{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DELIA   M REYNOLDS","gend":1,"add":"11729 HIGHLANDS DRIVE","city":"POUND","state":"VA","zip":"24279-5621","dob":"1961-08-03","age":"","mstatus":"","insh":10060903,"cliId":"","pno":2764090075,"cno":2762202241,"email":"","ename":"","eno":"","pphy":"BEVINS, ASHLEY R","ppno":2766798890,"pcpadd":"716 Spring Ave SE, Ste 204","pcpcity":"Wise","pcpstate":"VA","pcpzip":242935702,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"SOUTHWEST","aligned":"","ano":2762073092,"add2":"                                                            ","add3":"","madd1":"11729 HIGHLANDS DRIVE","madd2":"                                                            ","madd3":"","mcity":"POUND","mstate":"VA","mzip":"24279-5621","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R68.89","Z12.31","F20.9","Z79.899","M19.011","Z96.611","Z91.14","R79.9","Z04.89","R74.8","E11.9","D64.9","K76.0","R16.1","D69.6","R13.14","E55.9","M25.511","K58.9","J44.9","K21.9","Z45.89","Z79.84","Z47.1","E04.1","G89.4","M53.3","M47.816","Z86.010","K63.5","K57.90","M17.12","G60.3","J30.9","H25.813","H52.03","H52.223","H52.4","T84.498A","M19.90","R07.9","K57.32","R19.5","F41.9","M25.562","M17.10","M19.111","Z12.11","M54.5","G89.29","M51.37","M12.88","E78.5","Z87.81","M85.851","M85.852","T84.498D","M62.81","D12.6","R19.7","R03.0","Z78.0","M81.0","Z87.891","Z01.818","Z01.812","R79.89","G89.18","Z99.81","E66.9","Z90.49","D12.2","D12.3","R71.8","R06.00","R92.1","T14.8XXA","F31.9","M51.36","Z88.8","Z91.030","Z53.8","I10"],"date":["2021-02-24","2020-03-04","2021-04-13","2021-02-24","2019-08-12","2020-03-04","2019-08-12","2020-02-05","2021-02-24","2020-12-28","2021-04-30","2021-03-16","2021-05-19","2021-05-19","2021-05-19","2021-05-19","2019-03-21","2020-06-04","2021-03-16","2021-03-16","2021-03-16","2019-06-17","2021-04-30","2019-09-12","2020-03-04","2020-06-04","2020-09-23","2021-03-19","2021-03-16","2021-03-16","2021-03-16","2021-04-14","2019-02-18","2019-03-21","2021-04-30","2021-04-30","2021-04-30","2021-04-30","2019-06-17","2020-09-23","2020-05-27","2020-05-19","2021-02-22","2021-02-22","2021-04-09","2021-04-29","2019-05-21","2021-03-16","2020-09-23","2020-09-23","2020-07-28","2020-07-28","2021-03-16","2019-01-04","2019-04-22","2019-04-22","2019-07-01","2019-07-01","2019-07-19","2019-07-19","2020-04-21","2019-04-22","2019-04-22","2021-03-16","2019-06-10","2019-06-10","2019-06-10","2019-06-17","2020-03-10","2020-03-10","2021-03-05","2021-03-16","2021-03-16","2021-03-16","2019-07-23","2020-03-04","2020-06-10","2021-03-16","2021-03-16","2021-03-16","2021-03-16","2021-03-16","2021-03-29"],"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":[["","42858010401","OXYCOD\/APAP ","TAB 10-325MG","49","Select","Select",""],["","76385010410","BENZTROPINE ","TAB 1MG","30","Select","Select",""],["","13107003105","MIRTAZAPINE ","TAB 15MG","30","Select","Select",""],["","16729011917","MONTELUKAST ","TAB 10MG","30","Select","Select",""],["","62756014202","METFORMIN ","TAB 500MG ER","60","Select","Select",""],["","68462039610","OMEPRAZOLE ","CAP 20MG","60","Select","Select",""],["","69543038530","OLANZAPINE ","TAB 20MG","30","Select","Select",""],["","99073070827","FREESTYLE    TES LITE","TES LITE","100","Select","Select",""],["","99073070914","FREESTYLE    KIT FREEDOM","KIT FREEDOM","1","Select","Select",""],["","87701040750","GNP ","TAB 1000UNIT","30","Select","Select",""],["","59385002260","BELBUCA ","MIS 150MCG","60","Select","Select",""],["","57237016999","ROSUVASTATIN ","TAB 10MG","30","Select","Select",""],["","69452015120","VITAMIN ","CAP 50000UNT","4","Select","Select",""],["","16571040250","CETIRIZINE ","TAB 10MG","30","Select","Select",""],["","49884046565","CHOLESTYRAM ","POW 4GM","30","Select","Select",""],["","00185061501","HYDROXYZ ","CAP 50MG","30","Select","Select",""],["","65862001205","SERTRALINE ","TAB 50MG","30","Select","Select",""],["","00173086910","ANORO ","AER 62.5-25","60","Select","Select",""],["","62332002790","LOSARTAN ","TAB 25MG","30","Select","Select",""],["","00406012410","HYDROCO\/APAP ","TAB 7.5-325","42","Select","Select",""],["","31722053305","METHOCARBAM ","TAB 500MG","10","Select","Select",""],["","99073013001","FREESTYLE    MIS LANCETS","MIS LANCETS","100","Select","Select",""],["","00904678744","MAG ","SOL LEMON","296","Select","Select",""],["","68462011944","FLUCONAZOLE ","TAB 150MG","2","Select","Select",""],["","55111012705","CIPROFLOXACN ","TAB 500MG","20","Select","Select",""],["","68001036503","METRONIDAZOL ","TAB 500MG","30","Select","Select",""],["","00904759080","FEROSUL ","TAB 325MG","30","Select","Select",""],["","68462024805","RANITIDINE ","TAB 150MG","60","Select","Select",""],["","49502010202","EPINEPHRINE ","INJ 0.3MG","2","Select","Select",""],["","67877026410","DULOXETINE ","CAP 30MG","30","Select","Select",""],["","11822060597","RA ","LIE F 10 MG T","30","Select","Select",""],["","91237000103","COMFORT-HEAL ","PAD 12\"X24\"","1","Select","Select",""],["","72217000402","PROCARE ","MIS BP MONIT","1","Select","Select",""],["","99073070805","FREESTYLE    MIS LITE","MIS LITE","1","Select","Select",""],["","00597015330","JARDIANCE ","TAB 25MG","30","Select","Select",""],["","57237007530","ONDANSETRON ","TAB 4MG","2","Select","Select",""],["","60505082901","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","00904792760","BISACODYL ","TAB 5MG EC","4","Select","Select",""],["","00904759180","FERROUS ","TAB 325MG","21","Select","Select",""],["","00781577626","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","00781502207","METHYLPRED ","TAB 4MG","21","Select","Select",""],["","00591555510","PROPRANOLOL ","20MG","180","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":""}]}]}