{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ELIZABETH   A LITTLEFIELD","gend":1,"add":"202 LAUREL HILL DRIVE                                       ","city":"VINTON                        ","state":"VA","zip":"24179-1539","dob":"1975-07-08","age":"","mstatus":"","insh":10056006,"cliId":"","pno":5409157379,"cno":5409157379,"email":"","ename":"","eno":"","pphy":"REA, CATHERINE G                                            ","ppno":"","pcpadd":"37 Laymantown Rd","pcpcity":"Troutville                    ","pcpstate":"VA","pcpzip":241756635,"pcpcounty":"","pcpid":"P0117322","pcpname":"CARILION FAMILY MEDICINE PARKWAY PHYS BLUE RIDGE","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"APARTMENT 5                                                 ","add3":"","madd1":"414 Forest Hill Ave NE                                      ","madd2":"                                                            ","madd3":"","mcity":"Roanoke                       ","mstate":"VA","mzip":"24012-7909","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F33.1","Z12.31","E03.8","D51.0","F31.32","K21.9","E03.9","F31.81","J30.89","J01.90","J30.9","Z23","Z91.09","H10.13","J02.9","M25.561","Z01.419","Z30.41","A60.04","J32.9","K59.09","Z88.0","Z88.2","R06.02","J32.8","J32.4","R51","Z68.27","F41.9","R53.83","R11.0","R05","Z20.828","R52","N64.89","M79.10","B34.9","R68.83","R30.0","E22.1","G43.909","G44.89","L30.8","Z98.51","L20.9","Z68.31","N89.8","Z68.33","F41.1","G47.9","M79.671"],"date":["2019-01-08","2020-06-12","2021-10-19","2019-08-07","2021-11-17","2019-09-04","2019-09-04","2019-09-04","2021-10-28","2021-06-29","2021-04-12","2021-01-29","2021-04-12","2021-04-12","2020-01-03","2020-02-07","2021-05-11","2021-05-11","2020-03-06","2021-04-12","2020-04-10","2020-04-21","2020-04-21","2020-07-22","2021-01-29","2021-10-28","2020-07-01","2021-01-21","2021-01-21","2020-09-03","2020-07-15","2021-01-05","2020-09-03","2020-07-22","2020-08-10","2020-09-03","2020-09-03","2020-09-03","2020-09-03","2021-10-19","2021-10-28","2020-10-26","2021-04-12","2021-05-11","2021-10-28","2021-07-27","2021-08-03","2021-10-28","2021-11-17","2021-11-17","2021-11-18"],"priorHcc":["","","","",null,"","","",null,"","","","","","","","","","","","","","","","",null,"","","","","","","","","","","","","","",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":[["","23155019201","BUPROPION","100MG","120","Select","Select",""],["","42794001802","LIOTHYRONINE","5MCG","120","Select","Select",""],["","55111025760","ZIPRASIDONE","40MG","30","Select","Select",""],["","66993048532","ZILEUTON","600MG","120","Select","Select",""],["","00054327099","FLUTICASONE","50MCG","16","Select","Select",""],["","51672400501","CARBAMAZEPIN","200MG","120","Select","Select",""],["","16714069801","VALACYCLOVIR","500MG","60","Select","Select",""],["","68382080610","TRAZODONE","100MG","30","Select","Select",""],["","62011031502","FEXOFENADINE","180MG","30","Select","Select",""],["","60505083305","AZELASTINE","0.10%","30","Select","Select",""],["","16714033002","GABAPENTIN","600MG","60","Select","Select",""],["","68180097103","LEVOTHYROXIN","125MCG","90","Select","Select",""],["","16714043901","NITROFURANTN","100MG","20","Select","Select",""],["","62175013643","OMEPRAZOLE","40MG","90","Select","Select",""],["","16714069211","FLUCONAZOLE","150MG","2","Select","Select",""],["","49348012813","ACID","10MG","60","Select","Select",""],["","75834011629","DROSPIR\/ETHI","3-0.02MG","84","Select","Select",""],["","65862069790","VENLAFAXINE","150MG ER","30","Select","Select",""],["","68382018305","BUSPIRONE","30MG","60","Select","Select",""],["","16714008310","HYDROXYZ","50MG","90","Select","Select",""],["","68462072029","DROSPIRENONE","ETHY