{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MELISSA   D HAY","gend":1,"add":"3610 FRYING PAN ROAD","city":"BIRCHLEAF","state":"VA","zip":"24220-7854","dob":"1968-10-13","age":"","mstatus":"","insh":10070580,"cliId":"","pno":2762023318,"cno":2762023318,"email":"","ename":"","eno":"","pphy":"OWENS, DIA P","ppno":2765977081,"pcpadd":"185 Redwood Ave, Ste 102","pcpcity":"Pennington Gap","pcpstate":"VA","pcpzip":242772599,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"SOUTHWEST","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"3610 FRYING PAN ROAD","madd2":"                                                            ","madd3":"","mcity":"BIRCHLEAF","mstate":"VA","mzip":"24220-7854","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["A41.9","J18.9","J96.92","M51.36","Z79.899","J20.9","Z00.8","F17.200","Z13.9","Z13.89","J96.21","J44.1","I50.33","M54.5","J44.9","R30.0","D72.829","I50.9","I10","J20.8","E11.9","M46.06","R20.2","G89.29","R06.02","J96.91","Z68.41","I11.0","E66.9","K76.1","I25.10","G47.30","E88.09","M51.26","J96.01","R79.89","J96.02","J18.1","J44.0","E87.1","N28.9","D75.1","E05.90","Z68.39","F17.210","M25.561","M25.562","I50.31","I47.2","J96.22","E87.5","E83.42","F41.9","G89.4","Z79.891","Z99.81","I50.20","R07.9","R10.10","R05","I50.22","Z86.19","Z87.01","J98.4","R91.8","I51.7","R16.0","Z03.818","B96.89","R65.20","I50.21","F33.9","R73.09","R53.1","R53.82","D63.8","R65.10","I50.30","J96.10","J98.11","R79.0","I27.20","Z20.828","M15.0","E78.6","J96.11","R53.83","G47.10","R06.83","J96.12","N17.9","F41.0","J96.20","I50.23","Z01.818","Z83.3","Z72.0","R91.1"],"date":["2020-01-06","2020-01-09","2019-01-16","2021-04-20","2021-04-29","2020-10-21","2020-06-30","2020-06-30","2020-06-30","2020-06-30","2020-01-06","2020-01-06","2019-06-25","2019-07-17","2021-04-01","2019-08-12","2020-01-06","2021-04-29","2021-04-29","2020-11-03","2020-11-03","2021-04-20","2020-12-02","2020-12-02","2019-12-09","2019-01-16","2019-01-16","2020-01-05","2020-01-05","2019-01-16","2019-01-16","2019-05-03","2019-07-01","2019-01-16","2019-01-21","2020-01-06","2019-01-21","2019-12-13","2020-11-03","2020-01-05","2019-06-25","2020-01-05","2019-06-25","2019-06-25","2020-11-03","2019-07-17","2019-07-17","2019-11-07","2019-11-07","2020-01-06","2020-01-06","2019-11-06","2019-12-09","2019-12-09","2021-03-24","2020-05-20","2019-12-16","2020-11-03","2020-07-02","2020-01-05","2019-01-18","2019-06-04","2019-06-04","2019-12-09","2020-01-09","2019-12-11","2020-07-02","2020-11-03","2020-11-03","2020-01-06","2020-04-20","2019-07-11","2019-05-03","2019-05-03","2019-05-03","2019-05-03","2019-11-08","2019-11-08","2020-10-21","2020-01-05","2020-01-05","2020-01-05","2020-11-03","2021-04-29","2021-04-29","2019-12-09","2019-04-25","2019-04-25","2019-04-25","2019-12-09","2019-12-09","2019-12-09","2020-01-05","2020-01-05","2019-08-14","2019-08-14","2019-12-09","2020-01-09"],"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":[["","65862002306","MIRTAZAPINE ","TAB 45MG ODT","30","Select","Select",""],["","69315011710","FUROSEMIDE ","TAB 40MG","60","Select","Select",""],["","62542030104","HYD ","SUS 10-8\/5ML","100","Select","Select",""],["","68001033408","LISINOPRIL ","TAB 10MG","30","Select","Select",""],["","00781571010","POT  CL MICRO","TAB 10MEQ ER","90","Select","Select",""],["","42799012001","BUMETANIDE ","TAB 1MG","60","Select","Select",""],["","60432060416","PROMETHAZINE ","SYP DM","300","Select","Select",""],["","46122025415","GNP ","LOZ MINI 2MG","243","Select","Select",""],["","00406012405","HYDROCO\/APAP ","TAB 7.5-325","90","Select","Select",""],["","57664050658","METOPROL ","TAB 25MG","60","Select","Select",""],["","50111078751","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","10370010250","BUPROPN ","TAB 300MG XL","30","Select","Select",""],["","59746017310","PREDNISONE ","TAB 10MG","8","Select","Select",""],["","27808015601","ROSUVASTATIN ","TAB 10MG","30","Select","Select",""],["","00228300350","CLONAZEPAM ","TAB 0.5MG","5","Select","Select",""],["","65862053750","LEVOFLOXACIN ","TAB 500MG","5","Select","Select",""],["","68001036206","CEFDINIR ","CAP 300MG","20","Select","Select",""],["","16729011917","MONTELUKAST ","TAB 10MG","30","Select","Select",""],["","00185041060","BUPROPION ","TAB 100MG SR","30","Select","Select",""],["","16729018317","HYDROCHLOROT ","TAB 25MG","30","Select","Select",""],["","66993058597","FLUTIC\/SALME ","AER 250\/50","60","Select","Select",""],["","68382070718","DOXYCYC ","CAP 100MG","14","Select","Select",""],["","60432060616","PROMETH\/COD ","SOL 6.25-10","300","Select","Select",""],["","42571016242","AMOX\/K ","TAB 875-125","14","Select","Select",""],["","59310057922","PROAIR ","AER ","8.5","Select","Select",""],["","76204010060","IPRATROPIUM ","SOL 0.02%INH","150","Select","Select",""],["","00536589688","NICOTINE ","DIS 21MG\/24H","14","Select","Select",""],["","68001036700","POT  CHLORIDE","TAB 10MEQ ER","60","Select","Select",""],["","59746000103","METHYLPRED ","TAB 4MG","21","Select","Select",""],["","49100040007","CULTURELLE ","CAP ","14","Select","Select",""],["","51224000150","BENZONATATE ","CAP 200MG","30","Select","Select",""],["","69097031987","BUDESONIDE ","SUS 0.5MG\/2","30","Select","Select",""],["","76204060060","IPRATROPIUM\/ ","SOL ALBUTER","180","Select","Select",""],["","00143980350","DOXYCYCL ","CAP 100MG","4","Select","Select",""],["","00173069600","ADVAIR ","250\/50","60","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":""}]}]}