{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TERRY   L WARD","gend":0,"add":"OLGA WARD","city":"PILGRAMS KNOB","state":"VA","zip":"24634-0002","dob":"1958-06-08","age":"","mstatus":"","insh":10062761,"cliId":"","pno":2763454293,"cno":"               ","email":"","ename":"","eno":"","pphy":"TITHA, RAVI K","ppno":2769646711,"pcpadd":"3150 CLINCH ST, ","pcpcity":"RICHLANDS","pcpstate":"VA","pcpzip":246412159,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"SOUTHWEST","aligned":"","ano":"","add2":"P. O. BOX 2","add3":"","madd1":"OLGA WARD","madd2":"P. O. BOX 2","madd3":"","mcity":"PILGRAMS KNOB","mstate":"VA","mzip":"24634-0002","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I10","E29.9","G47.00","F33.1","E29.1","I31.3","J44.9","E11.9","R05","J81.1","R22.31","J82","E11.65","E55.9","M16.4","R68.89","F11.20","S60.511A","I21.4","F10.231","I25.110","E11.59","R91.8","D64.9","E87.1","E88.09","Z95.1","I25.89","M51.26","J96.00","Z99.81","F17.210","B19.20","F11.21","F79","J18.9","I77.6","Z51.81","Z79.899","R21","E78.2","R60.9","I25.119","I36.1","I25.10","I50.9","R53.81","Z48.812","Z79.84","Z71.51","M15.0","H10.13","H47.012","E11.40","M54.9","J90","I51.7","F32.9","M79.606","R06.02","R06.00","K74.60","Z79.82","N52.1","S62.524A","S69.91XA","W01.0XXA","Y93.01","Y92.014","Z79.891","K82.4","B18.2","R06.09","E78.5","I34.0","N17.9","R09.89","Z01.811","I25.111","I45.9","R07.9","R94.31","R07.89","T81.9XXA","Z87.891","B37.2","B35.1","K70.30","J44.0","I11.0","F10.20","I82.890","I31.9","G89.18","R42","R00.2","J30.9","J32.9","H10.45","F41.9","E11.8","E66.01","G89.29","K21.9","Z68.29","R79.89","I31.1","I37.1","Z12.5","Z68.41","D72.829","R53.1","G47.33","Z01.818","D47.3","R11.0","J06.9","J20.8","N52.9","R00.0","R14.0","M54.5","R03.0","F41.0","Z74.3","Z68.39","G89.4","F41.8","F10.10","J98.11","Z86.19"],"date":["2021-04-15","2019-01-18","2019-01-31","2019-01-31","2019-06-19","2019-05-08","2021-03-18","2021-04-10","2019-04-20","2019-04-20","2019-04-20","2019-04-20","2021-04-15","2021-04-15","2021-04-15","2021-02-16","2021-05-17","2019-12-22","2020-06-19","2020-06-12","2020-06-12","2020-06-12","2020-06-10","2020-06-18","2020-06-19","2020-06-19","2021-04-11","2020-09-22","2021-03-18","2020-12-01","2020-12-01","2021-05-17","2021-02-01","2021-05-17","2021-05-17","2019-04-21","2019-06-19","2019-08-16","2021-04-10","2020-01-13","2021-01-18","2020-01-20","2020-06-01","2020-06-02","2021-04-10","2020-06-12","2020-06-19","2020-07-03","2021-04-10","2020-10-19","2020-09-22","2019-06-19","2019-07-03","2020-05-29","2020-05-29","2020-06-28","2020-06-28","2021-04-10","2020-11-19","2019-05-10","2019-05-08","2019-12-01","2021-04-10","2019-10-15","2019-10-18","2019-10-18","2019-10-18","2019-10-18","2019-10-18","2020-05-29","2020-05-29","2020-06-12","2020-05-29","2020-05-29","2020-05-29","2020-06-01","2020-06-01","2020-06-01","2020-06-01","2020-06-28","2021-04-11","2020-06-28","2021-04-10","2020-06-28","2020-12-17","2019-04-05","2019-04-05","2021-04-10","2019-04-14","2020-06-12","2019-04-14","2019-04-14","2020-06-01","2019-04-15","2019-04-29","2019-05-08","2019-05-08","2019-05-08","2019-05-08","2020-06-01","2020-05-29","2020-06-12","2020-05-29","2020-08-03","2020-05-29","2019-04-14","2019-04-15","2019-05-10","2019-08-19","2020-06-01","2020-06-19","2020-06-01","2020-06-01","2020-06-02","2020-06-17","2021-04-19","2019-01-02","2019-01-07","2019-01-07","2019-04-14","2020-06-09","2020-12-14","2019-12-01","2019-12-01","2020-06-01","2020-06-12","2020-06-12","2020-06-12","2020-06-12","2020-06-28","2021-04-10"],"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":[["","65862001305","SERTRALINE ","TAB 100MG","30","Select","Select",""],["","13668025090","OLMESA ","TAB 