{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DESIREE SHAFER","gend":1,"add":"628 INDUSTRIAL AVENUE","city":"MARION","state":"VA","zip":"24354-1816","dob":"1980-02-23","age":"","mstatus":"","insh":10195830,"cliId":"","pno":7405501661,"cno":7405501661,"email":"","ename":"","eno":"","pphy":"CLAMPITT, ROBERT V","ppno":2767837167,"pcpadd":"1020 Terrace Dr, Ste 100","pcpcity":"Marion","pcpstate":"VA","pcpzip":243544392,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"SOUTHWEST","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"628 INDUSTRIAL AVENUE","madd2":"                                                            ","madd3":"","mcity":"MARION","mstate":"VA","mzip":"24354-1816","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J95.821","D49.6","I10","J32.9","R73.9","G47.33","E87.79","F41.9","G43.909","G91.1","D32.0","R00.0","D32.9","Z98.2","G93.2","G93.89","E11.9","G47.00","Z79.899","H69.81","J30.1","J01.00","R53.83","J01.90","R19.00","G91.9","E66.01","N91.2","R45.1","C75.3","E66.9","Z30.42","J20.9","R05","R22.2","D35.4","G93.5","Z46.82","R91.8","Z86.011","R51","R42","G93.9","Q21.1","D49.7","Z98.890","H53.8","R55","R53.1","R91.1","N39.0","Z30.011","J20.8","M79.89","R22.0","J96.00","Z68.44","D69.6","F32.9","E87.6","R33.9","N92.6","J06.9","J02.9","R06.2","J90","Z03.89","Z01.818","D44.5","R60.0","R11.0","G47.30","C71.9","H66.91","R30.0"],"date":["2020-02-04","2020-02-08","2021-05-13","2020-02-08","2020-03-27","2021-02-11","2020-02-08","2020-02-08","2020-02-08","2020-02-12","2020-05-26","2020-02-07","2020-05-26","2020-02-12","2021-02-08","2020-05-26","2020-07-30","2021-02-11","2021-05-13","2021-05-24","2021-05-24","2020-01-31","2021-05-13","2020-01-31","2020-01-31","2020-02-28","2020-07-30","2021-05-13","2020-10-08","2020-10-08","2020-10-08","2021-05-13","2019-10-19","2020-03-27","2019-11-21","2020-02-28","2020-02-07","2020-02-07","2020-02-12","2020-02-12","2020-02-03","2020-02-03","2020-02-03","2020-02-04","2020-02-07","2020-02-07","2020-02-28","2019-12-27","2019-11-21","2019-11-21","2019-11-21","2021-02-11","2019-09-25","2020-02-04","2020-02-03","2020-02-06","2020-02-03","2020-02-03","2020-02-03","2020-02-03","2020-02-03","2020-07-02","2019-12-27","2019-12-27","2019-12-27","2019-12-27","2020-02-04","2020-02-05","2020-02-05","2020-02-06","2020-03-27","2020-05-28","2020-05-28","2021-05-13","2021-05-13"],"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":[["","13668001990","VENLAFAXINE ","CAP 75MG ER","30","Select","Select",""],["","67877014601","TEMAZEPAM ","CAP 15MG","30","Select","Select",""],["","68645052254","SERTRALINE ","TAB 50MG","30","Select","Select",""],["","99073013001","FREESTYLE    MIS LANCETS","MIS LANCETS","100","Select","Select",""],["","65862031560","LEVETIRACETA ","TAB 1000MG","60","Select","Select",""],["","42858000101","OXYCODONE ","TAB 5MG","15","Select","Select",""],["","57599157904","FREESTYLE    TES PREC NEO","TES PREC NEO","100","Select","Select",""],["","29300011516","TOPIRAMATE ","TAB 25MG","60","Select","Select",""],["","68645014059","FAMOTIDINE ","TAB 20MG","20","Select","Select",""],["","62037059705","CARTIA ","CAP 120\/24HR","30","Select","Select",""],["","00054418425","DEXAMETHASON ","TAB 4MG","11","Select","Select",""],["","00591544310","PREDNISONE ","TAB 20MG","15","Select","Select",""],["","00093317431","ALBUTEROL ","FAT E","8.5","Select","Select",""],["","00143924920","AMOX\/K ","TAB 875-125","20","Select","Select",""],["","69315090501","LORAZEPAM ","TAB 1MG","30","Select","Select",""],["","69452014320","BENZONATATE ","CAP 100MG","15","Select","Select",""],["","68180012202","CEPHALEXIN ","CAP 500MG","40","Select","Select",""],["","00713063415","MOMETASONE ","CRE 0.001","15","Select","Select",""],["","24979002602","DILTIAZEM ","CAP 120MG ER","30","Select","Select",""],["","00781261305","AMOXICILLIN ","CAP 500MG","40","Select","Select",""],["","16729018201","HYDROCHLOROT ","TAB 12.5MG","30","Select","Select",""],["","00008083621","EFFEXOR ","CAP 150MG","30","Select","Select",""],["","50111078751","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","68180071160","CEFDINIR ","CAP 300MG","14","Select","Select",""],["","00703680101","MEDROXYPR ","INJ 150MG\/ML","1","Select","Select",""],["","00172392670","DIAZEPAM ","TAB 5MG","2","Select","Select",""],["","16729013716","CLONAZEPAM ","TAB 1MG","2","Select","Select",""],["","60505001408","DILT-XR ","CAP 120MG","30","Select","Select",""],["","64380083406","ACETAZOLAMID ","TAB 250MG","60","Select","Select",""],["","57599517501","PREC ","KIT FREESTYL","1","Select","Select",""],["","00054327099","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","55111014512","FLUCONAZOLE ","TAB 150MG","2","Select","Select",""],["","60505084805","AZELASTINE ","0.15%","30","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":""}]}]}