{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KIMBERLY LUJAN","gend":1,"add":"7 COMANCHE ROAD","city":"RIDGEWAY","state":"VA","zip":"24148-3587","dob":"1972-10-23","age":"","mstatus":"","insh":10056261,"cliId":"","pno":2763362137,"cno":2763403079,"email":"","ename":"","eno":"","pphy":"PALLONE, AMANDA W","ppno":2766703300,"pcpadd":"1107 Brookdale St # A, ","pcpcity":"Martinsville","pcpstate":"VA","pcpzip":241124501,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":2763403079,"add2":"                                                            ","add3":"","madd1":"7 COMANCHE ROAD","madd2":"                                                            ","madd3":"","mcity":"RIDGEWAY","mstate":"VA","mzip":"24148-3587","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R68.89","R07.89","R07.9","F41.9","G47.00","R00.0","J44.9","K21.9","M19.90","F31.9","F17.200","E11.9","E78.5","Z79.899","R92.8","M50.13","D64.9","J45.909","I10","J43.9","R56.9","G47.30","F17.210","Z91.89","M00.831","J45.901","M79.89","Z48.00","L08.9","H40.013","Z12.31","J10.1","F12.10","M25.511","M54.6","R11.2","Z79.51","M54.2","M50.221","M53.82","R06.00","R06.09","E78.00","R73.01","J41.0","Z72.0","M54.5","R09.89","N30.01","M54.42","G89.29","M50.11","M48.02","I82.629","M54.9","R09.1","M94.0","J30.9","F32.9","M47.22","M54.12","M50.121","M40.40","M79.641","Z98.890","J31.0","R05","R06.02","G47.33","D50.9","M17.12","M50.30","M47.12","F31.81","M79.18","M47.812","J44.1","L03.113","Z11.59","M25.519","M25.311","M62.838","M50.21","F31.32","L02.511","Z23","M00.841","B08.4","Z90.49","R07.2","R94.31","Z82.49","M00.9","Y04.1XXA","Y92.9","I80.8","S61.254A","B96.89","Z04.9","A41.9","R60.9","S61.421D","M25.541","M25.641","T81.49XA","R11.0"],"date":["2019-10-21","2019-09-02","2020-01-21","2020-03-10","2019-09-02","2020-01-21","2020-07-18","2020-07-11","2019-09-02","2020-07-13","2020-07-18","2020-01-16","2019-09-02","2020-08-06","2019-09-30","2020-01-16","2020-07-11","2020-03-10","2020-01-16","2020-01-16","2020-01-16","2020-01-16","2020-01-21","2020-01-16","2020-07-14","2020-07-13","2020-07-14","2020-08-06","2020-08-06","2020-10-29","2019-03-27","2019-04-18","2019-04-18","2019-06-26","2019-06-12","2019-06-12","2020-07-11","2019-08-07","2019-08-07","2019-08-07","2019-10-30","2020-01-21","2020-04-16","2020-04-16","2020-04-16","2020-04-16","2020-02-23","2020-01-09","2020-01-09","2020-02-23","2020-02-23","2020-06-29","2020-06-29","2020-07-13","2019-06-12","2020-03-10","2020-03-10","2020-03-10","2020-03-10","2020-06-29","2020-06-29","2020-06-29","2020-06-29","2020-07-11","2020-08-10","2020-04-16","2019-04-10","2020-03-01","2020-01-12","2020-07-18","2020-01-12","2020-04-16","2020-04-16","2020-04-16","2020-01-22","2020-01-22","2020-03-01","2020-07-11","2020-08-19","2019-06-26","2019-06-26","2019-06-26","2019-08-07","2020-09-01","2020-07-11","2020-07-11","2020-07-11","2020-07-18","2020-07-18","2019-10-30","2020-01-21","2020-01-21","2020-07-11","2020-07-11","2020-07-11","2020-07-13","2020-07-11","2020-07-11","2020-07-11","2020-07-11","2020-07-11","2020-07-23","2020-07-23","2020-07-23","2020-08-06","2020-08-06"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}},{"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":[["","00487020103","IPRATROPIUM\/ ","SOL ALBUTER","270","Select","Select",""],["","65862039010","ONDANSETRON ","TAB 4MG