{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CHAD   E MANN","gend":0,"add":"34520 FLEET ROAD","city":"GLADE SPRING","state":"VA","zip":"24340-5902","dob":"1980-03-31","age":"","mstatus":"","insh":10156107,"cliId":"","pno":2765255248,"cno":2765255248,"email":"","ename":"","eno":"","pphy":"ELMORE, KAREN A","ppno":2766950205,"pcpadd":"12180 ALDER ST, ","pcpcity":"MEADOWVIEW","pcpstate":"VA","pcpzip":243610000,"pcpcounty":"","pcpid":"","pcpname":"ABINGDON FAMILY PRACTICE","ano":"","add2":"                                                            ","add3":"","madd1":"34520 FLEET ROAD","madd2":"                                                            ","madd3":"","mcity":"GLADE SPRING","mstate":"VA","mzip":"24340-5902","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"SOUTHWEST","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H66.016","H69.83","I10","G47.30","R07.89","R53.83","R53.81","L03.115","S80.811A","E11.9","Z79.84","Z79.82","J44.9","Z79.899","F17.210","M79.661","Z20.828","R39.12","F40.02","F41.1","N41.0","R30.0","H72.01","H65.01","H92.11","J32.9","J34.2","J34.89","N31.9","R33.9","Z12.5","R10.2","R39.11","R31.29","R10.9","G47.61","Z87.891","R00.2","F31.9","Z76.89","Z13.29","R10.11","J30.1","J01.00","R09.82","M26.623","G50.0","R69","W01.198A","J01.80","J44.1","R07.9","R11.0","J09.X2","Z72.0","R39.9","F41.9","R82.998","R06.00","I49.3","Z53.29","F11.20","R68.83","R19.7","Z20.822","J20.9","R05","T14.8XXA","J02.9","W57.XXXA","Y93.9","Y92.9","J06.9","E11.40","K21.9","F40.00","H72.02","J32.8","H61.22","M89.8X9","R52","H92.01","Z13.220","R73.9","Z01.811","J32.1","J32.3","J30.0","R50.9","M25.50","Z01.818","Z01.810","F51.01","F12.11"],"date":["2019-08-28","2020-09-10","2020-03-04","2019-08-28","2019-12-06","2019-12-06","2019-12-06","2020-03-04","2020-03-04","2020-08-13","2020-03-04","2020-03-04","2020-10-22","2020-03-04","2020-03-04","2020-03-05","2020-05-12","2020-10-15","2020-08-13","2021-01-20","2020-09-18","2020-09-14","2019-08-06","2019-08-06","2019-08-06","2019-12-06","2019-12-06","2019-12-06","2020-10-15","2020-10-15","2020-09-14","2020-09-14","2020-09-14","2020-10-15","2020-10-15","2020-10-22","2020-10-22","2020-11-16","2020-10-22","2020-11-13","2020-11-13","2021-03-02","2020-09-10","2020-09-10","2020-09-10","2019-11-21","2019-11-21","2020-03-04","2020-03-04","2020-02-25","2019-06-11","2019-12-06","2019-12-06","2020-02-02","2021-05-22","2020-08-13","2020-08-13","2020-09-18","2020-11-16","2020-11-16","2021-05-22","2021-05-22","2021-05-22","2021-05-22","2021-05-22","2019-08-04","2020-02-02","2019-08-04","2019-08-04","2019-08-04","2019-08-04","2019-08-04","2019-08-04","2019-08-04","2019-08-04","2020-06-12","2020-09-10","2020-09-10","2020-09-10","2021-03-17","2019-08-06","2019-08-06","2021-01-20","2021-01-20","2019-08-12","2020-01-21","2020-01-21","2020-01-21","2020-02-02","2020-02-02","2019-08-12","2019-08-12","2020-07-14","2020-07-14"],"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":[["","63304069301","CLINDAMYCIN ","CAP 300MG","30","Select","Select",""],["","62175061743","PANTOPRAZOLE ","TAB 40MG","90","Select","Select",""],["","00245531911","KLOR-CON ","TAB 20MEQ ER","30","Select","Select",""],["","00193731221","CONTOUR ","TES NEXT","100","Select","Select",""],["","70377002711","ATORVASTATIN ","TAB 10MG","90","Select","Select",""],["","51991081403","AZELASTINE ","SPR 0.001","30","Select","Select",""],["","53746010901","HYDROCO\/APAP ","TAB 