{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"STEVEN   L SARGENT","gend":0,"add":"249 ELK KNOB ROAD","city":"PENNINGTON GAP","state":"VA","zip":"24277-8296","dob":"1970-08-09","age":"","mstatus":"","insh":10064612,"cliId":"","pno":2767016294,"cno":2763451824,"email":"","ename":"","eno":"","pphy":"ALMATARI, ABDULLATIEF","ppno":2765463001,"pcpadd":"127 Health Care Dr, Ste 12","pcpcity":"Pennington Gap","pcpstate":"VA","pcpzip":242772853,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"SOUTHWEST","aligned":"","ano":2763451824,"add2":"LOT 115","add3":"","madd1":"130 Dale Aly","madd2":"                                                            ","madd3":"","mcity":"Pennington Gap","mstate":"VA","mzip":"24277-3206","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R68.89","F11.20","F13.10","F10.99","F41.9","B18.2","F17.200","B19.20","F29","A41.9","L02.414","M71.032","R73.9","F19.90","L03.114","R05","M60.011","M71.111","M00.032","M00.011","K68.12","F19.10","M46.20","M46.45","R60.9","R60.0","N17.9","K74.69","A49.02","E87.2","E87.5","T88.7XXA","R21","D70.9","R50.81","T50.905D","R91.8","J90","M86.9","M00.9","I82.623","R52","M46.46","M54.5","G89.29","M48.061","M25.432","M85.832","M85.842","I10","K74.60","J44.9","Z86.718","B95.62","I11.0","I50.9","M54.9","K21.9","F41.0","R06.02","R50.9","R10.13","Z59.0","R06.82","Z87.891","Z79.899","F15.20","R07.9","R45.1","Z79.891","R41.82","Z86.19","F17.290","M25.532","L03.116","M65.832","L02.419","L27.0","T78.49XA","F19.239","R25.1","R07.89","R44.3","M79.89","I33.0","N12","E87.1","I76","K52.9","R65.20","R78.81","I38","L02.512","A41.02","R65.21","M46.26","R59.9","M79.642","R22.32","D70.2","J81.1","G89.18","L03.113","M79.641","Z79.01","R53.83","Z87.898","Z87.442","Z86.79","Z53.21","J01.00","L02.519","M13.0","M71.011","I82.611","R93.89","Z51.81","F11.99","M65.9","D72.819","N10","B00.9","Z98.890","J39.1","R09.02","I82.A12","R79.1","Z91.89","M65.042","M65.032","Z45.2","M46.49","M60.009","Z88.9","F43.25","F11.90","R82.998","R18.8","M89.8X4","Z47.89","M51.16","L53.9","S50.852A","Z74.3","J30.2","F17.220","S39.012A","S33.5XXA","L03.012","X58.XXXA","M10.9","M62.9","R93.421","K76.9","I70.0","M51.34","G06.2","M76.71","M25.571","I07.9","I49.9","I51.7","I26.99","I82.90","G89.4","Z29.8","F15.10","F13.139","F19.939","R06.00","M25.511","R06.03","L02.412","R11.2","N17.0","L02.413","M00.811","M86.8X4","I45.81","I34.2","M60.000","D61.818","D64.9","D72.820","D72.822","D75.89","Z79.2","Z20.822","F11.23","M79.671","R53.81","Z46.82","N32.89","I34.8","R93.7","Z13.6","L50.9","L29.9","T78.40XA","R46.89","R19.7","R68.83","F11.10","Z87.01","Z82.49"],"date":["2021-02-26","2021-02-26","2019-08-14","2019-08-14","2021-03-05","2020-10-10","2020-08-16","2021-03-05","2019-11-07","2020-09-23","2021-02-01","2020-10-04","2020-08-16","2020-09-02","2021-02-01","2021-02-05","2020-08-24","2020-08-25","2020-09-09","2020-09-09","2020-10-01","2021-02-25","2020-09-09","2020-09-09","2020-09-23","2020-09-30","2020-10-09","2020-09-29","2020-11-12","2020-10-09","2020-10-09","2020-10-07","2020-10-07","2020-10-07","2020-10-07","2020-10-07","2020-10-12","2020-10-08","2021-02-01","2021-01-21","2020-10-26","2020-10-26","2020-11-28","2020-11-30","2021-02-17","2020-11-28","2020-11-28","2020-11-28","2020-11-28","2020-11-28","2021-02-01","2021-03-05","2021-03-03","2021-02-01","2021-03-05","2021-03-05","2021-02-01","2021-02-01","2021-02-05","2021-02-05","2021-02-05","2021-02-05","2021-02-05","2021-02-05","2021-03-03","2021-03-05","2021-02-26","2021-03-05","2021-03-05","2020-08-08","2020-10-08","2020-08-08","2020-08-08","2020