EST","28","Select","Select",""],["","00536355601","VITAMIN","1000MCG","30","Select","Select",""],["","65862039010","ONDANSETRON","4MG ODT","12","Select","Select",""],["","00054004544","IPRATROPIUM","0.03%","30","Select","Select",""],["","64380080307","RANITIDINE","150MG","60","Select","Select",""],["","16714040102","CEFUROXIME","500MG","28","Select","Select",""],["","45802006305","TRIAMCINOLON","0.03%","15","Select","Select",""],["","59267100002","PFIZER","COVID-19","0.3","Select","Select",""],["","00065427325","PAZEO","0.70%","2.5","Select","Select",""],["","59746017509","PREDNISONE","20MG","10","Select","Select",""],["","61314027225","OLOPATADINE","0.20%","2.5","Select","Select",""],["","00168008915","NYSTAT\/TRIAM","","15","Select","Select",""],["","65862053750","LEVOFLOXACIN","500MG","7","Select","Select",""],["","16571020150","DICLOFENAC","75MG DR","30","Select","Select",""],["","66993008269","SUMATRIPTAN","20MG\/ACT","6","Select","Select",""],["","23155019201","BUPROPION ","TAB 100MG","120","Select","Select",""],["","42794001802","LIOTHYRONINE ","TAB 5MCG","120","Select","Select",""],["","55111025760","ZIPRASIDONE ","CAP 40MG","30","Select","Select",""],["","66993048532","ZILEUTON ","TAB 600MG","120","Select","Select",""],["","00054327099","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","51672400501","CARBAMAZEPIN ","TAB 200MG","120","Select","Select",""],["","16714069801","VALACYCLOVIR ","TAB 500MG","60","Select","Select",""],["","68382080610","TRAZODONE ","TAB 100MG","30","Select","Select",""],["","62011031502","FEXOFENADINE ","TAB 180MG","30","Select","Select",""],["","60505083305","AZELASTINE ","SPR 0.001","30","Select","Select",""],["","16714033002","GABAPENTIN ","TAB 600MG","60","Select","Select",""],["","68180097103","LEVOTHYROXIN ","TAB 125MCG","90","Select","Select",""],["","16714043901","NITROFURANTN ","CAP 100MG","20","Select","Select",""],["","62175013643","OMEPRAZOLE ","CAP 40MG","90","Select","Select",""],["","16714069211","FLUCONAZOLE ","TAB 150MG","2","Select","Select",""],["","49348012813","ACID ","TAB 10MG","60","Select","Select",""],["","75834011629","DROSPIR\/ETHI ","TAB 3-0.02MG","84","Select","Select",""],["","65862069790","VENLAFAXINE ","CAP 150MG ER","30","Select","Select",""],["","68382018305","BUSPIRONE ","TAB 30MG","60","Select","Select",""],["","16714008310","HYDROXYZ ","TAB 50MG","90","Select","Select",""],["","68462072029","DROSPIRENONE ","TAB ETHY EST","28","Select","Select",""],["","00536355601","VITAMIN ","TAB 1000MCG","30","Select","Select",""],["","65862039010","ONDANSETRON ","TAB 4MG ODT","12","Select","Select",""],["","00054004544","IPRATROPIUM ","SPR 0.0003","30","Select","Select",""],["","64380080307","RANITIDINE ","TAB 150MG","60","Select","Select",""],["","16714040102","CEFUROXIME ","TAB 500MG","28","Select","Select",""],["","45802006305","TRIAMCINOLON ","CRE 0.00025","15","Select","Select",""],["","59267100002","PFIZER ","INJ COVID-19","0.3","Select","Select",""],["","00065427325","PAZEO ","DRO 0.007","2.5","Select","Select",""],["","62135098505","DOXYCYCL ","CAP 100MG","14","Select","Select",""],["","59746017509","PREDNISONE ","TAB 20MG","10","Select","Select",""],["","61314027225","OLOPATADINE ","SOL 0.002","2.5","Select","Select",""],["","31722072610","MONTELUKAST ","TAB 10MG","30","Select","Select",""],["","00168008915","NYSTAT\/TRIAM ","OIN ","15","Select","Select",""],["","65862053750","LEVOFLOXACIN ","TAB 500MG","7","Select","Select",""],["","16571020150","DICLOFENAC ","TAB 75MG DR","30","Select","Select",""],["","66993008269","SUMATRIPTAN ","SPR 20MG\/ACT","6","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":""}]}]}