40MG","30","Select","Select",""],["","55111015810","OMEPRAZOLE ","CAP 20MG","30","Select","Select",""],["","68462012705","GABAPENTIN ","TAB 800MG","90","Select","Select",""],["","00591352530","LIDOCAINE ","PAD 0.05","30","Select","Select",""],["","52536062501","TESTOST ","INJ 200MG\/ML","2","Select","Select",""],["","13107003105","MIRTAZAPINE ","TAB 15MG","30","Select","Select",""],["","68180051703","LISINOPRIL ","TAB 40MG","30","Select","Select",""],["","51672130903","AUG ","GEL 0.0005","50","Select","Select",""],["","00536100836","ASPIRIN ","CHW 81MG","30","Select","Select",""],["","00093075210","ATENOLOL ","TAB 50MG","30","Select","Select",""],["","08290309574","3ML ","MIS 22GX1.5\"","4","Select","Select",""],["","00006027731","JANUVIA ","TAB 100MG","30","Select","Select",""],["","08290305196","BD  NEEDLES  ","MIS 18GX1.5\"","2","Select","Select",""],["","60505257808","ATORVASTATIN ","TAB 10MG","30","Select","Select",""],["","69315012710","FOLIC ","TAB 1000MCG","30","Select","Select",""],["","00536468010","VITAMIN ","TAB 100MG","30","Select","Select",""],["","69315011710","FUROSEMIDE ","TAB 40MG","15","Select","Select",""],["","35046000077","DAILY ","TAB HEALTH","30","Select","Select",""],["","00193731221","CONTOUR ","TES NEXT","100","Select","Select",""],["","00378668877","PANTOPRAZOLE ","TAB 20MG","30","Select","Select",""],["","12496120803","SUBOXONE ","MIS 8-2MG","7","Select","Select",""],["","68462010630","ONDANSETRON ","TAB 8MG","20","Select","Select",""],["","00185061505","HYDROXYZ ","CAP 50MG","14","Select","Select",""],["","63646001004","KETOCONAZOLE ","SHA 0.02","120","Select","Select",""],["","16729017217","AMITRIPTYLIN ","TAB 25MG","30","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","20","Select","Select",""],["","52565008230","CLOBETASOL ","GEL 0.0005","30","Select","Select",""],["","00115521116","COLESTIPOL ","TAB 1GM","60","Select","Select",""],["","51224000160","BENZONATATE ","CAP 200MG","30","Select","Select",""],["","31722094105","HYDROCO\/APAP ","TAB 5-325MG","4","Select","Select",""],["","63824005632","MUCINEX ","TAB 30-600ER","60","Select","Select",""],["","50111078751","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","69315030660","NYSTATIN ","POW 100000","60","Select","Select",""],["","00172409680","BACLOFEN ","TAB 10MG","14","Select","Select",""],["","00173068220","VENTOLIN ","AER ","18","Select","Select",""],["","00536589588","NICOTINE ","DIS 14MG\/24H","28","Select","Select",""],["","33342002208","LEVOFLOXACIN ","TAB 500MG","7","Select","Select",""],["","10702001850","OXYCODONE ","TAB 5MG","18","Select","Select",""],["","00143924920","AMOX\/K ","TAB 875-125","14","Select","Select",""],["","50111056103","TRAZODONE ","TAB 100MG","30","Select","Select",""],["","24385010878","GNP ","TAB 100MG","30","Select","Select",""],["","40093010588","B-1 ","TAB 100MG","30","Select","Select",""],["","00143314205","DOXYCYCL ","CAP 100MG","14","Select","Select",""],["","76385012450","METHOCARBAM ","TAB 750MG","60","Select","Select",""],["","21922000909","DICLOFENAC ","GEL 0.01","100","Select","Select",""],["","52817018100","CLONIDINE ","TAB 0.2MG","30","Select","Select",""],["","00472017956","TRIPLE ","OIN ","28","Select","Select",""],["","00574200802","NYSTOP ","POW 100000","60","Select","Select",""],["","42571025201","CLINDAMYCIN ","CAP 300MG","30","Select","Select",""],["","10135013201","THIAMINE ","TAB 100MG","30","Select","Select",""],["","13107004505","OXYCOD\/APAP ","TAB 7.5-325","8","Select","Select",""],["","67877021620","CEFUROXIME ","TAB 500MG","20","Select","Select",""],["","70710135103","COLCHICINE ","0.6MG","60","Select","Select",""],["","67877061115","TIZANIDINE ","4MG","90","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":""}]}]}