-11-28","2020-08-18","2020-08-18","2020-08-19","2020-10-01","2020-11-17","2021-02-26","2021-02-17","2021-03-04","2019-11-07","2020-11-28","2020-08-16","2020-08-16","2020-10-09","2020-08-16","2020-08-16","2020-08-16","2020-10-05","2020-08-17","2020-08-19","2020-09-02","2020-09-20","2020-09-20","2020-09-20","2020-11-28","2020-09-20","2020-10-09","2020-09-30","2020-10-15","2020-12-17","2020-11-04","2020-12-01","2021-03-03","2021-03-03","2021-03-03","2021-03-03","2021-03-05","2019-11-07","2020-08-17","2020-08-17","2020-09-20","2020-09-27","2020-09-27","2020-10-09","2020-10-01","2020-10-01","2020-10-05","2020-10-01","2020-10-01","2020-10-05","2020-10-08","2021-02-05","2020-10-09","2020-10-09","2020-10-09","2020-08-20","2020-08-20","2020-08-27","2020-09-21","2020-09-21","2020-09-21","2020-09-28","2020-09-28","2020-09-30","2020-09-30","2020-11-19","2020-11-19","2020-11-28","2020-11-28","2020-11-28","2020-11-28","2020-11-30","2020-08-03","2020-08-03","2020-08-08","2020-08-08","2020-08-08","2020-08-12","2020-08-18","2020-08-18","2020-08-18","2020-08-18","2020-08-20","2020-08-20","2020-08-20","2020-08-20","2020-09-02","2020-09-30","2020-10-08","2020-10-16","2020-10-16","2020-11-29","2020-11-29","2021-02-26","2021-02-25","2021-02-26","2021-03-04","2020-08-18","2020-08-12","2020-08-16","2020-08-16","2020-08-17","2020-08-17","2020-08-17","2020-08-17","2020-08-18","2020-08-19","2020-08-20","2020-10-05","2020-10-05","2020-10-05","2020-10-05","2020-10-05","2020-10-10","2021-02-25","2021-02-26","2020-08-16","2020-08-17","2020-08-18","2020-09-20","2020-10-01","2020-10-04","2020-10-17","2020-11-17","2020-11-17","2020-11-17","2021-02-25","2021-02-26","2021-02-26","2021-02-26","2021-02-26","2021-02-26"],"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":[["","00228315573","BUPREN\/NALOX ","SUB 8-2MG","14","Select","Select",""],["","59762501801","FLUCONAZOLE ","TAB 200MG","180","Select","Select",""],["","68462012605","GABAPENTIN ","TAB 600MG","84","Select","Select",""],["","16571040250","CETIRIZINE ","TAB 10MG","60","Select","Select",""],["","00904578051","HEARTBURN ","TAB 20MG","30","Select","Select",""],["","50383077916","LACTULOSE ","SOL 10GM\/15","240","Select","Select",""],["","52817018000","CLONIDINE ","TAB 0.1MG","15","Select","Select",""],["","00003089421","ELIQUIS ","TAB 5MG","120","Select","Select",""],["","00093314705","CEPHALEXIN ","CAP 500MG","21","Select","Select",""],["","67877041920","LINEZOLID ","TAB 600MG","18","Select","Select",""],["","00406012305","HYDROCO\/APAP ","TAB 5-325MG","9","Select","Select",""],["","65862001105","SERTRALINE ","TAB 25MG","28","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","14","Select","Select",""],["","00378108601","COLCHICINE ","TAB 0.6MG","20","Select","Select",""],["","12496120803","SUBOXONE ","MIS 8-2MG","14","Select","Select",""],["","43547040750","CLONAZEPAM ","TAB 1MG","14","Select","Select",""],["","00115180301","HYDROXYZ ","CAP 25MG","90","Select","Select",""],["","65862056090","PANTOPRAZOLE ","TAB 40MG","30","Select","Select",""],["","00143980305","DOXYCYCL ","CAP 100MG","20","Select","Select",""],["","70954005920","PREDNISONE ","TAB 10MG","10","Select","Select",""],["","42806064801","DIPHENHYDRAM ","CAP 25MG","20","Select","Select",""],["","65862050320","AMOX\/K ","TAB 875-125","20","Select","Select",""],["","68462015713","ONDANSETRON ","TAB 4MG ODT","20","Select","Select",""],["","68462019005","NAPROXEN ","TAB 500MG","14","Select","Select",""],["","52817033200","CYCLOBENZAPR ","TAB 10MG","20","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":""}]}]}