{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"RUBY   J HANCOCK","gend":1,"add":"21 DOGPATCH LANE","city":"MARTINSVILLE","state":"VA","zip":"24112-8305","dob":"1968-11-30","age":"","mstatus":"","insh":10064971,"cliId":"","pno":2766321012,"cno":2766702200,"email":"","ename":"","eno":"","pphy":"ISERNIA, JAMES M","ppno":2766660070,"pcpadd":"319 Hospital Dr Ste 19, ","pcpcity":"Martinsville","pcpstate":"VA","pcpzip":241121948,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":2762246095,"add2":"                                                            ","add3":"","madd1":"21 DOGPATCH LANE","madd2":"                                                            ","madd3":"","mcity":"MARTINSVILLE","mstate":"VA","mzip":"24112-8305","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F31.9","R39.81","R07.9","R45.851","J96.00","J18.9","T42.4X2A","F33.2","Z23","J44.9","I10","Z87.891","N95.9","R73.01","D64.9","I25.10","R74.8","M54.89","G56.01","M25.50","Z12.31","R16.0","R16.1","M87.052","M25.561","M25.562","M87.9","G89.29","F25.9","R07.1","R11.10","Z20.828","F17.210","F41.9","R73.03","G89.4","E11.9","E11.42","M15.9","F17.200","F11.90","I20.0","I24.9","R94.31","F41.1","J44.1","R07.89","T42.4X1A","J96.90","D72.829","M87.00","F10.129","G92","J69.0","J44.0","K58.9","Z95.5","Z91.041","F31.81","F32.9","F60.3","E78.00","M54.9","M79.605","M79.604","Z79.82","I25.110","T82.855A","Z72.0","M06.9","F19.10","Z86.73","Z79.02","Z79.899","Z88.1","Z88.5","I25.810","Z90.49","Z98.51","Z98.890","Z80.1","Z88.6","Z88.8","Z79.51","R41.82","R41.3","Z46.82","Z46.59","Z01.810","M54.2","R91.8","M17.12","K21.9","E66.9","R40.4","R09.02","T88.7XXA","R45.6","I95.9","Z53.20","F31.89","K02.9","S46.012A","R07.2","M17.0","D22.9","M51.9","E78.5","M85.89","Z12.11","R29.898","Z12.2","M54.16","M47.816","G62.89","G31.84","T50.905A","Z00.00","J96.01","J96.02","T50.904A","M25.569","K76.0","R50.9","G62.9","G47.00","Z51.81","G40.909","Z90.12","R09.1","R06.02","Z86.69","I25.2","R09.89","R53.81","R10.9","Z99.81"],"date":["2019-10-14","2019-05-20","2020-02-28","2019-09-06","2019-09-03","2019-09-03","2019-09-03","2019-09-06","2020-07-21","2021-05-06","2021-02-03","2021-05-06","2020-03-19","2021-02-03","2020-07-28","2020-12-04","2020-03-19","2020-03-19","2020-11-24","2020-03-19","2021-02-03","2020-04-15","2020-04-15","2021-05-06","2020-07-29","2020-11-24","2021-01-13","2020-11-24","2021-05-06","2020-12-04","2020-12-04","2020-12-04","2020-12-04","2020-12-04","2020-12-04","2019-07-30","2020-02-28","2019-04-08","2019-07-30","2019-07-30","2019-05-10","2019-10-14","2019-10-14","2019-05-06","2019-07-30","2019-07-26","2019-07-26","2019-08-31","2019-08-31","2021-02-03","2020-12-17","2019-05-03","2019-08-31","2019-08-31","2019-08-31","2020-07-28","2020-12-04","2019-08-31","2019-09-03","2019-10-03","2019-09-03","2019-09-03","2019-09-03","2021-05-06","2019-09-03","2019-09-03","2019-10-14","2019-10-14","2019-10-14","2019-10-14","2019-10-14","2019-10-14","2020-07-28","2020-07-28","2019-10-14","2019-10-14","2020-07-28","2020-07-28","2020-07-28","2020-07-28","2020-05-01","2020-07-28","2020-12-04","2020-05-01","2019-08-31","2019-08-31","2019-08-31","2019-08-31","2019-09-03","2020-03-19","2020-05-01","2020-11-18","2019-05-03","2019-05-03","2019-08-31","2019-08-31","2019-08-31","2019-08-31","2019-08-31","2021-05-06","