{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CARLEEN WOODSON","gend":1,"add":"298 CONCORD DRIVE","city":"NORTH TAZEWELL","state":"VA","zip":"24630-8059","dob":"1958-11-30","age":"","mstatus":"","insh":10157579,"cliId":"","pno":2769708576,"cno":2769708576,"email":"","ename":"","eno":"","pphy":"CREWS, MICHAEL O","ppno":2766884331,"pcpadd":"12301 Grapefield Rd, ","pcpcity":"Bastian","pcpstate":"VA","pcpzip":243144547,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"SOUTHWEST","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"298 CONCORD DRIVE","madd2":"                                                            ","madd3":"","mcity":"NORTH TAZEWELL","mstate":"VA","mzip":"24630-8059","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I10","E11.9","J44.9","E03.9","E78.2","K59.09","G62.9","G47.00","M54.5","N39.3","G89.29","Z71.3","Z71.82","Z95.5","Z86.39","R68.89","I25.10","R53.83","R41.0","R29.810","R53.1","M62.838","E16.2","Z09","N39.0","R10.30","K59.00","R11.2","D64.9","R10.9","M54.9","E11.8","N39.46","R39.81","M25.551","M25.552","Z02.2","Z68.24","M79.606","K44.9","Z90.49","K57.30","R32","L60.8","L29.9","T88.7XXA","Z99.81","M79.669","R10.84","E87.1","R79.89","R10.32","R11.10","R06.02","R33.9","Z20.828","M51.36","Z90.710","R41.82","Z02.71","M25.561","M79.604","M84.359A","M70.61","H25.13","E55.9","I11.0","I50.9","Z79.84","I25.2","Z86.73","Z79.02","T16.9XXA","M79.605","M48.061","M62.81","M79.676","R00.1","N17.9","K52.9","E86.0","R26.2","F17.200","N30.00","R53.81","R26.9","B96.20","Z20.822","T16.1XXA","H92.01","X58.XXXA","F17.210","F41.9","E11.40","B35.1","L60.0","Z91.81","N39.498","S09.90XA","M79.661","M79.662","Z96.651","L03.115","R11.0"],"date":["2021-01-19","2021-03-05","2019-04-23","2021-03-08","2019-04-23","2019-09-23","2020-07-29","2020-04-21","2021-03-04","2019-04-23","2020-09-20","2020-04-21","2020-04-21","2021-03-08","2020-04-21","2021-01-19","2020-09-14","2019-09-23","2019-09-23","2019-09-23","2021-03-03","2019-09-23","2020-02-18","2020-08-13","2021-03-08","2021-03-04","2020-09-17","2020-09-17","2020-09-17","2020-09-17","2021-03-03","2021-05-15","2021-05-15","2021-05-15","2021-03-04","2021-03-04","2021-01-19","2021-01-19","2021-03-04","2021-03-04","2021-04-20","2021-04-20","2020-04-21","2020-07-13","2020-10-05","2020-10-05","2020-11-10","2020-02-18","2020-09-14","2020-10-01","2020-09-14","2021-03-04","2021-04-20","2020-10-01","2020-10-01","2020-11-10","2021-03-07","2021-04-20","2021-04-20","2019-02-28","2020-05-26","2021-03-03","2020-06-08","2020-11-12","2020-06-29","2020-09-14","2020-10-05","2021-03-05","2020-10-05","2021-03-05","2020-10-05","2020-10-05","2020-10-29","2021-03-03","2019-08-13","2020-06-29","2020-07-13","2020-09-05","2020-09-14","2020-09-14","2020-09-14","2020-09-14","2020-09-14","2021-03-05","2021-03-08","2021-03-08","2021-03-08","2021-03-05","2020-10-29","2020-10-29","2020-10-29","2021-03-08","2020-04-21","2020-04-29","2020-04-29","2020-04-29","2020-11-10","2021-03-05","2021-03-06","2021-03-05","2021-03-05","2020-05-08","2020-06-04","2020-09-14"],"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":[["","00781571001","POT  CL MICRO","TAB 10MEQ ER","30","Select","Select",""],["","65162027250","SMZ\/TMP ","TAB 800-160","20","Select","Select",""],["","50111043301","TRAZODONE ","TAB 50MG","30","Select","Select",""],["","00378075110","CYCLOBENZAPR ","TAB 10MG","90","Select","Select",""],["","45963043965","CONSTULOSE ","SOL 10GM\/15","450","Select","Select",""],["","68180051703","LISINOPRIL ","TAB 40MG","30","Select","Select",""],["","68180096503","LEVOTHYROXIN ","TAB 25MCG","30","Select","Select",""],["","69315011701","FUROSEMIDE ","TAB 40MG","30","Select","Select",""],["","65862035705","CLOPIDOGREL ","TAB 75MG","30","Select","Select",""],["","42858000101","OXYCODONE ","TAB 5MG","10","Select","Select",""],["","16714050402","GABAPENTIN ","CAP 300MG","90","Select","Select",""],["","67877021905","CEPHALEXIN ","CAP 500MG","30","Select","Select",""],["","31722072250","LEVOFLOXACIN ","TAB 500MG","7","Select","Select",""],["","00378456105","POT  CHLORIDE","TAB 10MEQ ER","30","Select","Select",""],["","51293080101","PHENAZOPYRID ","TAB 100MG","6","Select","Select",""],["","75834002012","VITAMIN ","CAP 50000UNT","4","Select","Select",""],["","00172392670","DIAZEPAM ","TAB 5MG","2","Select","Select",""],["","00185012201","NITROFURANTN ","CAP 100MG","14","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":""}]}]}