{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KIMBERLY   J ROBERSON","gend":1,"add":"318 WEST MAIN STREET","city":"APPALACHIA","state":"VA","zip":"24216-1713","dob":"1969-07-01","age":"","mstatus":"","insh":10064060,"cliId":"","pno":2762071654,"cno":2768707221,"email":"","ename":"","eno":"","pphy":"KUMAR, VIJAY","ppno":2763250121,"pcpadd":"610 PARK AVE NW, ","pcpcity":"NORTON","pcpstate":"VA","pcpzip":242730000,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"SOUTHWEST","aligned":"","ano":2768707221,"add2":"APT I","add3":"","madd1":"318 WEST MAIN STREET","madd2":"APT I","madd3":"","mcity":"APPALACHIA","mstate":"VA","mzip":"24216-1713","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J44.9","R10.9","N39.0","N17.9","E27.40","Z78.9","F11.20","F17.200","I10","F41.1","F12.20","F19.982","F31.9","M54.5","F12.10","R68.89","J98.11","I11.0","I50.9","F17.210","E03.9","E66.9","G89.29","Z79.899","M54.9","I95.9","F33.1","F41.9","E78.5","R35.1","Z13.1","R10.32","R11.2","N63.10","Z12.31","F33.0","N18.2","E66.01","F17.211","R11.0","R73.03","Z13.89","Z00.8","N18.1","R06.02","Z13.9","Z12.4","G60.3","N20.1","R09.89","F19.280","R31.9","Z51.81","Z79.891","F31.0","F32.9","H40.053","H25.013","H52.03","H52.223","H52.4"],"date":["2020-10-18","2019-03-27","2020-07-16","2019-04-11","2019-04-12","2019-04-12","2021-05-04","2021-04-28","2021-04-28","2020-05-19","2020-07-02","2019-10-15","2020-07-02","2020-03-24","2020-07-02","2021-02-28","2019-04-10","2019-04-10","2019-04-10","2020-01-05","2021-04-28","2019-04-10","2019-04-10","2019-04-25","2019-04-10","2019-04-10","2019-10-30","2020-07-02","2021-04-28","2020-01-23","2020-01-23","2020-07-16","2020-07-16","2021-05-19","2021-05-19","2020-08-24","2020-01-28","2020-04-28","2020-07-02","2020-07-16","2021-04-28","2021-04-28","2021-04-28","2020-01-23","2020-01-23","2021-04-28","2021-04-28","2021-04-28","2019-03-27","2019-04-10","2019-10-08","2020-01-05","2019-04-25","2019-04-25","2019-07-25","2019-08-01","2021-03-11","2021-03-11","2021-03-11","2021-03-11","2021-03-11"],"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":[["","65862052305","GABAPENTIN ","TAB 600MG","90","Select","Select",""],["","68382004001","PROMETHAZINE ","TAB 12.5MG","30","Select","Select",""],["","00378018601","CLONIDINE ","TAB 0.2MG","30","Select","Select",""],["","43547040710","CLONAZEPAM ","TAB 1MG","11","Select","Select",""],["","68180012102","CEPHALEXIN ","CAP 250MG","126","Select","Select",""],["","00173068220","VENTOLIN ","AER ","18","Select","Select",""],["","00378623305","CITALOPRAM ","TAB 40MG","30","Select","Select",""],["","49483060350","IBUPROFEN ","TAB 600MG","90","Select","Select",""],["","00904645780","DOK ","CAP 100MG","90","Select","Select",""],["","43547028211","ESCITALOPRAM ","TAB 20MG","90","Select","Select",""],["","69238183901","LEVOTHYROXIN ","TAB 175MCG","90","Select","Select",""],["","00172208380","HYDROCHLOROT ","TAB 25MG","90","Select","Select",""],["","60505257908","ATORVASTATIN ","TAB 20MG","30","Select","Select",""],["","68180051902","LISINOP\/HCTZ ","TAB 20-12.5","60","Select","Select",""],["","68001033508","LISINOPRIL ","TAB 20MG","60","Select","Select",""],["","00054018913","BUPREN\/NALOX ","SUB 8-2MG","28","Select","Select",""],["","00378351593","MIRTAZAPINE ","TAB 15MG","30","Select","Select",""],["","00378521077","AMLODIPINE ","TAB 10MG","30","Select","Select",""],["","00904634946","RANITIDINE ","TAB 75MG","60","Select","Select",""],["","68462039610","OMEPRAZOLE ","CAP 20MG","90","Select","Select",""],["","00781152610","POT  CHLORIDE","TAB 10MEQ CR","90","Select","Select",""],["","00378020810","FUROSEMIDE ","TAB 20MG","60","Select","Select",""],["","00093317431","ALBUTEROL ","FAT E HFA INH","8.5","Select","Select",""],["","00832046530","NYAMYC ","POW 100000","30","Select","Select",""],["","80777027399","MODERNA ","INJ COVID-19","0.5","Select","Select",""],["","47781030301","NITROFURANTN ","CAP 100MG","10","Select","Select",""],["","59746000103","METHYLPRED ","TAB 4MG","21","Select","Select",""],["","59762332801","CLINDAMYCIN ","CAP 150MG","28","Select","Select",""],["","75826011410","PHENAZOPYRID ","TAB 100MG","12","Select","Select",""],["","57237023305","SMZ-TMP ","TAB 800-160","6","Select","Select",""],["","00603390021","HYDROCORT ","TAB 10MG","28","Select","Select",""],["","68462015713","ONDANSETRON ","TAB 4MG ODT","8","Select","Select",""],["","65862007701","CIPROFLOXACN ","TAB 500MG","20","Select","Select",""],["","68180030360","CEFUROXIME ","TAB 500MG","20","Select","Select",""],["","69547035302","NARCAN ","SPR ","2","Select","Select",""],["","67877057305","BENZONATATE ","CAP 100MG","42","Select","Select",""],["","00143211205","DOXYCYCL ","TAB 100MG","20","Select","Select",""],["","69097095505","PREGABALIN ","50MG","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":[[["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":""}]}]}