{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LAURA   L ESTES","gend":1,"add":"PO BOX 607","city":"VANSANT","state":"VA","zip":"24656-0607","dob":"1976-01-20","age":"","mstatus":"","insh":10063773,"cliId":"","pno":2767014442,"cno":2763126340,"email":"","ename":"","eno":"","pphy":"OWENS, DIA P","ppno":2765977081,"pcpadd":"185 Redwood Ave, Ste 102","pcpcity":"Pennington Gap","pcpstate":"VA","pcpzip":242772599,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"SOUTHWEST","aligned":"","ano":2763126340,"add2":"                                                            ","add3":"","madd1":"PO BOX 607","madd2":"                                                            ","madd3":"","mcity":"VANSANT","mstate":"VA","mzip":"24656-0607","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J15.9","J44.9","A41.9","R65.20","J15.7","N17.9","J90","J98.11","R91.8","I36.1","I27.20","R31.9","J18.9","E87.2","R68.89","J45.909","F32.9","M54.5","R73.9","G43.909","F19.11","Z85.41","B18.2","Z98.51","Z83.3","F11.20","I33.0","B17.10","I38","I26.90","M79.89","J01.90","Z87.891","I08.1","R06.02","R53.83","Z51.81","E55.9","R53.1","J44.1","D64.9","R07.9","B07.0","M79.605","M79.672","N39.0","J44.0","D73.89","J13","I07.9","B19.20","R06.89","R09.1","R04.2","E87.1","I36.8","N30.90","E83.52","R77.1","A41.01","I76","F17.220","F15.10","N30.91","R19.7","R79.89","Z23","R10.9"],"date":["2019-10-25","2019-11-23","2019-11-26","2019-11-22","2019-11-21","2019-11-26","2019-11-21","2019-11-24","2019-11-21","2019-11-23","2019-11-22","2019-11-23","2019-11-25","2019-11-23","2020-12-08","2020-08-28","2020-10-05","2020-08-28","2020-08-28","2020-08-28","2020-08-28","2020-08-28","2020-08-28","2020-08-28","2020-08-28","2021-04-28","2019-11-26","2019-11-24","2019-11-26","2019-11-26","2019-06-30","2019-11-08","2019-11-08","2019-11-25","2019-11-22","2020-03-26","2020-08-28","2020-08-28","2020-08-28","2020-10-05","2019-11-22","2019-11-23","2019-06-30","2019-06-30","2019-06-30","2019-11-19","2019-11-20","2019-11-19","2019-11-22","2019-11-23","2019-11-23","2019-11-23","2019-11-24","2019-11-24","2019-11-19","2019-11-19","2019-11-19","2019-11-19","2019-11-19","2019-11-22","2019-11-22","2019-11-22","2019-11-22","2019-11-22","2019-11-25","2020-10-05","2020-10-05","2020-10-05"],"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":[["","12496120803","SUBOXONE ","MIS 8-2MG","56","Select","Select",""],["","64380073706","VITAMIN ","CAP 50000UNT","4","Select","Select",""],["","47335038283","DULOXETINE ","CAP 30MG","30","Select","Select",""],["","00093317431","ALBUTEROL ","FAT E","8.5","Select","Select",""],["","00603533932","PREDNISONE ","TAB 20MG","15","Select","Select",""],["","68180016013","AZITHROMYCIN ","TAB 250MG","5","Select","Select",""],["","69547035302","NARCAN ","SPR ","2","Select","Select",""],["","60505082901","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","41167431004","ALLEGRA-D ","TAB 12 HOUR","15","Select","Select",""],["","65862050220","AMOX\/K ","TAB 500-125","21","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","",""],["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":""}]}]}