2021-05-06","2021-02-03","2021-05-06","2020-02-28","2019-10-03","2019-10-03","2020-11-24","2021-05-06","2020-11-24","2020-11-24","2021-03-22","2021-05-06","2021-05-06","2021-05-06","2021-05-06","2019-05-31","2019-05-31","2019-07-26","2019-09-02","2019-09-02","2019-09-02","2020-07-21","2020-07-21","2020-12-04","2019-01-29","2019-01-29","2019-01-29","2019-07-26","2019-07-26","2020-02-28","2020-02-28","2020-02-28","2020-12-04","2020-02-28","2020-12-04","2020-12-04","2020-12-04"],"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":[["","00186037020","SYMBICORT ","AER 160-4.5","10.2","Select","Select",""],["","65862035705","CLOPIDOGREL ","TAB 75MG","90","Select","Select",""],["","00378001805","METOPROL ","TAB 25MG","30","Select","Select",""],["","65162010250","GABAPENTIN ","CAP 300MG","90","Select","Select",""],["","00363056314","ASPIRIN ","TAB 81MG EC","30","Select","Select",""],["","00005555619","CALTRATE+D ","TAB 600-800","60","Select","Select",""],["","55111025660","ZIPRASIDONE ","CAP 20MG","60","Select","Select",""],["","68180098003","LISINOPRIL ","TAB 10MG","30","Select","Select",""],["","00085720601","DULERA ","AER 100-5MCG","13","Select","Select",""],["","43547028910","BUPROPION ","TAB 150MG SR","60","Select","Select",""],["","00378623201","CITALOPRAM ","TAB 20MG","30","Select","Select",""],["","59762106101","DIPHEN\/ATROP ","TAB 2.5MG","90","Select","Select",""],["","00193654621","BAYER ","MIS LANCETS","100","Select","Select",""],["","00193731150","CONTOUR ","TES NEXT","100","Select","Select",""],["","65862049501","QUETIAPINE ","TAB 400MG","60","Select","Select",""],["","55111012205","ATORVASTATIN ","TAB 20MG","90","Select","Select",""],["","59762372004","ALPRAZOLAM ","TAB 0.5MG","90","Select","Select",""],["","57664037718","TRAMADOL ","TAB 50MG","60","Select","Select",""],["","13668000810","ZOLPIDEM ","TAB 10MG","30","Select","Select",""],["","00228255111","DICLOFENAC ","TAB 75MG DR","60","Select","Select",""],["","31604001281","VITAMIN ","TAB 100MG","30","Select","Select",""],["","11534016503","FOLIC ","TAB 1MG","30","Select","Select",""],["","00378385777","ESCITALOPRAM ","TAB 20MG","30","Select","Select",""],["","43598016430","OLANZAPINE ","TAB 5MG","30","Select","Select",""],["","57664037088","OXYCODONE ","TAB 10MG","90","Select","Select",""],["","00904672059","ACETAMIN ","TAB 500MG","120","Select","Select",""],["","00069047103","CHANTIX ","PAK 0.5& 1MG","53","Select","Select",""],["","00536589688","NICOTINE ","DIS 21MG\/24H","28","Select","Select",""],["","57237007710","ONDANSETRON ","TAB 4MG ODT","12","Select","Select",""],["","70710122600","AMITRIPTYLIN ","TAB 25MG","30","Select","Select",""],["","00406012305","HYDROCO\/APAP ","TAB 5-325MG","12","Select","Select",""],["","43598043501","NITROGLYCERN ","SUB 0.3MG","25","Select","Select",""],["","49281042050","FLUZONE ","INJ 2020-21","0.5","Select","Select",""],["","43598029390","PREGABALIN ","CAP 75MG","60","Select","Select",""],["","66685100101","AMOX\/K ","TAB 875-125","10","Select","Select",""],["","13107003134","MIRTAZAPINE ","15MG","90","Select","Select",""],["","29300012410","MELOXICAM ","7.5MG","20","Select","Select",""],["","00591544305","PREDNISONE ","20MG","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":[[["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":""}]}]}