{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BRANDON BRITT","gend":0,"add":"2619 BOWMAN STREET","city":"ROANOKE","state":"VA","zip":"24012-4319","dob":"1994-03-20","age":"","mstatus":"","insh":10118570,"cliId":"","pno":5404006215,"cno":5404006215,"email":"","ename":"","eno":"","pphy":"TU, PRISCILLA","ppno":5404279200,"pcpadd":"2145 Mount Pleasant Blvd Se, ","pcpcity":"Roanoke","pcpstate":"VA","pcpzip":240143632,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":5404913657,"add2":"LOT 12","add3":"","madd1":"2619 BOWMAN STREET","madd2":"LOT 12","madd3":"","mcity":"ROANOKE","mstate":"VA","mzip":"24012-4319","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N18.6","Q99.8","I15.1","Z99.2","N28.89","E88.09","E46","N25.81","G47.30","D50.9","D63.1","T82.591A","D35.1","E21.3","R68.89","Z01.810","Z72.0","Z68.1","I16.0","D84.1","E21.2","I10","G47.33","G89.18","N03.2","Z90.89","E89.0","F12.20","M25.561","M25.562","A41.9","R09.02","E87.5","D72.829","I12.0","F32.9","F90.9","J81.1","J18.9","F19.10","F91.3","I47.1","J02.9","Z01.818","I51.7","I45.81","R94.31","E83.51","M25.551","G89.29","N18.9","R63.4","Z23","I87.1","T82.858A","Y95","J96.90","R04.2","R53.1","R53.83","F10.10","F14.10","F12.10","R91.8","R06.02","R55","R00.0","E89.2","E16.1","J02.0","E04.1","M79.89","N19","I50.22","N34.2","M54.9","R53.81","R30.0","F17.200","D15.0","D34","F31.9","I16.1","E87.1","F17.210","E21.5","E83.81","N17.9","Z94.89","E16.2","Z91.5","Z87.441","Z91.19"],"date":["2021-04-30","2019-07-30","2019-07-30","2021-04-02","2019-07-30","2021-04-19","2021-04-19","2021-04-30","2020-05-07","2021-04-02","2021-04-02","2021-02-09","2019-09-03","2020-05-09","2019-10-23","2020-01-23","2020-12-29","2020-01-23","2020-06-02","2020-05-09","2020-05-09","2020-12-29","2020-05-07","2020-05-09","2020-05-09","2020-06-01","2020-05-09","2020-08-12","2020-12-29","2020-12-29","2019-01-14","2019-01-14","2020-06-02","2019-01-14","2020-06-01","2020-09-22","2019-01-14","2019-01-14","2019-01-14","2019-01-14","2019-01-14","2019-10-14","2019-11-19","2020-05-07","2020-06-01","2020-06-01","2020-06-01","2020-06-02","2020-12-29","2020-12-29","2021-03-10","2021-03-10","2020-03-02","2021-02-09","2021-02-09","2019-01-14","2019-01-14","2019-01-14","2020-06-01","2019-01-14","2019-01-14","2019-01-14","2019-01-14","2019-01-15","2020-02-04","2019-10-14","2019-10-14","2020-06-01","2020-06-01","2019-07-28","2020-05-07","2019-07-15","2020-01-09","2020-01-09","2020-01-14","2019-01-14","2019-01-14","2020-01-14","2020-01-14","2020-05-07","2020-05-07","2020-05-07","2020-05-07","2020-05-07","2020-06-01","2020-05-08","2020-06-01","2020-06-01","2020-06-01","2020-06-01","2020-06-01","2020-06-01","2020-06-01"],"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":[["","00378668999","PANTOPRAZOLE ","TAB 40MG","30","Select","Select",""],["","65162062711","TRAMADOL ","TAB 50MG","60","Select","Select",""],["","00597003334","CATAPRES-TTS ","DIS 0.3\/24HR","12","Select","Select",""],["","69097086283","CALC ","CAP 667MG","180","Select","Select",""],["","29300013601","CLONIDINE ","TAB 0.2MG","90","Select","Select",""],["","65862020299","LOSARTAN ","TAB 50MG","90","Select","Select",""],["","69097015907","MELOXICAM ","TAB 15MG","30","Select","Select",""],["","00378064110","PREDNISONE ","TAB 10MG","20","Select","Select",""],["","65862001501","AMOXICILLIN ","TAB 875MG","20","Select","Select",""],["","45963070911","METOPROL ","TAB 25MG ER","90","Select","Select",""],["","00406012305","HYDROCO\/APAP ","TAB 5-325MG","90","Select","Select",""],["","64380080307","RANITIDINE ","TAB 150MG","15","Select","Select",""],["","14539067401","HYDROXYZ ","CAP 25MG","60","Select","Select",""],["","69452020720","CALCITRIOL ","CAP 0.25MCG","30","Select","Select",""],["","00363037507","ANTI-DIARRHE ","TAB 2MG","30","Select","Select",""],["","00185001001","LABETALOL ","TAB 100MG","60","Select","Select",""],["","67877057305","BENZONATATE ","CAP 100MG","30","Select","Select",""],["","49884029001","MEGESTROL ","TAB 40MG","60","Select","Select",""],["","00310110530","LOKELMA ","PAK 5GM","30","Select","Select",""],["","65862053750","LEVOFLOXACIN ","TAB 500MG","4","Select","Select",""],["","65862050220","AMOX\/K ","500-125","20","Select","Select",""],["","68180016006","AZITHROMYCIN ","250MG","6","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","",""],["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":""}]}]}