{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DAVID   E ROBERTSON","gend":0,"add":"PO BOX 46","city":"THAXTON","state":"VA","zip":"24174-0046","dob":"1963-03-25","age":"","mstatus":"","insh":10057611,"cliId":"","pno":5406553675,"cno":"               ","email":"","ename":"","eno":"","pphy":"WILGUS, ALEXANDER M","ppno":4342005200,"pcpadd":"171 W Main St, ","pcpcity":"Bedford","pcpstate":"VA","pcpzip":245231950,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":5409154814,"add2":"                                                            ","add3":"","madd1":"PO BOX 46","madd2":"                                                            ","madd3":"","mcity":"THAXTON","mstate":"VA","mzip":"24174-0046","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F33.1","F10.129","F10.120","F32.9","J44.1","F10.10","F33.9","T43.596A","Z91.128","Z91.19","Z91.14","F41.9","F25.9","F17.210","F17.290","H90.5","J44.9","Z23","Z72.0","R63.4","E78.5","N40.1","T50.905A","E55.9","N13.8","G47.00","R19.5","W19.XXXA","Y93.9","Y92.9","Y99.9","R45.851","F33.2","R44.0","S40.022A","S00.83XA","J43.9","R06.02","F10.929","I10","E86.0","Z99.81","F19.94","G89.4","Z79.899","F19.980","R68.89","R93.0","R41.82","G31.9","Z43.8","R40.4","R05","J93.0","J96.01","F17.200","F41.8","Z93.8","J93.83","J93.9","Y83.8","J96.21","J81.0","J18.9","Z20.822","H91.90","Z91.5","D72.829","Z03.89","F10.24","F10.20","F10.229","F41.1","F41.0","F40.10","M25.60","R30.0","R39.198","M19.90","Z87.11","F12.90","Z79.51","R07.9","R91.8","R07.89","J45.909","M25.541","F32.1","S43.491A","S46.911A","M25.50","Z04.1","R06.00","Z20.9","F29","R09.02","E03.9","R47.81","R00.0","I95.9","R06.9","R06.2","R11.0","F32.89","J96.11","F25.8","F33.40","Z20.828","N40.0","Z79.52","J96.22","E87.2","Z09","F13.10","F39","F23","R44.3","F33.41","Y90.5","R06.89","F10.920","E86.1","R53.83","R97.20","B37.0","I51.7","I45.19","Z11.59","J18.1","F19.10","Z46.82"],"date":["2020-02-27","2020-04-25","2019-01-28","2020-09-09","2021-04-24","2021-04-19","2020-06-06","2019-01-29","2019-01-29","2019-01-29","2020-01-11","2020-09-09","2021-04-19","2021-04-19","2021-04-19","2019-05-02","2021-04-19","2019-11-13","2021-05-10","2019-11-13","2020-09-09","2020-09-09","2019-11-13","2020-06-16","2019-11-13","2020-09-09","2019-11-13","2020-01-11","2020-01-11","2020-01-11","2020-01-11","2021-04-11","2020-01-11","2020-02-26","2020-01-11","2020-01-11","2021-05-10","2021-04-11","2020-05-15","2020-05-15","2020-06-07","2021-04-19","2020-08-20","2021-04-19","2020-09-09","2020-08-21","2020-08-21","2020-09-09","2020-09-09","2020-09-09","2021-04-28","2020-04-25","2020-06-07","2021-04-14","2021-04-14","2021-04-11","2021-04-11","2021-04-27","2021-05-10","2021-04-28","2021-04-19","2021-04-19","2021-04-19","2021-04-19","2021-04-19","2021-04-19","2021-04-19","2021-04-24","2021-04-24","2019-02-28","2020-06-16","2020-09-09","2019-06-02","2019-06-02","2019-06-02","2019-06-02","2019-06-02","2019-06-02","2019-09-08","2020-06-07","2021-04-11","2021-04-11","2020-05-15","2021-04-20","2021-04-11","2020-09-09","2019-05-10","2019-06-02","2019-05-10","2019-05-10","2019-05-10","2020-01-11","2020-02-27","2020-05-15","2020-05-15","2021-04-11","2020-09-09","2020-09-09","2021-04-23","2020-02-26","2021-04-11","2021-04-11","2021-04-11","2019-05-20","2020-06-07","2020-06-07","2020-06-07","2020-06-07","2021-04-11","2020-06-07","2021-04-11","2021-04-11","2021-04-15","2019-03-05","2019-03-05","2019-03-24","2019-03-24","2019-03-24","2019-03-24","2019-08-13","2020-01-12","2020-02-26","2020-02-26","2020-06-16","2021-04-15","2021-04-19","2020-01-12","2020-06-07","2021-04-19","2021-04-19","2021-04-20"],"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":[["","00597007541","SPIRIVA ","CAP HANDIHLR","30","Select","Select",""],["","00173069600","ADVAIR ","AER 250\/50","60","Select","Select",""],["","00186037020","SYMBICORT ","AER 160-4.5","10.2","Select","Select",""],["","69097081507","GABAPENTIN ","CAP 400MG","90","Select","Select",""],["","00904672080","ACETAMIN ","TAB 500MG","18","Select","Select",""],["","45802086803","POLYETH ","POW 3350 NF","510","Select","Select",""],["","37000014343","ALIGN ","CAP 4MG","28","Select","Select",""],["","00000000000",""," ","120","Select","Select",""],["","70000051102","NICOTINE ","DIS 14MG\/24H","28","Select","Select",""],["","00093206301","QUETIAPINE ","TAB 25MG","30","Select","Select",""],["","16729008110","NALTREXONE ","TAB 50MG","14","Select","Select",""],["","13668001005","CITALOPRAM ","TAB 20MG","30","Select","Select",""],["","00228300350","CLONAZEPAM ","TAB 0.5MG","120","Select","Select",""],["","10702001150","HYDROXYZ ","TAB 25MG","84","Select","Select",""],["","43547030303","ARIPIPRAZOLE ","TAB 5MG","30","Select","Select",""],["","57237001401","TAMSULOSIN ","CAP 0.4MG","30","Select","Select",""],["","00093742698","MONTELUKAST ","TAB 10MG","30","Select","Select",""],["","69452015120","VITAMIN ","CAP 50000UNT","4","Select","Select",""],["","00378699252","ALBUTEROL ","NEB 1.25MG\/3","450","Select","Select",""],["","00143973805","PREDNISONE ","TAB 20MG","15","Select","Select",""],["","69842093108","ACETAMINOPHN ","TAB 500MG","60","Select","Select",""],["","50111056001","TRAZODONE ","TAB 50MG","60","Select","Select",""],["","70436005901","BUPROPION ","TAB 150MG SR","90","Select","Select",""],["","55111053401","DIVALPROEX ","TAB 500MG ER","30","Select","Select",""],["","59310057922","PROAIR ","AER ","8.5","Select","Select",""],["","65862022701","LAMOTRIGINE ","TAB 25MG","70","Select","Select",""],["","60432053760","NYSTATIN ","SUS 100000","140","Select","Select",""],["","70436001002","BUPROPN ","TAB 150MG XL","30","Select","Select",""],["","10702001801","OXYCODONE ","TAB 5MG","12","Select","Select",""],["","57664049983","MIRTAZAPINE ","TAB 15MG","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":""}]}]}