{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JANICE BROOKS","gend":1,"add":"PO BOX 223","city":"CLINCHCO","state":"VA","zip":"24226-0223","dob":"1948-05-15","age":"","mstatus":"","insh":10059269,"cliId":"","pno":2768352125,"cno":2768352125,"email":"","ename":"","eno":"","pphy":"COPLEY, CHRISTOPHER","ppno":2769351760,"pcpadd":"8243 RIVERSIDE DR, ","pcpcity":"OAKWOOD","pcpstate":"VA","pcpzip":246318973,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"SOUTHWEST","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"PO BOX 223","madd2":"                                                            ","madd3":"","mcity":"CLINCHCO","mstate":"VA","mzip":"24226-0223","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K21.9","K59.00","K64.8","K64.4","R14.0","I10","E78.5","E11.9","E87.1","M54.5","E66.9","Z79.02","Z79.4","Z79.899","J10.89","J20.9","Z87.891","H40.1131","H25.813","E10.69","R53.1","R68.89","M16.12","M79.605","M79.604","M25.552","M25.551","Z76.0","M19.90","S39.012A","W01.0XXA","Y93.9","Y92.9","I25.10","M16.0","R26.2","F41.1","Z00.8","Z13.9","Z71.89","Z13.89","E87.6","E11.65","E55.9","D51.9","H25.13","E11.43","F17.200","J10.1","R05","S40.022A","W19.XXXA","F32.9","F03.90","S90.32XA","M79.672","Y93.01","Z79.84","Z79.82","K20.9","Z12.11","K22.10","K29.50","M79.602","S49.92XA","W50.0XXA","I11.0","I50.9","F41.9","R73.9","E87.5","S33.5XXA","M79.89","Z23"],"date":["2019-10-08","2019-01-10","2019-01-10","2019-01-10","2019-01-10","2021-05-18","2021-03-23","2021-05-18","2019-01-10","2019-11-13","2019-01-10","2019-01-10","2019-01-10","2021-05-18","2019-02-20","2019-02-20","2019-04-18","2020-05-21","2019-04-02","2019-04-23","2019-04-23","2021-01-13","2020-01-06","2020-01-06","2020-01-06","2020-01-06","2020-01-06","2019-05-30","2019-07-29","2019-09-07","2021-05-18","2019-09-07","2019-09-07","2020-01-06","2020-01-06","2020-01-06","2021-03-23","2021-05-05","2021-05-05","2020-02-12","2021-05-05","2019-04-18","2019-04-23","2021-01-13","2019-11-13","2020-05-21","2021-05-05","2021-05-05","2019-02-20","2019-02-20","2019-06-14","2019-06-14","2019-07-29","2019-07-29","2021-05-18","2021-05-18","2021-05-18","2021-05-18","2021-05-18","2019-01-10","2019-02-18","2019-02-18","2019-02-18","2019-06-14","2019-06-14","2019-06-14","2019-06-14","2019-06-14","2019-06-14","2019-04-18","2019-04-23","2019-09-07","2021-05-18","2019-10-08"],"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":[["","70069000501","CYANOCOBALAM ","INJ 1000MCG","1","Select","Select",""],["","16571020110","DICLOFENAC ","TAB 75MG DR","14","Select","Select",""],["","59762040101","SUCRALFATE ","TAB 1GM","120","Select","Select",""],["","68382080501","TRAZODONE ","TAB 50MG","30","Select","Select",""],["","00378668910","PANTOPRAZOLE ","TAB 40MG","30","Select","Select",""],["","00591086001","LISINOP\/HCTZ ","TAB 10-12.5","30","Select","Select",""],["","08290326895","BD ","PAD SNGL USE","100","Select","Select",""],["","99073070827","FREESTYLE    TES LITE","TES LITE","100","Select","Select",""],["","99073013001","FREESTYLE    MIS LANCETS","MIS LANCETS","100","Select","Select",""],["","08222710086","PEN  NEEDLES  ","MIS 