5-325MG","15","Select","Select",""],["","65862007701","CIPROFLOXACN ","TAB 500MG","28","Select","Select",""],["","00378021610","FUROSEMIDE ","TAB 40MG","30","Select","Select",""],["","00065853302","CIPRODEX ","SUS 0.3-0.1%","7.5","Select","Select",""],["","00093321205","CLONAZEPAM ","TAB 1MG","60","Select","Select",""],["","00173088210","BREO ","INH 200-25","60","Select","Select",""],["","65862053820","LEVOFLOXACIN ","TAB 750MG","14","Select","Select",""],["","00193658621","MICROLET ","MIS LANCETS","100","Select","Select",""],["","57664049983","MIRTAZAPINE ","TAB 15MG","30","Select","Select",""],["","00781185220","AMOX\/K ","TAB 875-125","20","Select","Select",""],["","10702005601","OXYCODONE ","TAB 10MG","4","Select","Select",""],["","70010049110","METFORMIN ","TAB 500MG ER","90","Select","Select",""],["","65162052110","PROMETHAZINE ","TAB 25MG","10","Select","Select",""],["","00093310905","AMOXICILLIN ","CAP 500MG","15","Select","Select",""],["","00172392770","DIAZEPAM ","TAB 10MG","4","Select","Select",""],["","00054001925","PREDNISONE ","TAB 50MG","5","Select","Select",""],["","00173086910","ANORO ","AER 62.5-25","60","Select","Select",""],["","69097094312","GABAPENTIN ","CAP 300MG","3","Select","Select",""],["","68180016013","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","43547030403","ARIPIPRAZOLE ","TAB 10MG","30","Select","Select",""],["","50428660019","CVS ","CHW 80MG","20","Select","Select",""],["","13668013601","ESCITALOPRAM ","TAB 10MG","30","Select","Select",""],["","69842000003","FLUTICASONE ","SPR 50MCG","9.9","Select","Select",""],["","53489011905","DOXYCYCL ","CAP 100MG","42","Select","Select",""],["","57237001401","TAMSULOSIN ","CAP 0.4MG","90","Select","Select",""],["","69238126601","OSELTAMIVIR ","CAP 75MG","10","Select","Select",""],["","00093101042","MUPIROCIN ","OIN 0.02","22","Select","Select",""],["","65862057490","MONTELUKAST ","TAB 10MG","90","Select","Select",""],["","00093317431","ALBUTEROL ","FAT E HFA INH","8.5","Select","Select",""],["","00904530660","BANOPHEN ","CAP 25MG","30","Select","Select",""],["","50111064701","FLUOXETINE ","CAP 10MG","30","Select","Select",""],["","67877057305","BENZONATATE ","CAP 100MG","15","Select","Select",""],["","00591292754","LEVALBUTEROL ","AER 45\/ACT","15","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","28","Select","Select",""],["","68180012202","CEPHALEXIN ","CAP 500MG","40","Select","Select",""],["","00904205661","DIPHENHYDRAM ","CAP 50MG","20","Select","Select",""],["","12496120803","SUBOXONE ","MIS 8-2MG","28","Select","Select",""],["","10702001150","HYDROXYZ ","TAB 25MG","30","Select","Select",""],["","69547035302","NARCAN ","SPR ","2","Select","Select",""],["","43547036009","LOSARTAN ","TAB 25MG","30","Select","Select",""],["","63824000834","MUCINEX ","TAB 600MG ER","40","Select","Select",""],["","68180098103","LISINOPRIL ","20MG","30","Select","Select",""],["","45802048678","DOCUSATE ","100MG","60","Select","Select",""],["","50228014605","HYDROCHLOROT ","12.5MG","30","Select","Select",""],["","00121087316","LACTULOSE ","10GM\/15","150","Select","Select",""],["","10572010001","PEG-3350 ","ELECTROL","4,000.00","Select","Select",""],["","50383077504","LIDOCAINE ","2% VISC","200","Select","Select",""],["","50428029821","CHEST ","400MG","14","Select","Select",""],["","00536589488","NICOTINE ","7MG\/24HR","28","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","",""],["N\/A","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":""}]}]}