{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"RHONDA MULLINS","gend":1,"add":"PO BOX 494","city":"POUND","state":"VA","zip":"24279-0494","dob":"1956-12-17","age":"","mstatus":"","insh":10061136,"cliId":"","pno":2768704296,"cno":2768704296,"email":"","ename":"","eno":"","pphy":"DEEL, ROY R","ppno":2769260200,"pcpadd":"364 Hospital Dr, ","pcpcity":"Clintwood","pcpstate":"VA","pcpzip":242286786,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"SOUTHWEST","aligned":"","ano":"","add2":"APT 7","add3":"","madd1":"PO BOX 494","madd2":"APT 7","madd3":"","mcity":"POUND","mstate":"VA","mzip":"24279-0494","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F33.2","F41.9","I10","G89.29","J32.9","F30.10","Z72.0","M81.0","Z78.0","J01.90","G89.4","M25.531","M19.90","F32.9","M51.34","M47.814","M41.84","M51.16","I63.9","G47.00","J18.9","A41.9","J44.1","B00.9","I25.10","E78.5","E55.9","Z29.8","R94.6","J32.0","K59.00","K21.9","M54.2","M54.9","R45.1","R68.82","N94.10","Z79.899","F43.21","R51","Z00.00","Z12.31","Z12.72","R06.02","J02.9","R05","F17.210","Z79.02","Z79.82","Z20.828","J44.0","J31.0","Z51.81","Z87.01","J01.10","M67.431","M54.32","F41.1","J20.9","Z09","B37.9","J01.91","M25.512","F17.200","J44.9","F33.9","R45.851","Z86.73","J30.2","M50.30","M47.892","M47.894","J34.9","Z23","U07.1","R06.00","Z12.4","R45.850","R63.4","Z59.9","B00.1","J90","J01.00","G89.3"],"date":["2020-02-03","2021-05-06","2021-05-06","2021-05-06","2021-04-09","2020-01-03","2021-02-12","2020-09-15","2019-10-16","2021-05-06","2021-03-12","2020-09-15","2021-05-06","2020-07-17","2020-02-18","2020-02-18","2020-02-18","2020-02-28","2020-09-15","2021-04-09","2020-12-01","2020-11-14","2020-12-27","2020-11-14","2020-11-14","2020-11-14","2020-11-14","2020-11-14","2020-11-14","2021-05-06","2021-05-06","2021-05-06","2021-05-06","2021-05-06","2021-02-12","2020-09-15","2020-09-15","2020-11-13","2020-01-03","2020-07-17","2021-05-06","2019-10-16","2019-10-08","2020-11-24","2020-11-06","2020-11-06","2020-11-14","2020-11-06","2020-11-13","2020-11-13","2020-11-13","2020-11-17","2021-02-12","2020-12-27","2021-04-09","2020-07-17","2019-02-20","2019-11-11","2020-11-12","2020-11-12","2020-11-24","2021-05-06","2019-02-20","2021-02-12","2020-11-30","2019-11-08","2019-11-08","2019-11-08","2019-11-08","2020-02-18","2020-02-18","2020-02-18","2020-10-16","2020-10-16","2020-11-06","2020-11-13","2020-09-15","2019-11-08","2019-11-08","2019-11-08","2020-09-15","2020-11-13","2021-02-12","2021-02-12"],"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":[["","42858010450","OXYCOD\/APAP ","TAB 10-325MG","180","Select","Select",""],["","00904645780","DOK ","CAP 100MG","60","Select","Select",""],["","68462010340","FLUCONAZOLE ","TAB 150MG","1","Select","Select",""],["","65862053820","LEVOFLOXACIN ","TAB 750MG","7","Select","Select",""],["","08496021101","BP ","MIS WRIST","1","Select","Select",""],["","60505082901","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","76204060030","IPRATROPIUM\/ ","SOL ALBUTER","360","Select","Select",""],["","68001033508","LISINOPRIL ","TAB 20MG","30","Select","Select",""],["","64764075030","TRINTELLIX ","TAB 20MG","30","Select","Select",""],["","33342020010","LEVOCETIRIZI ","TAB 5MG","30","Select","Select",""],["","68382003410","VENLAFAXINE ","CAP 37.5 ER","90","Select","Select",""],["","68001000703","GABAPENTIN ","TAB 800MG","90","Select","Select",""],["","50111043403","TRAZODONE ","TAB 100MG","30","Select","Select",""],["","62175089143","ATORVASTATIN ","TAB 20MG","30","Select","Select",""],["","68001015303","CARVEDILOL ","TAB 3.125MG","60","Select","Select",""],["","16571040250","CETIRIZINE ","TAB 10MG","30","Select","Select",""],["","65862035705","CLOPIDOGREL ","TAB 75MG","30","Select","Select",""],["","46122035374","GNP ","DIS 21MG\/24H","28","Select","Select",""],["","59762372104","ALPRAZOLAM ","TAB 1MG","90","Select","Select",""],["","63824000850","MUCINEX ","TAB 600MG ER","60","Select","Select",""],["","69097052444","DICLOFENAC ","GEL 0.01","100","Select","Select",""],["","00781261305","AMOXICILLIN ","CAP 500MG","21","Select","Select",""],["","46122018087","ASPIRIN ","TAB 81MG EC","30","Select","Select",""],["","31722077805","ACYCLOVIR ","TAB 800MG","15","Select","Select",""],["","00904323392","CALCIUM\/D ","TAB 600-400","60","Select","Select",""],["","16729011917","MONTELUKAST ","TAB 10MG","30","Select","Select",""],["","68462039710","OMEPRAZOLE ","CAP 40MG","30","Select","Select",""],["","00054001925","PREDNISONE ","TAB 50MG","5","Select","Select",""],["","68180016013","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","69452014330","BENZONATATE ","CAP 100MG","21","Select","Select",""],["","00093317431","ALBUTEROL ","FAT E","8.5","Select","Select",""],["","69547035302","NARCAN ","SPR ","2","Select","Select",""],["","29300011210","LAMOTRIGINE ","TAB 100MG","30","Select","Select",""],["","49502090030","EMSAM ","DIS 6MG\/24HR","30","Select","Select",""],["","00536589488","NICOTINE ","DIS 7MG\/24HR","28","Select","Select",""],["","46122045185","STOOL ","CAP 100MG","60","Select","Select",""],["","65862050320","AMOX\/K ","TAB 875-125","14","Select","Select",""],["","62135098505","DOXYCYCL ","CAP 100MG","20","Select","Select",""],["","91237000182","TALKING ","MIS BLOOD PR","1","Select","Select",""],["","16729044316","BUPROPN ","TAB 150MG XL","30","Select","Select",""],["","00054418425","DEXAMETHASON ","TAB 4MG","14","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":""}]}]}