31GX6MM","60","Select","Select",""],["","65862001105","SERTRALINE ","TAB 25MG","30","Select","Select",""],["","00002771559","BASAGLAR ","INJ 100UNIT","15","Select","Select",""],["","33342010215","MONTELUKAST ","TAB 10MG","30","Select","Select",""],["","08290309626","1ML ","MIS 25GX5\/8\"","1","Select","Select",""],["","99073070805","FREESTYLE    MIS LITE","MIS LITE","1","Select","Select",""],["","16729000615","SIMVASTATIN ","TAB 40MG","30","Select","Select",""],["","59762033302","LATANOPROST ","SOL 0.00005","2.5","Select","Select",""],["","00006027731","JANUVIA ","TAB 100MG","30","Select","Select",""],["","60505014200","GLIPIZIDE ","TAB 10MG","60","Select","Select",""],["","63868036336","ASPIRIN ","TAB 81MG EC","30","Select","Select",""],["","00603158658","PROMETHAZINE ","SYP DM","240","Select","Select",""],["","67877019810","AMLODIPINE ","TAB 5MG","30","Select","Select",""],["","00088221905","LANTUS ","INJ 100\/ML","30","Select","Select",""],["","13107003134","MIRTAZAPINE ","TAB 15MG","30","Select","Select",""],["","45802065087","LORATADINE ","TAB 10MG","30","Select","Select",""],["","45963043864","ENULOSE ","SOL 10GM\/15","900","Select","Select",""],["","33342015711","CELECOXIB ","CAP 200MG","30","Select","Select",""],["","71093011105","GABAPENTIN ","TAB 600MG","90","Select","Select",""],["","69452015120","VITAMIN ","CAP 50000UNT","13","Select","Select",""],["","57237002501","GLYB\/METFORM ","TAB 5-500MG","60","Select","Select",""],["","69230031203","ALLERGY ","TAB 10MG","90","Select","Select",""],["","00456342133","NAMENDA ","CAP 21MG","30","Select","Select",""],["","00093936405","GLYBURIDE ","TAB 5MG","60","Select","Select",""],["","08470115001","UNIFINE ","MIS 31GX3\/16","30","Select","Select",""],["","68001033708","LISINOPRIL ","TAB 40MG","30","Select","Select",""],["","67877056310","METFORMIN ","TAB 1000MG","60","Select","Select",""],["","68382005105","MELOXICAM ","TAB 15MG","30","Select","Select",""],["","68001019703","ESCITALOPRAM ","TAB 20MG","30","Select","Select",""],["","68462047201","POT  CL MICRO","TAB 20MEQ ER","10","Select","Select",""],["","00113048471","PAIN ","TAB 500MG","60","Select","Select",""],["","43547026910","ROPINIROLE ","TAB 0.5MG","90","Select","Select",""],["","00185067405","HYDROXYZ ","CAP 25MG","90","Select","Select",""],["","69543013650","TRAMADOL ","TAB 50MG","6","Select","Select",""],["","00904675816","ROBAFEN ","LIQ 10-100MG","180","Select","Select",""],["","67405060301","FLUCONAZOLE ","TAB 150MG","3","Select","Select",""],["","00456120230","LINZESS ","CAP 290MCG","30","Select","Select",""],["","43547040010","CYCLOBENZAPR ","TAB 10MG","90","Select","Select",""],["","49281063115","FLUZONE ","INJ 2019-20","0.5","Select","Select",""],["","47781047013","OSELTAMIVIR ","CAP 75MG","10","Select","Select",""],["","69315030615","NYSTATIN ","POW 100000","15","Select","Select",""],["","65862064163","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","52565008515","GENTAMICIN ","CRE 0.001","15","Select","Select",""],["","70461012003","FLUAD ","INJ 0.5ML","0.5","Select","Select",""],["","00406048401","APAP\/CODEINE ","TAB 300-30MG","12","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":""}]}]}