{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MARY   E LAMB","gend":1,"add":"70 DEVELOPMENT  ROAD                                        ","city":"STUART                        ","state":"VA","zip":"24171-3820","dob":"1963-11-14","age":"","mstatus":"","insh":10056576,"cliId":"","pno":2766933357,"cno":2766933357,"email":"","ename":"","eno":"","pphy":"KRAMER, RALPH L                                             ","ppno":"","pcpadd":"18877 Jeb Stuart Hwy","pcpcity":"Stuart                        ","pcpstate":"VA","pcpzip":241715223,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"70 DEVELOPMENT  ROAD                                        ","madd2":"                                                            ","madd3":"","mcity":"STUART                        ","mstate":"VA","mzip":"24171-3820","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F51.01","F31.2","I10","F20.9","B86","E78.00","R40.20","R07.89","J96.90","T43.011A","R41.82","Y92.003","G92","J69.0","J96.01","E78.5","E87.6","F31.9","E66.9","Z68.35","T46.5X1A","T43.201A","F32.9","T50.992A","R11.10","Z46.82","R91.8","T42.4X2A","T43.012A","J96.21","J18.9","T50.901A","R06.89","T50.904A","Z46.59","I50.9","I51.7","J90","Z99.11","J96.22","J98.4","J96.10","H10.022","M54.41","F31.32","M54.5","M54.31","M54.16","R45.851"],"date":["2021-05-25","2021-09-30","2021-09-30","2021-09-30","2020-03-20","2021-09-30","2019-09-21","2019-09-20","2019-09-26","2019-09-20","2019-09-22","2019-09-20","2019-09-20","2019-09-30","2019-09-30","2019-09-20","2019-09-30","2019-09-30","2019-09-20","2019-09-20","2019-09-20","2019-09-20","2019-09-20","2019-09-20","2019-09-20","2019-09-23","2019-09-30","2019-09-30","2019-09-30","2019-09-30","2019-09-30","2019-09-30","2019-09-22","2019-09-22","2019-09-22","2019-09-22","2019-09-22","2019-09-25","2019-09-23","2019-09-26","2019-09-30","2019-12-03","2019-12-12","2020-06-18","2020-06-09","2020-06-18","2020-06-09","2020-06-18","2021-05-25"],"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":[["","50111043401","TRAZODONE","100MG","180","Select","Select",""],["","61874013030","VRAYLAR","3MG","30","Select","Select",""],["","68180051901","LISINOP\/HCTZ","20-12.5","30","Select","Select",""],["","50428606624","STOOL","100MG","60","Select","Select",""],["","50458056401","INVEGA","234\/1.5","1.5","Select","Select",""],["","59651017701","DOXEPIN","100MG","30","Select","Select",""],["","00603233832","APAP\/CODEINE","300-30MG","60","Select","Select",""],["","68180072003","AMLODIPINE","5MG","30","Select","Select",""],["","00378064205","PREDNISONE","20MG","15","Select","Select",""],["","58657070101","HALOPERIDOL","1MG","90","Select","Select",""],["","65862070360","ZIPRASIDONE","40MG","60","Select","Select",""],["","10702001250","HYDROXYZ","50MG","90","Select","Select",""],["","51991074890","DULOXETINE","60MG","30","Select","Select",""],["","31722054501","LITHIUM","300MG","90","Select","Select",""],["","45802065078","LORATADINE","10MG","30","Select","Select",""],["","59651000305","OMEPRAZOLE","40MG","30","Select","Select",""],["","55111053401","DIVALPROEX","500MG ER","30","Select","Select",""],["","65862085901","FAMOTIDINE","20MG","60","Select","Select",""],["","64380080307","RANITIDINE","150MG","60","Select","Select",""],["","70377000812","ROSUVASTATIN","20MG","30","Select","Select",""],["","68180061507","QUETIAPINE","300MG ER","60","Select","Select",""],["","65862096901","ESZOPICLONE","3MG","30","Select","Select",""],["","45802026937","PERMETHRIN","5%","120","Select","Select",""],["","42799080601","IVERMECTIN","3MG","30","Select","Select",""],["","68180098003","LISINOPRIL","10MG","90","Select","Select",""],["","42806016105","HYDROXYZ ","TAB 50MG","270","Select","Select",""],["","65862070360","ZIPRASIDONE ","CAP 40MG","60","Select","Select",""],["","70377000812","ROSUVASTATIN ","TAB 20MG","30","Select","Select",""],["","50111043401","TRAZODONE ","TAB 100MG","180","Select","Select",""],["","61874013030","VRAYLAR ","CAP 3MG","30","Select","Select",""],["","68180051901","LISINOP\/HCTZ ","TAB 20-12.5","30","Select","Select",""],["","50428606624","STOOL ","CAP 100MG","60","Select","Select",""],["","50458056401","INVEGA ","INJ 234\/1.5","1.5","Select","Select",""],["","59651017701","DOXEPIN ","CAP 100MG","30","Select","Select",""],["","00603233832","APAP\/CODEINE ","TAB 300-30MG","60","Select","Select",""],["","68180072003","AMLODIPINE ","TAB 5MG","30","Select","Select",""],["","00378064205","PREDNISONE ","TAB 20MG","15","Select","Select",""],["","58657070101","HALOPERIDOL ","TAB 1MG","90","Select","Select",""],["","51991074890","DULOXETINE ","CAP 60MG","30","Select","Select",""],["","31722054501","LITHIUM ","CAP 300MG","90","Select","Select",""],["","45802065078","LORATADINE ","TAB 10MG","30","Select","Select",""],["","59651000305","OMEPRAZOLE ","CAP 40MG","30","Select","Select",""],["","55111053401","DIVALPROEX ","TAB 500MG ER","30","Select","Select",""],["","65862085901","FAMOTIDINE ","TAB 20MG","60","Select","Select",""],["","64380080307","RANITIDINE ","TAB 150MG","60","Select","Select",""],["","68180061507","QUETIAPINE ","TAB 300MG ER","60","Select","Select",""],["","65862096901","ESZOPICLONE ","TAB 3MG","30","Select","Select",""],["","45802026937","PERMETHRIN ","CRE 0.05","120","Select","Select",""],["","42799080601","IVERMECTIN ","TAB 3MG","30","Select","Select",""],["","68180098003","LISINOPRIL ","TAB 10MG","90","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":""}]}]}