{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ANTHONY   L GARRETT JR","gend":0,"add":"145A   WESTOVER ROAD                                        ","city":"ROCKY MOUNT                   ","state":"VA","zip":"24151-5377","dob":"1976-03-01","age":"","mstatus":"","insh":10055911,"cliId":"","pno":5404841734,"cno":5404841734,"email":"","ename":"","eno":"","pphy":"WOOD, CHRISTOPHER                                           ","ppno":"","pcpadd":"2001 Crystal Spring Ave SW","pcpcity":"Roanoke                       ","pcpstate":"VA","pcpzip":240142465,"pcpcounty":"","pcpid":"P9058917","pcpname":"NURSING HOME FRANKLIN HEALTH AND REHAB","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"145A   WESTOVER ROAD                                        ","madd2":"                                                            ","madd3":"","mcity":"ROCKY MOUNT                   ","mstate":"VA","mzip":"24151-5377","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K21.9","F41.1","F32.1","Z79.899","G47.09","G40.309","Z01.812","K62.5","K63.5","K31.9","K64.8","G40.409","Z88.5","Z88.1","G93.40","E87.2","G40.909","I45.81","D72.829","N17.9","F32.9","F12.90","Z88.0","Z87.891","G40.802","R56.9","R00.0","R94.31","R41.82","R45.6","Z74.3","G40.89","R55","R11.0","R07.89","R20.0","R07.9","G56.00","M77.11","M65.4","G56.03","E03.8","G56.02","W19.XXXA","Y93.9","Y92.000","S00.81XA","M25.562","E03.9","F41.8","Z63.4","Z87.898","Z87.828","Z02.89","F33.40","R10.9","R10.31","R30.0","G43.009","R19.7","R05.9"],"date":["2020-04-22","2021-10-26","2019-01-16","2021-10-26","2019-01-16","2020-03-26","2019-02-15","2019-02-26","2019-02-26","2019-02-26","2019-02-26","2019-04-30","2019-03-07","2019-02-26","2019-03-15","2020-04-22","2021-03-02","2019-03-07","2020-04-22","2019-03-15","2021-03-10","2019-03-07","2019-03-07","2020-04-22","2019-03-07","2020-04-22","2019-03-07","2019-03-08","2019-03-26","2019-03-07","2019-06-13","2020-04-22","2019-03-26","2019-03-29","2019-06-13","2019-10-01","2019-06-13","2019-10-01","2019-10-25","2019-10-25","2019-10-25","2020-03-26","2019-12-11","2020-04-22","2020-04-22","2020-04-22","2020-04-22","2020-04-22","2021-03-02","2021-11-05","2021-01-21","2021-01-28","2021-01-28","2021-02-02","2021-10-26","2021-08-26","2021-08-26","2021-08-26","2021-08-26","2021-11-05","2021-11-05"],"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":[["","00378180310","LEVOTHYROXIN","50MCG","30","Select","Select",""],["","62756079888","DIVALPROEX","500MG DR","120","Select","Select",""],["","65862000701","CITALOPRAM","40MG","15","Select","Select",""],["","10702001110","HYDROXYZ","25MG","60","Select","Select",""],["","49884021801","DOXEPIN","25MG","30","Select","Select",""],["","67877032105","IBUPROFEN","800MG","30","Select","Select",""],["","51991077290","LANSOPRAZOLE","30MG DR","15","Select","Select",""],["","65862039110","ONDANSETRON","8MG ODT","10","Select","Select",""],["","65862042005","SMZ\/TMP","800-160","20","Select","Select",""],["","00378180310","LEVOTHYROXIN ","TAB 50MCG","30","Select","Select",""],["","62756079888","DIVALPROEX ","TAB 500MG DR","120","Select","Select",""],["","65862000701","CITALOPRAM ","TAB 40MG","15","Select","Select",""],["","10702001110","HYDROXYZ ","TAB 25MG","60","Select","Select",""],["","49884021801","DOXEPIN ","CAP 25MG","30","Select","Select",""],["","67877032105","IBUPROFEN ","TAB 800MG","30","Select","Select",""],["","51991077290","LANSOPRAZOLE ","CAP 30MG DR","15","Select","Select",""],["","65862039110","ONDANSETRON ","TAB 8MG ODT","10","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","20","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":""}]}]}