{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"PAMELA   D SOWERS","gend":1,"add":"2181 PEPPERS FERRY ROAD","city":"CHRISTIANSBURG","state":"VA","zip":"24073-6474","dob":"1970-02-23","age":"","mstatus":"","insh":10057510,"cliId":"","pno":5406295650,"cno":5406295650,"email":"","ename":"","eno":"","pphy":"HENDRICKS, WILLIAM T","ppno":5409510352,"pcpadd":"901 Plantation Rd Ste 3, ","pcpcity":"Blacksburg","pcpstate":"VA","pcpzip":240603821,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"APT C","add3":"","madd1":"2181 PEPPERS FERRY ROAD","madd2":"APT C","madd3":"","mcity":"CHRISTIANSBURG","mstate":"VA","mzip":"24073-6474","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F31.76","F31.4","M25.552","Z23","M54.5","N18.3","I70.0","G89.29","F11.229","F43.10","R68.89","F11.20","R20.2","J01.00","J20.9","R05","I10","F33.2","F41.1","Z79.899","K63.5","K29.70","K21.9","K31.89","K22.70","J02.9","R74.8","L30.9","J20.8","R94.31","M25.562","J06.9","R62.7","S01.01XA","S09.90XA","S06.0X0A","R11.0","Z87.19","K92.2","R13.19","F17.200","B37.81","K29.50","K21.0","M25.531","M65.4","E87.5","R60.9","R63.5","R09.81","M79.7","M41.86","M51.36","M51.37","M47.816","M47.817","M51.27","M48.061","M48.07","G56.01","Z01.419","R10.2","E28.319","Z13.820","R07.9","Z86.010","R10.13","R10.84","K29.51","F41.9","F31.9","I11.0","I50.9","D12.6","M67.88","Z12.39","M54.16","M54.9","M54.42","M79.89","H93.13","R42","H91.91"],"date":["2019-11-08","2020-12-10","2020-03-13","2019-10-17","2020-10-12","2019-10-17","2019-10-17","2020-10-12","2020-06-25","2021-05-02","2021-02-28","2021-05-04","2020-01-24","2020-02-25","2020-02-25","2020-02-25","2021-03-10","2021-02-05","2021-02-05","2019-09-04","2019-11-20","2019-11-20","2020-08-04","2019-11-20","2019-12-23","2021-03-31","2019-09-13","2020-05-28","2019-02-23","2019-11-18","2020-01-24","2020-04-06","2021-05-07","2019-04-17","2019-04-17","2019-04-17","2019-05-02","2019-05-02","2019-05-02","2019-05-02","2019-11-18","2019-05-24","2019-05-24","2019-11-20","2019-09-13","2019-09-13","2019-10-24","2019-12-30","2019-12-30","2020-03-13","2021-02-26","2020-09-30","2020-09-30","2020-09-30","2020-09-30","2020-09-30","2020-09-30","2020-09-30","2020-09-30","2019-08-21","2019-09-10","2019-09-10","2019-09-10","2019-09-10","2019-11-14","2019-11-20","2019-11-18","2019-11-18","2019-11-20","2019-11-18","2019-11-18","2019-11-18","2019-11-18","2019-11-20","2019-11-12","2019-11-25","2020-10-12","2020-08-04","2020-08-24","2021-02-26","2021-02-26","2021-02-26","2021-02-26"],"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":[["","65862052405","GABAPENTIN ","TAB 800MG","90","Select","Select",""],["","68180098003","LISINOPRIL ","TAB 10MG","90","Select","Select",""],["","55111015810","OMEPRAZOLE ","CAP 20MG","180","Select","Select",""],["","57664050183","MIRTAZAPINE ","TAB 45MG","30","Select","Select",""],["","65862085901","FAMOTIDINE ","TAB 20MG","30","Select","Select",""],["","00536589688","NICOTINE ","DIS 21MG\/24H","28","Select","Select",""],["","00054001829","PREDNISONE ","TAB 20MG","10","Select","Select",""],["","29300011101","LAMOTRIGINE ","TAB 25MG","30","Select","Select",""],["","69097015907","MELOXICAM ","TAB 15MG","30","Select","Select",""],["","00093005805","TRAMADOL ","TAB 50MG","20","Select","Select",""],["","00185067405","HYDROXYZ ","CAP 25MG","30","Select","Select",""],["","45802065078","LORATADINE ","TAB 10MG","30","Select","Select",""],["","49281042050","FLUZONE ","INJ 2020-21","0.5","Select","Select",""],["","00781808926","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","49884093547","DICLOFENAC ","GEL 0.01","100","Select","Select",""],["","00168000615","TRIAMCINOLON ","OIN 0.001","15","Select","Select",""],["","70954001910","PRAZOSIN ","CAP 1MG","60","Select","Select",""],["","00054327099","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","52268001201","SUPREP ","SOL PREP KIT","354","Select","Select",""],["","67877057505","BENZONATATE ","CAP 200MG","30","Select","Select",""],["","59746000103","METHYLPRED ","TAB 4MG","21","Select","Select",""],["","00093314705","CEPHALEXIN ","CAP 500MG","30","Select","Select",""],["","00093026430","FLUOCINONIDE ","OIN 0.0005","30","Select","Select",""],["","69230031703","ALLERGY ","10MG","90","Select","Select",""],["","69315011610","FUROSEMIDE ","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":[[["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":""}]}]}