{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TORI CRAIG","gend":1,"add":"2725 MOSCO ROAD","city":"AXTON","state":"VA","zip":"24054-2629","dob":"1969-01-01","age":"","mstatus":"","insh":10065586,"cliId":"","pno":2767347582,"cno":"               ","email":"","ename":"","eno":"","pphy":"TRIVEDI, RAJENDRA S","ppno":4347923730,"pcpadd":"501 Rison St, Ste 120","pcpcity":"Danville","pcpstate":"VA","pcpzip":245412426,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"2725 Mosco Rd","madd2":"                                                            ","madd3":"","mcity":"Axton","mstate":"VA","mzip":"24054-2629","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F11.20","R68.89","M79.10","G43.011","J30.9","M79.2","I46.9","L50.8","B18.2","K59.04","K59.09","K21.9","R11.0","S20.96XA","M06.80","T68.XXXA","A41.9","J18.9","N17.9","J01.90","E83.42","R10.11","Z12.11","D89.1","B37.3","R60.1","M79.18","W01.0XXA","Y92.59","Y99.9","M06.9","I50.9","F17.210","Z79.899","R73.9","Z72.0","Z20.828","R10.30","N39.0","F41.9","F11.19","N89.9","L08.9","R19.07","E55.9"],"date":["2020-02-18","2020-10-09","2020-06-25","2020-11-05","2020-06-25","2020-11-05","2020-12-26","2019-10-23","2020-06-10","2019-06-12","2020-06-10","2020-06-10","2020-03-09","2020-11-05","2020-11-05","2020-12-26","2020-12-26","2020-12-26","2020-12-26","2019-06-12","2019-10-23","2019-11-25","2020-06-10","2019-11-13","2020-04-10","2020-04-10","2020-09-12","2020-09-12","2020-09-12","2020-09-12","2020-09-12","2020-09-12","2020-09-12","2020-09-12","2020-12-26","2020-12-26","2020-12-26","2019-04-29","2019-04-29","2020-03-09","2020-03-09","2020-03-09","2020-01-10","2020-06-10","2019-08-05"],"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":[["","45802086802","POLYETH ","POW 3350 NF","255","Select","Select",""],["","68462015713","ONDANSETRON ","TAB 4MG ODT","60","Select","Select",""],["","00591505210","PREDNISONE ","TAB 5MG","30","Select","Select",""],["","11917007499","CALCIUM ","TAB 500+D","30","Select","Select",""],["","53746051105","SPIRONOLACT ","TAB 25MG","30","Select","Select",""],["","69238110305","IBUPROFEN ","TAB 800MG","90","Select","Select",""],["","71093011205","GABAPENTIN ","TAB 800MG","90","Select","Select",""],["","69452015120","VITAMIN ","CAP 50000UNT","4","Select","Select",""],["","68382050010","OMEPRAZOLE ","CAP 40MG","30","Select","Select",""],["","00115180301","HYDROXYZ ","CAP 25MG","120","Select","Select",""],["","00172572860","FAMOTIDINE ","TAB 20MG","60","Select","Select",""],["","60505082901","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","68462034690","LEVOCETIRIZI ","TAB 5MG","30","Select","Select",""],["","57237000511","FLUCONAZOLE ","TAB 150MG","1","Select","Select",""],["","00093005401","BUSPIRONE ","TAB 10MG","90","Select","Select",""],["","11523715703","CLARITIN ","TAB 10MG","30","Select","Select",""],["","00904645760","DOK ","CAP 100MG","60","Select","Select",""],["","31722072250","LEVOFLOXACIN ","TAB 500MG","7","Select","Select",""],["","00173068220","VENTOLIN ","AER ","18","Select","Select",""],["","65862018601","CLINDAMYCIN ","CAP 300MG","30","Select","Select",""],["","42799080601","IVERMECTIN ","TAB 3MG","4","Select","Select",""],["","57237008663","RIZATRIPTAN ","TAB 10MG ODT","9","Select","Select",""],["","69097052444","DICLOFENAC ","GEL 0.01","100","Select","Select",""],["","47469006211","MELATONIN ","TAB 10MG","30","Select","Select",""],["","59310057922","PROAIR ","AER ","8.5","Select","Select",""],["","00406012305","HYDROCO\/APAP ","TAB 5-325MG","9","Select","Select",""],["","00406048410","APAP\/CODEINE ","TAB 300-30MG","18","Select","Select",""],["","00074262528","MAVYRET ","TAB 100-40MG","84","Select","Select",""],["","43386009019","GAVILYTE-G ","SOL ","4,000.00","Select","Select",""],["","00904674860","BISACODYL ","TAB 5MG EC","3","Select","Select",""],["","55111018015","TIZANIDINE ","TAB 4MG","60","Select","Select",""],["","45802008801","ALBUTEROL ","AER HFA","8.5","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","20","Select","Select",""],["","00186038430","ESOMEPRA ","CAP 40MG DR","30","Select","Select",""],["","47781030301","NITROFURANTN ","CAP 100MG","10","Select","Select",""],["","69238116609","DOXEPIN ","CAP 10MG","30","Select","Select",""],["","00093314705","CEPHALEXIN ","CAP 500MG","20","Select","Select",""],["","00054429931","FUROSEMIDE ","TAB 40MG","30","Select","Select",""],["","00527128201","DICYCLOMINE ","TAB 20MG","60","Select","Select",""],["","52817033010","CYCLOBENZAPR ","TAB 5MG","15","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":""}]}]}