{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KAREN   M NORMAN","gend":1,"add":"201 PALMER AVENUE","city":"MARION","state":"VA","zip":"24354-3017","dob":"1967-06-25","age":"","mstatus":"","insh":10061492,"cliId":"","pno":2767816641,"cno":2767816641,"email":"","ename":"","eno":"","pphy":"CLAMPITT, ROBERT V","ppno":2767837167,"pcpadd":"1020 Terrace Dr, Ste 100","pcpcity":"Marion","pcpstate":"VA","pcpzip":243544392,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"SOUTHWEST","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"201 PALMER AVENUE","madd2":"                                                            ","madd3":"","mcity":"MARION","mstate":"VA","mzip":"24354-3017","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H16.223","F17.208","R03.0","Z12.11","Z86.010","Z80.0","D12.5","M17.0","Z01.818","K11.5","D11.9","A41.89","R50.9","R53.1","K21.9","R22.1","H01.021","H01.024","R53.83","R00.2","R19.7","F41.9","R05","R00.0","F41.1","K92.1","A41.9","J18.9","J44.1","K52.1","F17.210","E78.5","G47.33","G47.00","T36.95XA","Z88.0","M54.5","F32.9","Z13.6","Z68.41","K63.5","K62.1","R59.0","K64.1","K62.5","J15.9","R53.81","S05.01XA","K62.0","F17.200","F43.21","Z00.00","R73.9","Z13.1","K57.30","K64.4","K64.8"],"date":["2021-03-19","2021-03-19","2021-03-19","2021-05-10","2021-05-10","2021-05-10","2021-04-27","2021-05-20","2021-05-20","2019-02-26","2019-02-26","2020-06-29","2020-06-29","2020-06-29","2020-08-04","2019-02-07","2019-02-18","2019-02-18","2021-03-17","2019-03-21","2019-02-18","2021-03-17","2020-06-29","2019-04-03","2019-03-08","2020-02-13","2020-06-29","2020-06-29","2020-06-29","2020-06-29","2021-04-27","2020-06-29","2020-06-29","2020-06-29","2020-06-29","2020-06-29","2020-12-16","2021-03-17","2021-03-17","2021-03-17","2021-04-27","2021-04-27","2019-02-13","2020-02-20","2020-02-20","2020-06-30","2020-08-04","2020-09-09","2020-02-17","2020-09-04","2021-03-17","2021-03-17","2021-03-17","2021-03-17","2021-04-27","2021-04-27","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":[["","00378064205","PREDNISONE ","TAB 20MG","10","Select","Select",""],["","59762011803","MESALAMINE ","SUP 1000MG","3","Select","Select",""],["","61314063136","NEO\/POLY\/DEX ","OIN 0.1% OP","3.5","Select","Select",""],["","49884072501","BUSPIRONE ","TAB 7.5MG","60","Select","Select",""],["","59651000305","OMEPRAZOLE ","CAP 40MG","30","Select","Select",""],["","14539067401","HYDROXYZ ","CAP 25MG","30","Select","Select",""],["","51991074790","DULOXETINE ","CAP 30MG","60","Select","Select",""],["","00781185220","AMOX\/K ","TAB 875-125","20","Select","Select",""],["","70710113803","FLUCONAZOLE ","TAB 100MG","3","Select","Select",""],["","68180016106","AZITHROMYCIN ","TAB 500MG","5","Select","Select",""],["","59746000103","METHYLPRED ","TAB 4MG","21","Select","Select",""],["","49281042050","FLUZONE ","INJ 2020-21","0.5","Select","Select",""],["","52268001201","SUPREP ","SOL PREP KIT","354","Select","Select",""],["","39423055048","FLORAJEN ","CAP BIFIDO","10","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":""}]}]}