{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ALLYSON   C LESTER","gend":1,"add":"613   2ND STREET                                            ","city":"RADFORD                       ","state":"VA","zip":"24141-1431","dob":"1981-09-07","age":"","mstatus":"","insh":10055901,"cliId":"","pno":5403203297,"cno":5403203297,"email":"","ename":"","eno":"","pphy":"LARD, CHAD T                                                ","ppno":"","pcpadd":"118 BROAD STREET","pcpcity":"DUBLIN                        ","pcpstate":"VA","pcpzip":240843211,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"APT A2                                                      ","add3":"","madd1":"613   2ND STREET                                            ","madd2":"APT A2                                                      ","madd3":"","mcity":"RADFORD                       ","mstate":"VA","mzip":"24141-1431","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F31.4","F43.12","N17.9","R44.0","T56.892A","F32.9","F31.81","F15.20","R00.0","R94.31","T56.894A","F31.9","D72.829","R82.71","F31.30","F60.3","F43.10","F19.10","F51.5","F43.25","Z91.5","Z79.3","Z79.899","Z88.8","Z91.040","Z91.011","H61.23","F17.200","T43.592A","Y92.9","N39.0","I10","E87.6","E78.00","B96.20","F17.210","F15.90","E86.0","Z91.14","Z51.81","T14.91XD","M25.561","M25.461","R68.89","R51","G44.201","E89.40","Z79.890","Z90.710","Z87.42","Z80.3","Z80.49","Z80.41","R30.0","R35.0","R63.5","T50.905A","M54.5","G89.29","Z23","M25.572","F33.3","R05","R52","Z20.828","J34.89","M79.10","R41.82","A41.9","T40.1X1A","R40.0","R06.83","Z20.822","W19.XXXA","R07.9","S41.111A","S51.811A","W45.8XXA","Y93.9","Z85.41","Z48.02","M79.601","M62.830","R07.81","R42","Z12.31"],"date":["2021-11-15","2019-02-01","2019-01-21","2019-01-17","2019-01-21","2019-01-21","2019-01-21","2019-01-23","2019-01-17","2021-06-10","2019-01-17","2019-01-18","2019-01-18","2019-01-18","2019-01-21","2019-01-23","2019-01-21","2019-01-21","2019-01-21","2019-01-23","2019-01-21","2019-01-21","2021-08-05","2019-01-21","2019-01-21","2019-01-21","2019-01-21","2021-03-02","2019-01-21","2021-07-20","2019-01-21","2021-07-20","2019-01-21","2021-07-20","2019-01-21","2021-10-21","2019-01-21","2019-01-21","2019-01-21","2021-06-10","2019-01-23","2019-02-06","2019-02-06","2019-12-16","2019-06-13","2019-06-13","2021-10-21","2019-07-23","2021-10-21","2019-07-23","2019-07-23","2019-07-23","2019-07-23","2019-07-31","2019-07-31","2019-07-31","2019-07-31","2019-11-14","2019-11-14","2021-07-20","2019-10-17","2020-05-13","2020-11-03","2020-09-02","2020-09-03","2020-11-03","2020-11-03","2021-03-02","2021-03-02","2021-03-02","2021-03-02","2021-03-02","2021-03-02","2021-03-02","2021-06-10","2021-07-20","2021-07-20","2021-07-20","2021-07-20","2021-07-20","2021-07-29","2021-07-29","2021-07-29","2021-08-05","2021-03-02","2021-10-21"],"priorHcc":[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":[["","65862069705","VENLAFAXINE","150MG ER","56","Select","Select",""],["","51991081701","PROPRANOLOL","60MG ER","28","Select","Select",""],["","23155010210","METFORMIN","500MG","56","Select","Select",""],["","10542001210","DIALYVITE\/","ZINC","28","Select","Select",""],["","14539067505","HYDROXYZ","50MG","84","Select","Select",""],["","96295013723","MELATONIN","3MG","56","Select","Select",""],["","00555088702","ESTRADIOL","2MG","28","Select","Select",""],["","68382013905","TOPIRAMATE","50MG","56","Select","Select",""],["","69097015915","MELOXICAM","15MG","28","Select","Select",""],["","00378145001","LITHIUM","450MG ER","56","Select","Select",""],["","68382007910","HALOPERIDOL","5MG","56","Select","Select",""],["","00781216760","ZIPRASIDONE","60MG","56","Select","Select",""],["","50111043403","TRAZODONE","100MG","28","Select","Select",""],["","57896075201","VITAMIN","400 UNIT","56","Select","Select",""],["","67877022305","GABAPENTIN","300MG","28","Select","Select",""],["","59762532001","PRAZOSIN","2MG","28","Select","Select",""],["","00378064110","PREDNISONE","10MG","21","Select","Select",""],["","69097084615","CYCLOBENZAPR","10MG","84","Select","Select",""],["","69547035302","NARCAN","","2","Select","Select",""],["","68546017160","AUSTEDO","9MG","14","Select","Select",""],["","50458056201","INVEGA","117\/0.75","0.75","Select","Select",""],["","65862069705","VENLAFAXINE ","CAP 150MG ER","56","Select","Select",""],["","51991081701","PROPRANOLOL ","CAP 60MG ER","28","Select","Select",""],["","23155010210","METFORMIN ","TAB 500MG","56","Select","Select",""],["","10542001210","DIALYVITE\/ ","TAB ZINC","28","Select","Select",""],["","14539067505","HYDROXYZ ","CAP 50MG","84","Select","Select",""],["","96295013723","MELATONIN ","TAB 3MG","56","Select","Select",""],["","00555088702","ESTRADIOL ","TAB 2MG","28","Select","Select",""],["","68382013905","TOPIRAMATE ","TAB 50MG","56","Select","Select",""],["","69097015915","MELOXICAM ","TAB 15MG","28","Select","Select",""],["","00378145001","LITHIUM ","TAB 450MG ER","56","Select","Select",""],["","68382007910","HALOPERIDOL ","TAB 5MG","56","Select","Select",""],["","00781216760","ZIPRASIDONE ","CAP 60MG","56","Select","Select",""],["","50111043403","TRAZODONE ","TAB 100MG","28","Select","Select",""],["","57896075201","VITAMIN ","CAP 400 UNIT","56","Select","Select",""],["","67877022305","GABAPENTIN ","CAP 300MG","28","Select","Select",""],["","59762532001","PRAZOSIN ","CAP 2MG","28","Select","Select",""],["","00378064110","PREDNISONE ","TAB 10MG","21","Select","Select",""],["","69097084615","CYCLOBENZAPR ","TAB 10MG","84","Select","Select",""],["","69547035302","NARCAN ","SPR ","2","Select","Select",""],["","68546017160","AUSTEDO ","TAB 9MG","14","Select","Select",""],["","40985021245","E-400 ","CAP 400UNIT","56","Select","Select",""],["","50458056201","INVEGA ","INJ 117\/0.75","0.75","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","",""],["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":""}]}]}