{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MELISSA   E NUNEZ","gend":1,"add":"709 N BEVERLY AVENUE","city":"COVINGTON","state":"VA","zip":"24426-1315","dob":"1986-03-27","age":"","mstatus":"","insh":10056611,"cliId":"","pno":5406201256,"cno":5406201256,"email":"","ename":"","eno":"","pphy":"HENDERSON, ROBERT J","ppno":5408626659,"pcpadd":"2145 Mount Pleasant Blvd SE, ","pcpcity":"Roanoke","pcpstate":"VA","pcpzip":240143632,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":5408620586,"add2":"                                                            ","add3":"","madd1":"709 N BEVERLY AVENUE","madd2":"                                                            ","madd3":"","mcity":"COVINGTON","mstate":"VA","mzip":"24426-1315","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z01.419","Z71.9","M54.9","M54.16","I10","Z34.81","Z36.82","O36.8130","Z3A.29","Z23","O09.93","O36.5930","Z3A.31","Z3A.33","Z3A.36","Z09","Z39.2","Z30.09","Z30.42","N93.9","J32.9","F41.9","K21.9","M50.223","M54.2","Z39.1","Z34.82","Z34.83","J01.90","M54.5","G62.9","M51.17","Z32.01","Z36.89","R06.02","J20.9","Z72.0","O99.89","R05","Z3A.27","J06.9","Z36.85","E66.9","F32.9","G89.29","J40","J18.9","J43.9","F31.9","F20.9","A41.9","F17.200","E03.9","E87.6","Z79.51","Z68.39","Z20.822","Z11.51","O20.0","O99.519","O13.9","O99.330","Z3A.00","I51.7","I50.9","N89.8","Z37.9","Z3A.37","Z30.431","R10.2","R06.00","J44.9","Z3A.28","O34.211","Z34.93","O16.4","O99.820","Z37.0","O34.219","Z98.891","O09.299","O36.70X0","Z3A.11","J96.01","O09.90","Z3A.35","Z30.430","Z32.02","E78.5","N91.2","O09.92","Z3A.26","O99.513","Z3A.34","R09.89","R11.0","J12.9","J44.1","O26.833","N17.9","J44.0","O99.283","O99.343","F17.210","R20.0","L98.9","R10.9","R79.1","N91.0","O42.911","O99.281","O16.1","O99.511","O99.341","Z79.890","R50.9","R07.9","Z36.2","J18.0","M50.222"],"date":["2020-02-19","2021-05-14","2020-01-28","2019-02-11","2021-05-14","2019-06-03","2019-06-03","2019-10-01","2019-10-01","2019-10-28","2019-11-11","2019-11-22","2019-10-28","2019-11-11","2019-11-21","2019-11-26","2020-01-28","2020-01-28","2020-01-28","2020-07-23","2020-07-23","2021-05-14","2020-07-23","2020-12-15","2020-12-15","2021-02-11","2021-02-11","2021-02-11","2021-05-07","2019-01-28","2019-01-22","2019-01-28","2021-01-15","2019-07-18","2021-05-10","2021-01-12","2019-09-15","2019-09-17","2021-05-10","2019-09-17","2019-10-15","2019-11-18","2021-05-10","2020-04-10","2020-01-28","2021-02-17","2021-05-14","2021-05-10","2021-05-10","2021-05-10","2021-05-10","2021-05-10","2021-05-14","2021-05-14","2021-05-10","2021-05-10","2021-05-10","2020-02-19","2019-04-16","2019-09-15","2019-09-15","2019-09-15","2019-11-22","2019-09-19","2019-09-19","2019-11-05","2019-11-22","2019-11-22","2020-03-03","2020-03-03","2019-09-22","2019-09-22","2019-09-22","2019-11-22","2019-11-22","2019-11-22","2019-11-22","2019-11-22","2019-11-22","2019-11-07","2019-05-06","2019-05-29","2019-05-29","2019-09-21","2019-11-11","2019-11-14","2020-02-19","2020-02-19","2021-02-24","2019-04-09","2019-09-10","2019-09-10","2019-10-15","2019-11-07","2021-05-14","2021-05-14","2019-09-21","2019-09-21","2019-09-21","2019-09-21","2021-05-10","2019-09-21","2019-09-21","2019-09-21","2020-11-25","2020-11-25","2021-01-15","2021-05-10","2019-05-06","2019-05-29","2019-05-29","2019-05-29","2019-05-29","2019-05-29","2019-05-29","2019-09-15","2019-09-20","2019-09-20","2019-10-09","2020-12-15"],"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":[["","45802026937","PERMETHRIN ","CRE 0.05","60","Select","Select",""],["","68682010810","NIFEDIPINE ","TAB 30MG ER","30","Select","Select",""],["","68180016013","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","69097083512","SERTRALINE ","TAB 100MG","30","Select","Select",""],["","47781055401","LABETALOL ","TAB 300MG","60","Select","Select",""],["","00378180310","LEVOTHYROXIN ","TAB 50MCG","30","Select","Select",""],["","00093317431","ALBUTEROL ","FAT E","8.5","Select","Select",""],["","00591505221","PREDNISONE ","PAK 5MG","21","Select","Select",""],["","55111015810","OMEPRAZOLE ","CAP 20MG","30","Select","Select",""],["","65862001501","AMOXICILLIN ","TAB 875MG","14","Select","Select",""],["","65162074510","PROMETHAZINE ","TAB 12.5MG","30","Select","Select",""],["","68180012202","CEPHALEXIN ","CAP 500MG","56","Select","Select",""],["","00186037020","SYMBICORT ","AER 160-4.5","10.2","Select","Select",""],["","59762453802","MEDROXYPR ","INJ 150MG\/ML","1","Select","Select",""],["","00093083205","CLONAZEPAM ","TAB 0.5MG","60","Select","Select",""],["","65862050320","AMOX\/K ","TAB 875-125","14","Select","Select",""],["","10702001801","OXYCODONE ","TAB 5MG","20","Select","Select",""],["","31722070430","VALACYCLOVIR ","TAB 500MG","10","Select","Select",""],["","67877032105","IBUPROFEN ","TAB 800MG","20","Select","Select",""],["","53746010901","HYDROCO\/APAP ","TAB 5-325MG","20","Select","Select",""],["","65862053750","LEVOFLOXACIN ","TAB 500MG","7","Select","Select",""],["","69097015907","MELOXICAM ","TAB 15MG","30","Select","Select",""],["","10631040701","PROCTOSOL ","CRE 0.025","56.7","Select","Select",""],["","70461031903","FLUCLVX ","INJ 2019-20","0.5","Select","Select",""],["","45802048678","DOCUSATE ","CAP 100MG","30","Select","Select",""],["","70710113908","FLUCONAZOLE ","TAB 150MG","1","Select","Select",""],["","50111033401","METRONIDAZOL ","TAB 500MG","14","Select","Select",""],["","68462010630","ONDANSETRON ","TAB 8MG","15","Select","Select",""],["","00093005805","TRAMADOL ","50MG","24","Select","Select",""],["","00603459315","METHYLPRED ","4MG","21","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":""}]}]}