{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ANGELA   L PUCKETT","gend":1,"add":"1152 MARIGOLD DRIVE","city":"GOODVIEW","state":"VA","zip":"24095-2894","dob":"1969-06-13","age":"","mstatus":"","insh":10057380,"cliId":"","pno":5405832006,"cno":5405832006,"email":"","ename":"","eno":"","pphy":"REA, CATHERINE G","ppno":5409771436,"pcpadd":"37 Laymantown Rd, Ste 100","pcpcity":"Troutville","pcpstate":"VA","pcpzip":241756635,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"1152 MARIGOLD DRIVE","madd2":"                                                            ","madd3":"","mcity":"GOODVIEW","mstate":"VA","mzip":"24095-2894","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11.29","E11.65","E78.49","E03.9","J44.9","J45.20","G25.81","R25.1","G47.19","Z86.73","Z87.898","R80.9","Z79.4","F41.9","F32.9","K21.9","R82.90","G40.909","M25.551","M25.552","H93.11","Z12.11","Z11.59","R06.83","G47.36","Z87.891","Z20.828","I95.9","M25.511","M75.01","M25.611","M62.81","J02.9","R05","M79.10","N17.9","R53.1","D64.9","Z99.81","E11.9","J43.9","Z90.49","U07.1","R52","R06.9","R09.02","M54.5","Z23","R11.0","R39.9","R53.83","G47.9","R07.89","R07.81","M79.604","M79.605","R11.2","R19.7","R10.9","R51","S61.216A","W25.XXXA","Y93.G1","Y92.000","I69.354","Z79.899","S61.219D","J10.1","J40","R68.89","M25.559","J30.2","E11.618"],"date":["2021-04-12","2021-04-12","2021-04-12","2021-04-12","2021-04-12","2020-08-25","2021-04-12","2020-08-25","2020-08-25","2021-04-12","2020-08-25","2021-04-12","2021-04-12","2021-04-12","2021-04-12","2021-04-12","2021-04-12","2021-04-12","2021-05-03","2021-05-03","2019-04-16","2020-05-14","2020-05-14","2021-03-02","2021-03-02","2021-03-02","2020-12-24","2020-12-20","2021-05-04","2021-05-04","2021-05-04","2021-05-04","2020-12-10","2020-12-10","2020-12-10","2020-12-20","2020-12-20","2020-12-20","2020-12-20","2020-12-20","2020-12-20","2020-12-20","2020-12-20","2020-12-20","2020-12-20","2020-12-20","2020-12-20","2020-09-24","2019-01-09","2019-03-05","2020-09-08","2019-04-11","2020-01-10","2020-01-10","2020-01-10","2020-01-10","2020-09-08","2020-09-08","2021-02-23","2020-09-08","2020-10-23","2020-10-23","2020-10-23","2020-10-23","2020-10-23","2020-10-23","2020-11-03","2019-03-05","2019-03-12","2020-12-20","2021-02-23","2020-05-14","2021-03-17"],"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":[["","99073012050","FREESTYLE    TES","TES ","150","Select","Select",""],["","43547027110","ROPINIROLE ","TAB 2MG","30","Select","Select",""],["","65162019011","NAPROXEN ","TAB 500MG","20","Select","Select",""],["","69097082112","GEMFIBROZIL ","TAB 600MG","60","Select","Select",""],["","60505258008","ATORVASTATIN ","TAB 40MG","30","Select","Select",""],["","00228212750","CLONIDINE ","TAB 0.1MG","60","Select","Select",""],["","00169643810","LEVEMIR ","INJ FLEXTOUC","24","Select","Select",""],["","00378111001","GLIPIZIDE ","TAB 10MG","60","Select","Select",""],["","68382000914","LAMOTRIGINE ","TAB 150MG","60","Select","Select",""],["","71093011205","GABAPENTIN ","TAB 800MG","180","Select","Select",""],["","68180051303","LISINOPRIL ","TAB 5MG","90","Select","Select",""],["","00006027731","JANUVIA ","TAB 100MG","30","Select","Select",""],["","00173087310","INCRUSE ","INH 62.5MCG","30","Select","Select",""],["","00378181310","LEVOTHYROXIN ","TAB 125MCG","30","Select","Select",""],["","00378064110","PREDNISONE ","TAB 10MG","21","Select","Select",""],["","66993001968","ALBUTEROL ","AER HFA","18","Select","Select",""],["","00169633910","NOVOLOG ","INJ FLEXPEN","3","Select","Select",""],["","23155010410","METFORMIN ","TAB 1000MG","60","Select","Select",""],["","00093221005","SUCRALFATE ","TAB 1GM","120","Select","Select",""],["","31722054501","LITHIUM ","CAP 300MG","60","Select","Select",""],["","68180067711","OSELTAMIVIR ","CAP 75MG","10","Select","Select",""],["","57599000200","FREESTYLE    MIS READER","MIS READER","1","Select","Select",""],["","57599000101","FREESTYLE    KIT SENSOR","KIT SENSOR","2","Select","Select",""],["","65862069730","VENLAFAXINE ","CAP 150MG ER","30","Select","Select",""],["","57599157904","FREESTYLE    TES PREC NEO","TES PREC NEO","200","Select","Select",""],["","56151210401","PEN  NEEDLES  ","MIS 32GX4MM","200","Select","Select",""],["","00173068220","VENTOLIN ","AER ","18","Select","Select",""],["","00193731150","CONTOUR ","TES NEXT","100","Select","Select",""],["","23155050110","HYDROXYZ ","TAB 25MG","60","Select","Select",""],["","65862014836","SUMATRIPTAN ","TAB 100MG","8","Select","Select",""],["","08290320109","BD  PEN NEEDL","MIS 31GX8MM","100","Select","Select",""],["","00603158658","PROMETHAZINE ","SYP DM","120","Select","Select",""],["","99073070805","FREESTYLE    MIS LITE","MIS LITE","1","Select","Select",""],["","47781030301","NITROFURANTN ","CAP 100MG","10","Select","Select",""],["","58160082311","SHINGRIX ","INJ 50\/0.5ML","1","Select","Select",""],["","68462015713","ONDANSETRON ","TAB 4MG ODT","12","Select","Select",""],["","00781577626","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","50111033401","METRONIDAZOL ","TAB 500MG","30","Select","Select",""],["","68180035202","SERTRALINE ","50MG","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":""}]}]}