{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DEREK ROSE","gend":0,"add":"623 E VALLEY DRIVE","city":"BRISTOL","state":"VA","zip":"24201-4907","dob":"1984-05-14","age":"","mstatus":"","insh":10064076,"cliId":"","pno":2764943395,"cno":2764943395,"email":"","ename":"","eno":"","pphy":"MOORE, JASON B","ppno":4239894050,"pcpadd":"1220 Volunteer Pkwy, ","pcpcity":"Bristol","pcpstate":"TN","pcpzip":376204628,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"SOUTHWEST","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"1762 Valley Drive","madd2":"                                                            ","madd3":"","mcity":"BRISTOL","mstate":"VA","mzip":"24201-4907","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J30.9","F32.9","J30.1","J30.81","J30.5","R68.89","K22.70","D37.6","K85.90","D72.829","R19.7","E78.5","I10","Z68.34","F42.9","R73.09","J30.89","H10.45","K21.9","R93.5","N14.1","T50.8X5A","N39.0","L89.151","K91.89","G47.33","E66.9","Z79.2","Z45.2","R26.9","S82.402A","V49.40XA","Z00.00","R63.5","B07.9","Z68.37","K44.9","R10.84","N17.9","R10.9","J18.9","R50.9","J90","R79.89","G80.9","R60.0","Z68.35","F71","D64.9","I95.9","Z99.3","D13.5","R91.8","Z68.36","E24.9","Z09","Z87.19","D48.9","R73.9","K20.9","K85.80","R10.13","R11.2","F42.2","R06.02"],"date":["2020-10-26","2020-11-03","2020-03-05","2020-03-05","2020-03-05","2020-03-12","2020-10-26","2019-11-12","2019-12-01","2019-11-23","2019-11-23","2020-11-12","2020-11-12","2020-11-12","2020-11-03","2020-10-26","2019-02-06","2019-02-06","2020-10-20","2019-11-21","2019-12-05","2019-11-26","2019-12-02","2019-11-26","2019-12-01","2021-03-12","2019-12-01","2019-12-01","2019-12-01","2019-12-02","2019-12-02","2019-12-02","2019-02-25","2019-02-25","2020-11-12","2019-02-25","2019-09-24","2019-11-12","2020-10-26","2019-11-21","2019-12-12","2019-11-22","2019-11-22","2019-12-03","2020-10-26","2020-10-26","2020-10-26","2021-03-18","2019-12-12","2019-12-05","2019-12-05","2020-10-20","2019-11-17","2019-03-11","2019-06-04","2019-12-12","2019-12-12","2020-11-12","2020-11-12","2019-09-24","2019-11-13","2019-11-13","2019-11-13","2019-07-30","2019-11-19"],"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":[["","68180051703","LISINOPRIL ","TAB 40MG","30","Select","Select",""],["","50111064701","FLUOXETINE ","CAP 10MG","30","Select","Select",""],["","51991081403","AZELASTINE ","SPR 0.001","30","Select","Select",""],["","00093720198","PRAVASTATIN ","TAB 20MG","30","Select","Select",""],["","45802091987","CETIRIZINE ","TAB 10MG","90","Select","Select",""],["","49281042050","FLUZONE ","INJ 2020-21","0.5","Select","Select",""],["","00054327099","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","62175061743","PANTOPRAZOLE ","TAB 40MG","60","Select","Select",""],["","29300012810","HYDROCHLOROT ","TAB 25MG","30","Select","Select",""],["","45802046564","KETOCONAZOLE ","SHA 0.02","120","Select","Select",""],["","51991077290","LANSOPRAZOLE ","CAP 30MG DR","30","Select","Select",""],["","58160084252","BOOSTRIX ","INJ ","0.5","Select","Select",""],["","65162071110","GUANFACINE ","TAB 1MG","30","Select","Select",""],["","00006409602","VAQTA ","INJ 50UNT\/ML","1","Select","Select",""],["","33332031901","AFLURIA ","INJ 2019-20","0.5","Select","Select",""],["","00378020810","FUROSEMIDE ","TAB 20MG","10","Select","Select",""],["","58160082652","HAVRIX ","INJ 1440UNIT","1","Select","Select",""],["","53746010901","HYDROCO\/APAP ","5-325MG","8","Select","Select",""],["","42858010201","OXYCOD\/APAP ","5-325MG","45","Select","Select",""],["","50428030067","OYST ","500-125","60","Select","Select",""],["","59779013705","CVS ","325MG EC","30","Select","Select",""],["","80777027399","MODERNA ","COVID-19","0.5","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":""}]}]}