{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ROBERTA   G MCCRAW","gend":1,"add":"125 DARK RUN ROAD                                           ","city":"ELLISTON                      ","state":"VA","zip":"24087-4359","dob":"1957-02-05","age":"","mstatus":"","insh":10056459,"cliId":"","pno":5404495459,"cno":5404495459,"email":"","ename":"","eno":"","pphy":"RAZA, SYED A                                                ","ppno":"","pcpadd":"3737 W Main St","pcpcity":"Salem                         ","pcpstate":"VA","pcpzip":241532073,"pcpcounty":"","pcpid":"P0060228","pcpname":"VALLEY INTERNAL MEDICINE ASSOCIATES PC","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"125 DARK RUN ROAD                                           ","madd2":"                                                            ","madd3":"","mcity":"ELLISTON                      ","mstate":"VA","mzip":"24087-4359","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J30.2","J45.909","D64.9","E78.5","M77.8","F33.9","G47.33","E66.01","K82.9","M25.561","H10.021","J01.90","J01.00","Z00.00","H10.32","H15.002","H57.12","R51","H15.092","S70.01XA","S40.011A","W19.XXXA","E66.9","H61.23","I10","H10.33","K56.609","K44.9","R16.1","R10.10","D72.829","I48.91","Z79.01","Z79.02","Z87.891","Z90.49","Z98.84","R04.0","R11.2","K56.699","R10.84","Z00.01","E05.90","D47.9","G89.4","F41.9","F32.9","E87.6","M54.5","R60.9","G60.9","E66.1","H60.501","Z23","M25.511","M19.011","M75.91","M77.9","M25.572","Z03.89","U07.1","H60.92"],"date":["2021-11-22","2021-11-22","2020-07-14","2021-11-22","2019-04-03","2020-06-05","2020-11-01","2020-02-12","2020-11-01","2020-11-01","2020-06-05","2021-10-21","2019-05-12","2019-05-31","2020-06-05","2019-08-17","2019-08-17","2019-08-17","2019-09-04","2019-12-05","2019-12-05","2019-12-06","2021-09-23","2021-10-21","2021-11-22","2020-05-05","2020-05-20","2020-05-19","2020-05-19","2020-05-19","2020-05-19","2021-11-22","2020-05-19","2020-05-19","2020-05-19","2020-05-19","2020-05-19","2020-05-19","2020-05-19","2020-05-20","2020-05-20","2021-11-22","2020-07-14","2020-07-14","2021-11-22","2021-09-23","2021-07-29","2021-09-23","2020-08-17","2021-07-19","2021-11-22","2020-11-01","2020-10-15","2021-11-22","2020-11-13","2020-11-03","2020-11-13","2020-11-13","2021-01-15","2021-07-29","2021-08-06","2021-10-21"],"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":[["","00406012505","HYDROCO\/APAP","10-325MG","120","Select","Select",""],["","00054429931","FUROSEMIDE","40MG","30","Select","Select",""],["","69238199201","DIGOXIN","0.25MG","30","Select","Select",""],["","65862001305","SERTRALINE","100MG","30","Select","Select",""],["","11917016631","CALCIUM+D3","600-800","120","Select","Select",""],["","62037099901","POT CL MICRO","20MEQ ER","180","Select","Select",""],["","00904759080","FEROSUL","325MG","60","Select","Select",""],["","59267100001","PFIZER","COVID-19","0.3","Select","Select",""],["","45802065087","LORATADINE","10MG","90","Select","Select",""],["","68462019005","NAPROXEN","500MG","15","Select","Select",""],["","66685100100","AMOX\/K","875-125","20","Select","Select",""],["","00093317431","ALBUTEROL","E","25.5","Select","Select",""],["","61314064511","NEO\/POLY\/HC","1% OTIC","10","Select","Select",""],["","00781808926","AZITHROMYCIN","250MG","6","Select","Select",""],["","00406012505","HYDROCO\/APAP ","TAB 10-325MG","120","Select","Select",""],["","00054429931","FUROSEMIDE ","TAB 40MG","30","Select","Select",""],["","69238199201","DIGOXIN ","TAB 0.25MG","30","Select","Select",""],["","65862001305","SERTRALINE ","TAB 100MG","30","Select","Select",""],["","11917016631","CALCIUM+D3 ","TAB 600-800","120","Select","Select",""],["","62037099901","POT  CL MICRO","TAB 20MEQ ER","180","Select","Select",""],["","00904759080","FEROSUL ","TAB 325MG","60","Select","Select",""],["","59267100001","PFIZER ","INJ COVID-19","0.3","Select","Select",""],["","45802065087","LORATADINE ","TAB 10MG","90","Select","Select",""],["","68462019005","NAPROXEN ","TAB 500MG","15","Select","Select",""],["","66685100100","AMOX\/K ","TAB 875-125","20","Select","Select",""],["","00093317431","ALBUTEROL ","FAT E","25.5","Select","Select",""],["","61314064511","NEO\/POLY\/HC ","SUS 1% OTIC","10","Select","Select",""],["","51224002218","AZITHROMYCIN ","TAB 250MG","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","",""],["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":""}]}]}