{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SHANNON MULLINS","gend":0,"add":"1884 DC CANEY RIDGE RD","city":"CLINTWOOD","state":"VA","zip":"24228-7844","dob":"1973-09-14","age":"","mstatus":"","insh":10061142,"cliId":"","pno":"               ","cno":"               ","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":"                                                            ","add3":"","madd1":"1884 DC CANEY RIDGE RD","madd2":"                                                            ","madd3":"","mcity":"CLINTWOOD","mstate":"VA","mzip":"24228-7844","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11.43","A41.9","K61.0","Z48.01","Z79.2","Z45.2","E11.9","K61.1","N41.2","R93.5","I26.99","R73.01","M25.50","R52","G62.9","I10","E66.9","I27.82","M25.512","N32.89","R91.8","K74.60","K21.9","Z72.0","Z79.4","Z79.899","E78.5","E11.42","K76.9","Z79.01","F17.200","E11.65","I26.94","Z91.19","E11.40","Z68.37","K62.89","R30.0","B37.9","R73.9","E87.5","B19.20","F32.9","F41.9","F19.90","F17.210","A40.1","R65.21","E11.10","B37.49","E87.2","K76.6","N13.6","B95.61","E87.6","B18.2","S90.111A","W22.8XXA","Z71.6","F17.290","J01.90","Z23","Z86.19","G47.00","M54.5","R11.0","J30.2","Z68.36","R00.0","M79.89","R60.0","X58.XXXA","Y93.E8","Y92.9","Z79.84","R39.15","Z51.81"],"date":["2020-07-20","2020-08-17","2020-08-17","2020-08-17","2020-08-03","2020-08-03","2020-09-17","2021-01-04","2021-01-04","2020-09-16","2020-09-17","2020-07-14","2020-07-14","2020-07-14","2020-09-17","2020-09-04","2020-01-15","2020-09-09","2019-12-16","2020-07-18","2020-09-04","2020-09-04","2020-09-04","2020-09-04","2020-09-04","2020-09-04","2020-09-17","2020-09-17","2021-01-04","2020-09-17","2021-01-04","2021-03-20","2021-01-04","2021-01-04","2019-07-01","2019-07-01","2020-07-13","2020-07-13","2020-07-23","2020-07-13","2020-07-13","2020-07-13","2020-07-13","2020-07-13","2020-07-13","2020-07-13","2020-07-14","2020-07-14","2020-07-14","2020-07-14","2020-07-14","2020-07-14","2020-07-14","2020-07-14","2020-07-14","2020-07-14","2020-01-19","2020-01-19","2021-01-04","2021-01-04","2019-03-06","2019-03-06","2019-03-06","2019-03-06","2019-03-06","2019-03-06","2019-03-06","2019-11-01","2019-11-01","2020-01-19","2020-01-19","2020-01-19","2020-01-19","2020-01-19","2020-01-19","2020-07-13","2020-07-27"],"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":[["","65162083366","DICLOFENAC ","GEL 0.01","100","Select","Select",""],["","60505082901","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","68001033508","LISINOPRIL ","TAB 20MG","30","Select","Select",""],["","67877056310","METFORMIN ","TAB 1000MG","60","Select","Select",""],["","50228017905","GABAPENTIN ","CAP 100MG","30","Select","Select",""],["","68462016405","CARVEDILOL ","TAB 12.5MG","60","Select","Select",""],["","65862019001","CYCLOBENZAPR ","TAB 5MG","10","Select","Select",""],["","68462019690","PRAVASTATIN ","TAB 20MG","30","Select","Select",""],["","60505006501","OMEPRAZOLE ","CAP 20MG","30","Select","Select",""],["","00002771559","BASAGLAR ","INJ 100UNIT","15","Select","Select",""],["","00002751001","HUMALOG ","INJ 100\/ML","10","Select","Select",""],["","00003089421","ELIQUIS ","TAB 5MG","60","Select","Select",""],["","08290324911","INSULIN ","MIS 0.5\/31G","100","Select","Select",""],["","94046000173","PEN  NEEDLES  ","MIS 31GX8MM","100","Select","Select",""],["","23155010601","HYDROXYZ ","TAB 25MG","120","Select","Select",""],["","72217000402","PROCARE ","MIS BP MONIT","1","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","20","Select","Select",""],["","67405055005","DOXYCYCL ","TAB 100MG","14","Select","Select",""],["","70710114003","FLUCONAZOLE ","TAB 200MG","14","Select","Select",""],["","10702001801","OXYCODONE ","TAB 5MG","10","Select","Select",""],["","65862039010","ONDANSETRON ","TAB 4MG ODT","30","Select","Select",""],["","91237000182","TALKING ","MIS BLOOD PR","1","Select","Select",""],["","59762501002","CLINDAMYCIN ","300MG","56","Select","Select",""],["","33342002208","LEVOFLOXACIN ","500MG","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":[[["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["No","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":""}]}]}