{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ALAN   E COX","gend":0,"add":"237 FROST LANE                                              ","city":"MAX MEADOWS                   ","state":"VA","zip":"24360-3011","dob":"1964-11-24","age":"","mstatus":"","insh":10055585,"cliId":"","pno":2766373170,"cno":2766373170,"email":"","ename":"","eno":"","pphy":"BOWSER, ERIN M                                              ","ppno":"","pcpadd":"791 Fort Chiswell Rd","pcpcity":"Max Meadows                   ","pcpstate":"VA","pcpzip":243604139,"pcpcounty":"","pcpid":"P0060082","pcpname":"FORT CHISWELL MEDICAL CENTER","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"237 FROST LANE                                              ","madd2":"                                                            ","madd3":"","mcity":"MAX MEADOWS                   ","mstate":"VA","mzip":"24360-3011","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11.319","E11.40","I10","G47.30","E78.5","E11.65","H25.813","E11.3513","H25.041","H25.11","Z51.81","Z79.4","E11.9","E78.2","E55.9","J06.9","Z46.81","S82.841A","M25.571","S82.891D","M84.471D","R79.89","Z23","H26.491","H25.12","D12.3","K63.5","K62.1","Z12.11","D12.4","K64.8","K56.2","E78.00","F32.9","E66.9","Z68.34","E11.42","E03.9","L84","Z96.1","R21","F41.8","E11.3519","G47.33","E13.3519","Z96.41","M70.22","E11.3511","S90.414A","E11.3512","Z79.899","L02.91","Z82.61","M25.532","M25.552","M19.132"],"date":["2021-08-24","2021-01-20","2021-11-30","2020-07-09","2020-07-09","2021-11-30","2019-02-05","2021-11-09","2019-03-25","2019-03-25","2021-01-20","2021-05-21","2020-01-15","2021-11-30","2021-08-24","2019-06-13","2021-08-24","2019-08-15","2019-08-13","2020-01-08","2019-10-25","2020-03-09","2020-11-04","2019-11-26","2021-06-15","2020-01-15","2020-01-15","2020-01-15","2020-01-15","2020-01-15","2020-01-15","2020-01-15","2020-01-15","2020-01-15","2020-01-15","2020-01-15","2021-11-30","2021-08-24","2020-04-07","2021-06-15","2020-07-09","2021-08-30","2021-11-30","2020-10-20","2021-05-21","2021-04-08","2020-11-04","2020-12-18","2021-01-20","2021-03-16","2021-08-24","2021-05-27","2021-08-24","2021-09-15","2021-08-30","2021-10-27"],"priorHcc":["","",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":[["","00168025846","CLOTRIM\/BETA","DIPROP","45","Select","Select",""],["","00169750111","NOVOLOG","100\/ML","30","Select","Select",""],["","00378180010","LEVOTHYROXIN","25MCG","30","Select","Select",""],["","62756014202","METFORMIN","500MG ER","60","Select","Select",""],["","57237001999","DULOXETINE","60MG","30","Select","Select",""],["","00193731150","CONTOUR","NEXT","150","Select","Select",""],["","00603385532","HYDROCHLOROT","12.5MG","30","Select","Select",""],["","64679092603","ENALAPRIL","20MG","30","Select","Select",""],["","00093762398","PREGABALIN","50MG","90","Select","Select",""],["","61442010310","DICLOFENAC","75MG DR","60","Select","Select",""],["","67877049005","EZETIMIBE","10MG","30","Select","Select",""],["","69097015907","MELOXICAM","15MG","30","Select","Select",""],["","70436001002","BUPROPN","150MG XL","30","Select","Select",""],["","10572010001","PEG-3350","ELECTROL","4,000.00","Select","Select",""],["","49348003210","SM","LAXATIVE","4","Select","Select",""],["","65862042005","SMZ\/TMP","800-160","10","Select","Select",""],["","73070010011","INSULIN ","INJ 100\/ML","30","Select","Select",""],["","51672404003","ENALAPRIL ","TAB 20MG","90","Select","Select",""],["","70436001002","BUPROPN ","TAB 150MG XL","30","Select","Select",""],["","00168025846","CLOTRIM\/BETA ","CRE DIPROP","45","Select","Select",""],["","00169750111","NOVOLOG ","INJ 100\/ML","30","Select","Select",""],["","00378180010","LEVOTHYROXIN ","TAB 25MCG","30","Select","Select",""],["","62756014202","METFORMIN ","TAB 500MG ER","60","Select","Select",""],["","57237001999","DULOXETINE ","CAP 60MG","30","Select","Select",""],["","00193731150","CONTOUR ","TES NEXT","150","Select","Select",""],["","00603385532","HYDROCHLOROT ","CAP 12.5MG","30","Select","Select",""],["","00093762398","PREGABALIN ","CAP 50MG","90","Select","Select",""],["","61442010310","DICLOFENAC ","TAB 75MG DR","60","Select","Select",""],["","67877049005","EZETIMIBE ","TAB 10MG","30","Select","Select",""],["","69097015907","MELOXICAM ","TAB 15MG","30","Select","Select",""],["","10572010001","PEG-3350 ","SOL ELECTROL","4,000.00","Select","Select",""],["","49348003210","SM ","TAB LAXATIVE","4","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","10","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":[[["Yes","Select","","","","","Select","",""],["Yes","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":""}]}]}