ROANOKE","state":"VA","zip":"24014-1830","dob":"1985-09-28","age":"","mstatus":"","insh":10055252,"cliId":"","pno":5405778824,"cno":5405778824,"email":"","ename":"","eno":"","pphy":"LLAVORE, JOANNE","ppno":5409817000,"pcpadd":"3369 Colonial Ave SW, ","pcpcity":"Roanoke","pcpstate":"VA","pcpzip":240183739,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":5404913933,"add2":"                                                            ","add3":"","madd1":"1330 WOODBINE ST SE","madd2":"                                                            ","madd3":"","mcity":"ROANOKE","mstate":"VA","mzip":"24014-1830","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F11.20","Z00.01","F41.9","F41.0","Z72.820","Z86.59","I49.8","R53.83","E66.9","F17.200","R60.0","D64.9","R68.89","F11.21","F41.1","F12.20","R11.0","Z51.81","K25.9","R11.2","R10.9","F31.81","A08.4","R79.89","R74.0","R74.8","Z23","Z76.0","K80.20","Z01.818","F11.90","Z71.51","K21.9","K59.03","R30.0","K80.10","R10.11","T40.2X5A","F12.90","Z11.1","F11.23","K64.9","Z20.828","B35.1","L84","F32.0","K80.12","Z87.11","F32.9","B20","F17.210","Z79.899","Z98.890","Z88.0","Z88.2","R21","W57.XXXA","L60.0","M79.674","L85.1","F19.90","R53.82","L73.9","Z72.0","K80.50","Z21","F17.290","R41.840","J00","F41.8","T14.8XXA","F13.20"],"date":["2021-05-25","2019-10-25","2021-01-04","2020-03-03","2019-11-12","2020-06-23","2019-12-05","2019-11-12","2020-09-18","2021-04-22","2021-02-11","2019-12-10","2020-07-29","2021-04-15","2021-04-15","2021-04-15","2021-04-15","2021-04-01","2021-04-22","2021-04-22","2021-04-22","2019-09-05","2019-12-31","2019-11-12","2019-11-12","2019-11-12","2019-11-12","2020-03-10","2020-09-18","2020-09-13","2020-12-03","2021-04-08","2021-03-11","2021-03-25","2021-04-08","2020-07-08","2020-09-18","2021-03-25","2021-01-21","2019-12-05","2021-01-14","2021-01-25","2021-02-22","2019-05-07","2019-05-02","2020-09-01","2020-09-18","2020-09-18","2020-09-18","2020-09-18","2020-09-18","2020-09-18","2020-09-18","2020-09-18","2020-09-18","2020-07-21","2019-01-24","2019-05-07","2019-05-07","2019-05-07","2019-12-05","2019-12-05","2019-12-05","2019-12-05","2020-07-08","2020-07-28","2020-07-28","2020-07-21","2020-02-04","2020-11-02","2021-04-08","2021-04-08"],"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":[["","00093221001","SUCRALFATE ","TAB 1GM","60","Select","Select",""],["","00228315303","BUPRENORPHIN ","SUB 8MG","15","Select","Select",""],["","65162052111","PROMETHAZINE ","TAB 25MG","30","Select","Select",""],["","50428232902","ANTI-DIARRHE ","TAB 2MG","12","Select","Select",""],["","12496120803","SUBOXONE ","MIS 8-2MG","28","Select","Select",""],["","62175047132","PAROXETINE ","TAB 25MG ER","30","Select","Select",""],["","00093816601","QUETIAPINE ","TAB 50MG","60","Select","Select",""],["","33674060194","ALIVE ","TAB MENS","30","Select","Select",""],["","62175061743","PANTOPRAZOLE ","TAB 40MG","30","Select","Select",""],["","69547035302","NARCAN ","SPR ","2","Select","Select",""],["","14539067401","HYDROXYZ ","CAP 25MG","90","Select","Select",""],["","65862039010","ONDANSETRON ","TAB 4MG ODT","10","Select","Select",""],["","00228212750","CLONIDINE ","TAB 0.1MG","30","Select","Select",""],["","00904530660","BANOPHEN ","CAP 25MG","15","Select","Select",""],["","45802043401","CLOTRIMAZOLE ","CRE 0.01","15","Select","Select",""],["","12843035301","MILK ","SUS 400\/5ML","354","Select","Select",""],["","45802011222","MUPIROCIN ","OIN 0.02","22","Select","Select",""],["","00591079401","DICYCLOMINE ","CAP 10MG","16","Select","Select",""],["","59779035934","TUSSIN ","LIQ 10-100\/5","237","Select","Select",""],["","60505367503","PAROXETIN ","TAB 37.5MG","28","Select","Select",""],["","00143973805","PREDNISONE ","TAB 20MG","10","Select","Select",""],["","80777027315","MODERNA ","COVID-19","0.5","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":[[["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":""}]}]}