{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"RITA   C WILLIAMS","gend":1,"add":"161 SUNDOWN DRIVE","city":"WEBER CITY","state":"VA","zip":"24290-7340","dob":"1965-02-23","age":"","mstatus":"","insh":10165784,"cliId":"","pno":7233838808,"cno":4233838808,"email":"","ename":"","eno":"","pphy":"AKINS, MEGAN","ppno":4233926200,"pcpadd":"105 W Stone Dr Ste V, ","pcpcity":"Kingsport","pcpstate":"TN","pcpzip":376603256,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"SOUTHWEST","aligned":"","ano":4233838808,"add2":"LOT 411","add3":"","madd1":"161 SUNDOWN DRIVE","madd2":"LOT 411","madd3":"","mcity":"WEBER CITY","mstate":"VA","mzip":"24290-7340","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R05","J02.9","R00.2","I10","E78.5","E11.65","R68.89","R91.8","E11.621","L97.509","F33.9","H61.21","M23.90","L02.91","J06.9","C54.1","R39.9","K59.09","L53.9","N30.01","E11.21","E11.3299","E11.69","E78.2","E11.59","E11.9","E66.9","N84.2","R10.9","R93.89","R06.02","E11.39","Z85.42","F41.9","M54.5","S81.859A","L08.9","M18.9","M79.605","R26.2","G47.33","Q27.9","R91.1","Z13.89","E11.40","Z91.19","H11.31","W22.8XXA","Y93.9","R73.9","E11.3312","Z79.4","R30.0","I31.3","E11.3412","S00.11XA","Z23","H20.012","E11.8","L97.529","E11.3311","Z91.14","L03.90","E11.3392","K76.0","R16.1","E27.9","I70.8","I72.8","R10.84"],"date":["2021-04-21","2019-03-11","2019-05-13","2021-02-25","2020-10-22","2021-03-16","2020-03-25","2020-07-28","2020-06-11","2020-05-26","2020-05-26","2020-05-26","2020-05-26","2021-03-17","2019-03-11","2021-02-17","2020-01-27","2019-07-24","2019-07-24","2019-07-24","2020-10-22","2020-05-22","2020-01-03","2020-07-21","2020-10-22","2020-03-05","2020-01-03","2020-01-27","2020-02-07","2020-09-08","2021-04-21","2021-03-16","2019-05-13","2019-11-25","2019-05-13","2019-08-21","2019-08-21","2019-08-21","2020-04-13","2020-04-13","2021-03-10","2021-04-21","2021-04-14","2020-03-05","2021-02-25","2019-07-05","2019-11-01","2019-10-19","2019-10-19","2020-10-22","2021-02-24","2021-02-24","2021-02-17","2020-02-17","2020-11-13","2019-10-19","2019-11-01","2020-01-14","2020-06-11","2020-06-11","2020-10-28","2020-10-22","2021-03-16","2019-04-30","2020-02-07","2020-02-07","2020-02-07","2020-02-07","2020-02-07","2020-02-07"],"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":[["","99073070827","FREESTYLE    TES LITE","TES LITE","100","Select","Select",""],["","08290320109","BD  PEN NEEDL","MIS 31GX8MM","400","Select","Select",""],["","68382050010","OMEPRAZOLE ","CAP 40MG","30","Select","Select",""],["","00169633910","NOVOLOG ","INJ FLEXPEN","45","Select","Select",""],["","51672403903","ENALAPRIL ","TAB 10MG","30","Select","Select",""],["","59762033302","LATANOPROST ","SOL 0.00005","2.5","Select","Select",""],["","45963067711","METOPROL ","TAB 100MG ER","90","Select","Select",""],["","65862001305","SERTRALINE ","TAB 100MG","90","Select","Select",""],["","65862076990","FENOFIBRATE ","TAB 145MG","90","Select","Select",""],["","55111012305","ATORVASTATIN ","TAB 40MG","90","Select","Select",""],["","00002143380","TRULICITY ","INJ 0.75\/0.5","2","Select","Select",""],["","56151210401","PEN  NEEDLES  ","MIS 32GX4MM","100","Select","Select",""],["","00378718705","METFORMIN ","TAB 1000MG","60","Select","Select",""],["","99073070805","FREESTYLE    MIS LITE","MIS LITE","1","Select","Select",""],["","73070010315","INSULIN ","INJ FLEXPEN","3","Select","Select",""],["","00143980305","DOXYCYCL ","CAP 100MG","14","Select","Select",""],["","67877021905","CEPHALEXIN ","CAP 500MG","10","Select","Select",""],["","00169255013","TRESIBA ","INJ 200UNIT","27","Select","Select",""],["","00168037030","CLOTRIM\/BETA ","LOT DIPROP","30","Select","Select",""],["","00378932032","WIXELA ","AER 100\/50","60","Select","Select",""],["","69452014420","BENZONATATE ","CAP 200MG","20","Select","Select",""],["","57896048930","POLYETH ","POW 3350 NF","510","Select","Select",""],["","00173069500","ADVAIR ","AER 100\/50","60","Select","Select",""],["","57237023305","SMZ-TMP ","TAB 800-160","20","Select","Select",""],["","99073070914","FREESTYLE    KIT FREEDOM","KIT FREEDOM","1","Select","Select",""],["","00088221905","LANTUS ","INJ 100\/ML","69","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","20","Select","Select",""],["","00093101042","MUPIROCIN ","OIN 0.02","22","Select","Select",""],["","65862053750","LEVOFLOXACIN ","TAB 500MG","10","Select","Select",""],["","66685100100","AMOX\/K ","TAB 875-125","14","Select","Select",""],["","99073013001","FREESTYLE    MIS LANCETS","MIS LANCETS","100","Select","Select",""],["","61314063705","PREDNISOLONE ","SUS 1% OP","5","Select","Select",""],["","64679084810","METOPROLOL ","100MG ER","90","Select","Select",""],["","00310652401","BYETTA ","10MCG","7.2","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":""}]}]}