{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LINETTE   S GIBSON","gend":1,"add":"C\/O PATRICIA HENDERSON                                      ","city":"FERRUM                        ","state":"VA","zip":"24088-3504","dob":"1967-08-15","age":"","mstatus":"","insh":10055526,"cliId":"","pno":5404206137,"cno":"","email":"","ename":"","eno":"","pphy":"SUBUHI, TABASSUM                                            ","ppno":"","pcpadd":"180 Ferrum Mountain Rd","pcpcity":"Ferrum                        ","pcpstate":"VA","pcpzip":240882939,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"100   MULLINS COURT CIRCLE LOT 10                           ","add3":"","madd1":"C\/O PATRICIA HENDERSON                                      ","madd2":"100   MULLINS COURT CIRCLE LOT 10                           ","madd3":"","mcity":"FERRUM                        ","mstate":"VA","mzip":"24088-3504","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F25.0","E03.9","E78.2","F31.9","M54.9","Z12.4","M25.562","Z85.3","K21.9","H90.5","M17.12","I25.118","E78.5","F17.210","R89.9","T16.1XXA","Z87.891","H40.003","H52.13","I08.2","R07.9","R00.2","R00.0","R94.31","R06.2","E78.00","Z82.49","Z72.0","D05.92","Z79.899","Z23","J01.90","B96.89","F17.200","R06.02","J01.00","F41.9","B30.9","H53.8","G89.29","R05","J06.9","J01.01","F29","Z86.000","R30.0","F25.9","R05.9"],"date":["2021-10-15","2021-08-26","2021-05-27","2021-02-24","2020-08-14","2019-02-13","2019-05-15","2021-07-06","2021-05-27","2019-05-28","2019-07-25","2019-06-03","2019-10-11","2019-10-11","2019-06-11","2019-07-11","2019-07-11","2020-11-24","2019-09-19","2019-10-11","2019-10-11","2019-10-11","2019-10-11","2019-10-11","2020-02-18","2019-10-11","2019-10-11","2019-10-11","2019-10-15","2020-05-14","2019-10-23","2019-12-17","2019-12-17","2020-02-18","2020-02-18","2020-06-25","2020-05-14","2020-05-20","2020-11-12","2021-08-26","2021-06-22","2021-11-18","2021-02-24","2021-05-27","2021-07-06","2021-08-26","2021-08-26","2021-11-18"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",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":[["","00378181510","LEVOTHYROXIN","150MCG","90","Select","Select",""],["","43547034306","RISPERIDONE","3MG","60","Select","Select",""],["","68180016013","AZITHROMYCIN","250MG","6","Select","Select",""],["","11523433203","CLARITIN-D","10-240MG","15","Select","Select",""],["","50111056101","TRAZODONE","100MG","90","Select","Select",""],["","51991029401","OXCARBAZEPIN","600MG","120","Select","Select",""],["","68382065005","ISOSORB","30MG ER","30","Select","Select",""],["","65162083366","DICLOFENAC","1%","100","Select","Select",""],["","14539067501","HYDROXYZ","50MG","90","Select","Select",""],["","49483060450","IBUPROFEN","800MG","90","Select","Select",""],["","00093816501","QUETIAPINE","400MG","180","Select","Select",""],["","50458056401","INVEGA","234\/1.5","1.5","Select","Select",""],["","57664049983","MIRTAZAPINE","15MG","30","Select","Select",""],["","16729020301","BUSPIRONE","15MG","270","Select","Select",""],["","46122016752","ALLER\/CONGES","10-240MG","25","Select","Select",""],["","49281042150","FLUZONE","2021-22","0.5","Select","Select",""],["","50428459949","NIACIN","400-100","30","Select","Select",""],["","50428042799","ALLRGY","10-240MG","15","Select","Select",""],["","00536589488","NICOTINE","7MG\/24HR","28","Select","Select",""],["","80777027399","MODERNA","COVID-19","0.5","Select","Select",""],["","00591565810","CYCLOBENZAPR","10MG","90","Select","Select",""],["","59779030603","CVS","","510","Select","Select",""],["","46122035374","GNP","21MG\/24H","28","Select","Select",""],["","55111015810","OMEPRAZOLE","20MG","90","Select","Select",""],["","58160082311","SHINGRIX","50\/0.5ML","1","Select","Select",""],["","24208091055","ERYTHROMYCIN","OP","3.5","Select","Select",""],["","45802086803","POLYETH","3350 NF","510","Select","Select",""],["","70377000415","SIMVASTATIN","40MG","90","Select","Select",""],["","00143993905","AMOXICILLIN","500MG","20","Select","Select",""],["","65862042005","SMZ\/TMP","800-160","20","Select","Select",""],["","71930002643","BROM\/PSE\/DM","","473","Select","Select",""],["","00378181510","LEVOTHYROXIN ","TAB 150MCG","90","Select","Select",""],["","43547034306","RISPERIDONE ","TAB 3MG","60","Select","Select",""],["","68180016013","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","11523433203","CLARITIN-D ","TAB 10-240MG","15","Select","Select",""],["","50111056101","TRAZODONE ","TAB 100MG","90","Select","Select",""],["","51991029401","OXCARBAZEPIN ","TAB 600MG","120","Select","Select",""],["","68382065005","ISOSORB ","TAB 30MG ER","30","Select","Select",""],["","45802016000","DICLOFENAC ","GEL 0.01","100","Select","Select",""],["","50458056401","INVEGA ","INJ 234\/1.5","1.5","Select","Select",""],["","14539067501","HYDROXYZ ","CAP 50MG","90","Select","Select",""],["","70377000415","SIMVASTATIN ","TAB 40MG","90","Select","Select",""],["","49483060450","IBUPROFEN ","TAB 800MG","90","Select","Select",""],["","00093816501","QUETIAPINE ","TAB 400MG","180","Select","Select",""],["","57664049983","MIRTAZAPINE ","TAB 15MG","30","Select","Select",""],["","16729020301","BUSPIRONE ","TAB 15MG","270","Select","Select",""],["","46122016752","ALLER\/CONGES ","TAB 10-240MG","25","Select","Select",""],["","49281042150","FLUZONE ","INJ 2021-22","0.5","Select","Select",""],["","50428459949","NIACIN ","CAP 400-100","30","Select","Select",""],["","50428042799","ALLRGY ","TAB 10-240MG","15","Select","Select",""],["","00536589488","NICOTINE ","DIS 7MG\/24HR","28","Select","Select",""],["","80777027399","MODERNA ","INJ COVID-19","0.5","Select","Select",""],["","00781286810","OMEPRAZOLE ","CAP 20MG","90","Select","Select",""],["","00591565810","CYCLOBENZAPR ","TAB 10MG","90","Select","Select",""],["","59779030603","CVS ","POW ","510","Select","Select",""],["","46122035374","GNP ","DIS 21MG\/24H","28","Select","Select",""],["","58160082311","SHINGRIX ","INJ 50\/0.5ML","1","Select","Select",""],["","24208091055","ERYTHROMYCIN ","OIN OP","3.5","Select","Select",""],["","45802086803","POLYETH ","POW 3350 NF","510","Select","Select",""],["","00143993905","AMOXICILLIN ","CAP 500MG","20","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","20","Select","Select",""],["","71930002643","BROM\/PSE\/DM ","SYP ","473","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":""}]}]}