{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KATHERINE GRAVLEY","gend":1,"add":"336 FIRST STREET SW                                         ","city":"PULASKI                       ","state":"VA","zip":"24301-5519","dob":"1958-01-21","age":"","mstatus":"","insh":10055390,"cliId":"","pno":5409217737,"cno":5409217737,"email":"","ename":"","eno":"","pphy":"KAATZ, MATTHEW S                                            ","ppno":"","pcpadd":"101 1st St NW","pcpcity":"PULASKI                       ","pcpstate":"VA","pcpzip":243015603,"pcpcounty":"","pcpid":"P9058766","pcpname":"KAATZ MATTHEW S MD PC","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"336 FIRST STREET SW                                         ","madd2":"                                                            ","madd3":"","mcity":"PULASKI                       ","mstate":"VA","mzip":"24301-5519","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I47.1","E87.6","R07.9","R06.02","K21.9","Z87.891","I48.92","M53.9","M54.16","M51.37","Z79.899","G89.4","I10","J06.9","G60.9","M15.9","M25.561","M25.562","M25.569","M41.9","M51.27","M79.7","Z79.891","E55.9","F41.1","Z13.21","M25.551","M25.552","R00.2","I34.1","M23.301","M17.12","Z68.29","M23.332","M71.22","M65.88","R06.09","Z79.51","M23.322","Z68.27","K63.5","Z12.11","Z86.010","K62.1","K64.8","K44.9","I25.10","J45.998","G43.909","I08.1","F41.9","F33.1","Z79.1","R12","R06.83","Z68.1","M51.36","M54.5","G89.29","E78.2","Z13.89","E78.5","E04.1","F32.9","R53.82","M96.1","F19.20","M47.817","M48.061","M51.26","M47.816","M43.16","M51.86","M79.644","Z20.828","Z51.81","Z72.0","M79.645","R60.0","S69.90XA","F11.20","F43.10","F60.89","F17.200","M70.61","E66.3","Z68.28","Z12.39","Z12.31"],"date":["2019-07-23","2019-01-11","2019-07-23","2019-07-23","2021-09-02","2019-07-18","2019-01-11","2021-09-01","2021-09-28","2021-09-28","2021-09-28","2021-09-01","2019-07-23","2019-01-28","2019-04-30","2021-09-02","2021-09-01","2021-09-01","2021-07-07","2021-09-01","2021-09-01","2021-09-02","2021-09-28","2021-09-02","2019-04-30","2019-04-30","2021-03-17","2020-05-05","2019-07-23","2021-09-02","2019-06-17","2019-06-25","2019-06-05","2019-06-17","2019-06-17","2019-06-17","2019-06-20","2019-06-20","2019-06-25","2019-07-01","2019-07-18","2019-07-18","2019-07-18","2019-07-18","2019-07-18","2019-07-18","2019-07-18","2019-07-18","2019-07-18","2019-07-18","2021-09-02","2021-03-08","2019-07-18","2019-07-18","2019-07-23","2019-08-07","2021-09-01","2021-09-28","2021-02-17","2019-10-30","2020-01-27","2021-09-02","2021-09-02","2021-09-02","2020-02-14","2021-08-04","2020-04-21","2020-04-21","2020-04-21","2021-09-02","2020-07-29","2020-07-29","2020-07-29","2020-11-19","2020-12-18","2020-12-02","2020-12-02","2021-03-02","2021-02-23","2021-02-23","2021-09-03","2021-03-08","2021-03-08","2021-03-08","2021-04-07","2021-09-02","2021-06-02","2021-09-02","2021-09-20"],"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":[["","52817033050","CYCLOBENZAPR","5MG","60","Select","Select",""],["","57237001830","DULOXETINE","30MG","60","Select","Select",""],["","10702000850","OXYCODONE","15MG","120","Select","Select",""],["","29300012510","MELOXICAM","15MG","10","Select","Select",""],["","64380074207","BUSPIRONE","10MG","90","Select","Select",""],["","64980043710","ATENOLOL","25MG","30","Select","Select",""],["","16729011915","MONTELUKAST","10MG","30","Select","Select",""],["","42858011830","LIDOCAINE","5%","30","Select","Select",""],["","16714071503","OMEPRAZOLE","20MG","30","Select","Select",""],["","69238131409","PREGABALIN","150MG","60","Select","Select",""],["","33342015711","CELECOXIB","200MG","30","Select","Select",""],["","59310057922","PROAIR","","8.5","Select","Select",""],["","45802008801","ALBUTEROL","HFA","8.5","Select","Select",""],["","64380073706","VITAMIN","50000UNT","1","Select","Select",""],["","59676058015","JANSSEN","COVID-19","0.5","Select","Select",""],["","31722072610","MONTELUKAST ","TAB 10MG","30","Select","Select",""],["","52817033050","CYCLOBENZAPR ","TAB 5MG","60","Select","Select",""],["","57237001830","DULOXETINE ","CAP 30MG","60","Select","Select",""],["","10702000850","OXYCODONE ","TAB 15MG","120","Select","Select",""],["","29300012510","MELOXICAM ","TAB 15MG","10","Select","Select",""],["","68180096301","ALBUTEROL ","AER HFA","8.5","Select","Select",""],["","64380074207","BUSPIRONE ","TAB 10MG","90","Select","Select",""],["","64980043710","ATENOLOL ","TAB 25MG","30","Select","Select",""],["","62332012390","PREGABALIN ","CAP 150MG","60","Select","Select",""],["","16714071503","OMEPRAZOLE ","CAP 20MG","30","Select","Select",""],["","42858011830","LIDOCAINE ","PAD 0.05","30","Select","Select",""],["","33342015711","CELECOXIB ","CAP 200MG","30","Select","Select",""],["","59310057922","PROAIR ","AER ","8.5","Select","Select",""],["","64380073706","VITAMIN ","CAP 50000UNT","1","Select","Select",""],["","59676058015","JANSSEN ","INJ 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","",""],["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":""}]}]}