ODT","20","Select","Select",""],["","16714079904","CETIRIZINE ","TAB 10MG","30","Select","Select",""],["","16714074804","OMEPRAZOLE ","CAP 40MG","30","Select","Select",""],["","16714061205","SERTRALINE ","TAB 50MG","30","Select","Select",""],["","11534016503","FOLIC ","TAB 1MG","30","Select","Select",""],["","57896070310","IRON ","TAB 325MG","30","Select","Select",""],["","67877022310","GABAPENTIN ","CAP 300MG","90","Select","Select",""],["","59746017710","CYCLOBENZAPR ","TAB 10MG","30","Select","Select",""],["","29300014001","DIVALPROEX ","TAB 500MG DR","60","Select","Select",""],["","00186037220","SYMBICORT ","AER 80-4.5","10.2","Select","Select",""],["","00093100305","BUSPIRONE ","TAB 15MG","30","Select","Select",""],["","29300012510","MELOXICAM ","TAB 15MG","30","Select","Select",""],["","13925015901","LIDOCAINE ","CRE 0.03","141.75","Select","Select",""],["","00173068220","VENTOLIN ","AER ","18","Select","Select",""],["","00378306577","FENOFIBRATE ","TAB 48MG","30","Select","Select",""],["","99073070822","FREESTYLE    TES LITE","TES LITE","50","Select","Select",""],["","00193658621","MICROLET ","MIS LANCETS","100","Select","Select",""],["","00193731150","CONTOUR ","TES NEXT","100","Select","Select",""],["","66993001968","ALBUTEROL ","AER HFA","18","Select","Select",""],["","56151014701","TRUPLUS ","MIS 33G","100","Select","Select",""],["","00536589688","NICOTINE ","DIS 21MG\/24H","28","Select","Select",""],["","00597007541","SPIRIVA ","CAP HANDIHLR","30","Select","Select",""],["","99073012101","FREESTYLE    TES","TES ","50","Select","Select",""],["","00054327099","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","65162046550","IBUPROFEN ","TAB 600MG","30","Select","Select",""],["","00904759080","FEROSUL ","TAB 325MG","30","Select","Select",""],["","70677003201","SM ","DIS 21MG\/24H","30","Select","Select",""],["","59746017506","PREDNISONE ","TAB 20MG","10","Select","Select",""],["","70010075405","METHOCARBAM ","TAB 500MG","15","Select","Select",""],["","16714097601","DICLOFENAC ","GEL 0.01","100","Select","Select",""],["","16714047801","AMOX\/K ","TAB 875-125","16","Select","Select",""],["","55111018010","TIZANIDINE ","TAB 4MG","15","Select","Select",""],["","00603459315","METHYLPRED ","TAB 4MG","21","Select","Select",""],["","70461041910","FLUCLVX ","INJ 2019-20","0.5","Select","Select",""],["","99073070914","FREESTYLE    KIT FREEDOM","KIT FREEDOM","1","Select","Select",""],["","00406012305","HYDROCO\/APAP ","TAB 5-325MG","10","Select","Select",""],["","16714008310","HYDROXYZ ","TAB 50MG","90","Select","Select",""],["","10702000310","PROMETHAZINE ","TAB 25MG","6","Select","Select",""],["","00093220305","METOCLOPRAM ","TAB 10MG","20","Select","Select",""],["","16714062202","ZOLPIDEM ","TAB 10MG","6","Select","Select",""],["","69452014330","BENZONATATE ","CAP 100MG","30","Select","Select",""],["","00904759160","FERROUS ","TAB 325MG","30","Select","Select",""],["","49884072703","DOXYCYC ","CAP 100MG","14","Select","Select",""],["","50111078751","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","00591234101","METAXALONE ","TAB 800MG","5","Select","Select",""],["","72057000101","ATOPADERM ","CRE ","100","Select","Select",""],["","16714065204","CIPROFLOXACN ","TAB 500MG","10","Select","Select",""],["","50383008704","GUAIATUSSIN ","SYP 100-10\/5","150","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":""}]}]}