{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ALESIA   A MACEWEN","gend":1,"add":"43 OLD ALLEGHANY CIRCLE","city":"GOSHEN","state":"VA","zip":"24439-2404","dob":"1968-11-17","age":"","mstatus":"","insh":10056386,"cliId":"","pno":5409979005,"cno":5409979005,"email":"","ename":"","eno":"","pphy":"MONROE, JULIE A","ppno":5404633381,"pcpadd":"55 Comfort Way, Ste 1","pcpcity":"Lexington","pcpstate":"VA","pcpzip":244503788,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":5404166376,"add2":"                                                            ","add3":"","madd1":"43 OLD ALLEGHANY CIRCLE","madd2":"                                                            ","madd3":"","mcity":"GOSHEN","mstate":"VA","mzip":"24439-2404","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F31.9","E78.2","M46.96","M46.1","M54.31","M54.32","M54.5","S89.92XA","M25.562","W54.1XXA","Z87.891","Z79.82","Z79.51","Z79.1","Z79.899","Z88.8","Z88.6","N39.0","R10.9","K59.00","R16.1","Z23","D13.1","R10.13","R93.3","E11.40","E78.5","E88.81","F25.9","F41.9","I10","G40.909","J44.9","Z79.84","Z79.52","G89.29","M53.3","E78.00","E11.42","F31.70","G25.0","F17.200","R93.89","R19.7","R68.89","Z00.00","J30.1","M46.90","M54.2","M79.2","G47.00","F33.1","D73.4","E11.9","R10.10","R11.0","F31.89","M47.817","M77.01","L28.2","R10.84","M47.816","G43.909","Z82.61","R10.11","R06.02","Z79.2","Z85.41","K76.0","N28.1","F20.9","Z86.59","R10.811","K58.0","O71.6","O94","G40.109","Z98.890","Z86.69","R14.0","Z90.710","Z87.19","R35.0","R25.1","R16.0","D73.89","S80.912A","K58.9","H66.91","K21.9"],"date":["2021-05-15","2019-05-22","2021-03-10","2021-03-11","2020-06-18","2020-06-18","2021-03-11","2020-11-02","2021-01-15","2020-11-02","2021-05-15","2020-11-02","2021-05-15","2020-11-02","2021-05-15","2020-11-02","2021-05-15","2021-05-15","2021-05-21","2019-10-07","2019-10-07","2020-10-15","2019-10-09","2021-04-21","2019-10-09","2020-05-12","2020-05-12","2019-12-30","2019-12-30","2020-08-05","2019-10-09","2019-10-22","2020-08-24","2019-12-30","2019-12-30","2019-12-30","2021-03-10","2019-12-30","2020-06-24","2019-12-30","2019-12-30","2020-08-05","2020-10-13","2020-10-15","2019-04-29","2019-05-22","2020-03-19","2019-05-22","2019-05-22","2021-03-10","2019-05-22","2019-05-22","2021-05-15","2020-08-24","2019-10-22","2021-05-15","2019-10-22","2019-04-08","2019-06-03","2019-06-03","2019-09-30","2020-05-12","2020-05-12","2020-05-12","2021-05-15","2021-05-15","2021-05-15","2021-05-15","2021-05-15","2021-05-15","2021-05-15","2021-05-15","2021-05-15","2020-10-22","2019-04-12","2019-04-12","2019-04-12","2019-04-12","2019-04-12","2019-09-30","2019-09-30","2019-09-30","2020-08-05","2020-08-05","2020-09-17","2020-09-17","2020-11-02","2021-04-21","2020-03-19","2020-12-23"],"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":[["","00054327099","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","57782039726","CROMOLYN ","SPR 5.2\/ACT","26","Select","Select",""],["","51991074890","DULOXETINE ","CAP 60MG","60","Select","Select",""],["","69097012503","TOPIRAMATE ","TAB 200MG","60","Select","Select",""],["","70377000315","SIMVASTATIN ","TAB 20MG","30","Select","Select",""],["","33342032815","TRIAMCINOLON ","CRE 0.005","60","Select","Select",""],["","00093742698","MONTELUKAST ","TAB 10MG","30","Select","Select",""],["","68462019005","NAPROXEN ","TAB 500MG","60","Select","Select",""],["","00093816201","QUETIAPINE ","TAB 100MG","30","Select","Select",""],["","59779030603","CVS ","POW ","510","Select","Select",""],["","00186037020","SYMBICORT ","AER 160-4.5","10.2","Select","Select",""],["","65862007701","CIPROFLOXACN ","TAB 500MG","14","Select","Select",""],["","00143122701","DICYCLOMINE ","TAB 20MG","120","Select","Select",""],["","45802091987","CETIRIZINE ","TAB 10MG","30","Select","Select",""],["","59651000305","OMEPRAZOLE ","CAP 40MG","120","Select","Select",""],["","76385012810","METFORMIN ","TAB 500MG ER","30","Select","Select",""],["","47781030301","NITROFURANTN ","CAP 100MG","20","Select","Select",""],["","65862022801","LAMOTRIGINE ","TAB 100MG","30","Select","Select",""],["","45802057178","FEXOFENADINE ","TAB 180MG","30","Select","Select",""],["","16571020106","DICLOFENAC ","TAB 75MG DR","60","Select","Select",""],["","00378064110","PREDNISONE ","TAB 10MG","30","Select","Select",""],["","70710113908","FLUCONAZOLE ","TAB 150MG","2","Select","Select",""],["","68180016013","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","68180071160","CEFDINIR ","CAP 300MG","14","Select","Select",""],["","75826011410","PHENAZOPYRID ","TAB 100MG","30","Select","Select",""],["","59746000103","METHYLPRED ","TAB 4MG","21","Select","Select",""],["","68462010530","ONDANSETRON ","TAB 4MG","12","Select","Select",""],["","42858010201","OXYCOD\/APAP ","TAB 5-325MG","8","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","14","Select","Select",""],["","14832001101","NASALCROM ","SPR 5.2\/ACT","26","Select","Select",""],["","43386035701","HYDROCO\/APAP ","TAB 7.5-325","90","Select","Select",""],["","00378041510","DIPHEN\/ATROP ","TAB 2.5MG","10","Select","Select",""],["","00456120130","LINZESS ","CAP 145MCG","90","Select","Select",""],["","69547035302","NARCAN ","SPR ","2","Select","Select",""],["","13668013701","ESCITALOPRAM ","20MG","30","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":""}]}]}