{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"PEGGY   J MOORE","gend":1,"add":"505 W MAIN STREET","city":"APPALACHIA","state":"VA","zip":"24216-1726","dob":"1948-09-22","age":"","mstatus":"","insh":10060397,"cliId":"","pno":2765651349,"cno":2765651349,"email":"","ename":"","eno":"","pphy":"BASHAM, CHRISTOPHER M","ppno":2766790321,"pcpadd":"295 Wharton Ln NE, ","pcpcity":"Norton","pcpstate":"VA","pcpzip":242731541,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"SOUTHWEST","aligned":"","ano":"","add2":"APT 7D","add3":"","madd1":"505 W MAIN STREET","madd2":"APT 7D","madd3":"","mcity":"APPALACHIA","mstate":"VA","mzip":"24216-1726","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11.40","D50.9","E78.2","Z79.4","Z12.11","Z86.010","K64.8","E11.9","K21.9","I10","F32.89","Z87.891","L30.4","L98.7","E66.01","L03.115","R50.9","M79.661","I70.203","R60.0","E11.8","E11.65","E55.9","R68.2","Z12.31","Z79.899","B37.89","M10.9","F41.9","J30.2","K59.00","M79.89","I73.9","S31.109A","E65","S81.801A","L98.9","B85.3","Z51.81","C44.90","M54.5","M79.605","G47.00","R21","R60.9","R06.02","Z78.0","Z13.820","G47.01","B95.61","S81.801S","E11.628","L03.90","X58.XXXS","Z01.810","Z09","R09.81","L97.919","X58.XXXA","R06.00","D22.9","C44.321","D22.5","H10.13","R82.998"],"date":["2021-02-02","2020-05-04","2021-05-04","2021-04-27","2019-07-05","2019-07-05","2019-07-05","2021-01-26","2021-02-02","2021-05-04","2019-07-05","2020-09-08","2019-09-10","2019-09-10","2019-09-10","2020-10-07","2020-07-11","2020-07-11","2020-09-10","2020-12-23","2020-11-03","2021-05-04","2021-05-04","2021-05-04","2021-05-04","2020-11-03","2020-05-04","2020-07-29","2020-11-03","2021-05-04","2020-11-03","2020-09-08","2020-09-08","2021-02-24","2021-05-04","2020-09-23","2021-05-04","2021-05-04","2021-05-04","2021-05-04","2020-08-13","2020-08-13","2020-09-08","2020-10-21","2020-12-15","2020-12-15","2019-07-12","2019-07-12","2020-11-03","2020-10-07","2020-10-07","2020-10-07","2020-10-07","2020-10-07","2019-07-05","2019-07-05","2019-01-23","2020-09-08","2020-09-08","2020-12-23","2021-01-12","2021-02-09","2021-02-09","2020-08-03","2021-04-27"],"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":[["","00169750111","NOVOLOG ","INJ 100\/ML","10","Select","Select",""],["","68001025320","FLUCONAZOLE ","TAB 150MG","1","Select","Select",""],["","43386031208","GAVILAX ","POW ","238","Select","Select",""],["","68462039610","OMEPRAZOLE ","CAP 20MG","30","Select","Select",""],["","00527131301","PILOCARPINE ","TAB 5MG","90","Select","Select",""],["","00024586903","TOUJEO ","INJ 300IU\/ML","4.5","Select","Select",""],["","00904678370","ASPIRIN ","TAB 81MG EC","30","Select","Select",""],["","67877049005","EZETIMIBE ","TAB 10MG","30","Select","Select",""],["","29300034901","ALLOPURINOL ","TAB 100MG","120","Select","Select",""],["","80777027399","MODERNA ","INJ COVID-19","0.5","Select","Select",""],["","57664016758","METOPROL ","TAB 100MG","60","Select","Select",""],["","60505267109","ATORVASTATIN ","TAB 80MG","30","Select","Select",""],["","45802065087","LORATADINE ","TAB 10MG","90","Select","Select",""],["","08290320109","BD  PEN NEEDL","MIS 31GX8MM","100","Select","Select",""],["","33342005507","PIOGLITAZONE ","TAB 30MG","30","Select","Select",""],["","00904759182","FERROUS ","TAB 325MG","30","Select","Select",""],["","65862098799","POT  CHLORIDE","TAB 10MEQ ER","3","Select","Select",""],["","00904645780","DOK ","CAP 100MG","60","Select","Select",""],["","13668011510","LOSARTAN ","TAB 100MG","30","Select","Select",""],["","10370083105","DILTIAZEM ","CAP 240MG ER","30","Select","Select",""],["","60505014202","GLIPIZIDE ","TAB 10MG","30","Select","Select",""],["","00168003346","BETAMETH ","OIN 0.001","45","Select","Select",""],["","16729017317","AMITRIPTYLIN ","TAB 50MG","30","Select","Select",""],["","00185005501","METOLAZONE ","TAB 5MG","3","Select","Select",""],["","69097095705","PREGABALIN ","CAP 100MG","90","Select","Select",""],["","00193731221","CONTOUR ","TES NEXT","100","Select","Select",""],["","68308015260","NYSTATIN ","POW 100000","60","Select","Select",""],["","08290326895","BD ","PAD SNGL USE","100","Select","Select",""],["","00574200802","NYSTOP ","POW 100000","60","Select","Select",""],["","08290328418","INSULIN ","MIS 1ML\/31G","360","Select","Select",""],["","67777012114","ALCOHOL ","PAD ","100","Select","Select",""],["","00071101568","LYRICA ","CAP 100MG","90","Select","Select",""],["","33332041910","AFLURIA ","INJ 2019-20","0.5","Select","Select",""],["","68180012202","CEPHALEXIN ","CAP 500MG","40","Select","Select",""],["","00006011231","JANUVIA ","TAB 50MG","30","Select","Select",""],["","00143980305","DOXYCYCL ","CAP 100MG","20","Select","Select",""],["","42571025201","CLINDAMYCIN ","CAP 300MG","40","Select","Select",""],["","46122001431","GNP ","POW ","238","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","21","Select","Select",""],["","65862012701","TORSEMIDE ","TAB 20MG","10","Select","Select",""],["","52268001201","SUPREP ","SOL PREP KIT","354","Select","Select",""],["","00904759182","FEROSUL ","TAB 325MG","30","Select","Select",""],["","70461012003","FLUAD ","INJ 0.5ML","0.5","Select","Select",""],["","00904699880","DOCUSATE ","100MG","60","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":""}]}]}