{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SHALINDA HAIRSTON","gend":1,"add":"1501 LOUDON AVENUE NW","city":"ROANOKE","state":"VA","zip":"24017-5646","dob":"1982-03-17","age":"","mstatus":"","insh":10218054,"cliId":"","pno":5409704380,"cno":5409704380,"email":"","ename":"","eno":"","pphy":"SCHLEUPNER, MARK A","ppno":5402243870,"pcpadd":"615 McDowell Ave NW, ","pcpcity":"Roanoke","pcpstate":"VA","pcpzip":240161225,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":5408712130,"add2":"APT 9","add3":"","madd1":"1501 LOUDON AVENUE NW","madd2":"APT 9","madd3":"","mcity":"ROANOKE","mstate":"VA","mzip":"24017-5646","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R07.9","R42","R05","F31.32","R68.89","R06.83","R06.81","R51.9","R41.3","R41.840","G47.10","K21.9","F34.89","F51.3","G47.8","F32.9","F41.9","F33.3","F41.1","F14.10","O9A.211","R51","M54.2","R10.2","Y04.0XXA","S00.83XA","O99.331","O24.911","O99.341","O16.1","O99.511","F17.200","J45.909","Z3A.01","O03.9","Z00.00","N76.0","F33.1","B34.9","R53.83","E11.9","I10","Z20.828","Z79.84","R06.02","F17.210","I51.89","R94.31","R00.1","N91.2","E66.9","Z68.41","Z36.87","O09.511","O20.0","O26.891","R10.30","O46.91","O23.41","Z3A.11","E66.01","N93.9","J12.89","J45.40","J96.01","R11.10","I51.9","F19.10","F20.9","E11.65","Z79.4","E04.1","F41.8","E83.42","O99.519","J45.901","J06.9","Z3A.00","I50.20","E78.5","G47.33","F14.90","I51.7","I42.8","F33.42","F41.0","R07.89","R30.0","Z20.2","O20.9","N89.8","Z79.82","R09.02","J18.9","J45.41","E87.1","K59.00","D57.3","I20.0","R20.0","R09.81","O24.119","O16.9","B97.89","R50.9","R12","N72","Z87.898","E04.2","N30.00","Z76.0","S00.93XA","Y04.2XXA","S09.93XA","R21","R10.9","Z86.39","E05.00","Z72.0","I49.9","I49.3","Z23","I11.0","I50.9","G89.29","M54.9","Z87.891","Z79.899","E11.8"],"date":["2021-05-19","2020-01-06","2020-12-08","2020-02-24","2020-05-10","2021-01-18","2021-01-18","2021-01-18","2021-01-18","2021-01-18","2021-01-18","2021-01-18","2021-01-18","2021-01-18","2021-01-18","2021-01-18","2021-01-18","2021-05-23","2021-05-23","2021-05-23","2020-03-23","2020-03-23","2020-03-23","2020-04-23","2020-03-23","2020-03-23","2020-04-23","2020-04-23","2020-03-23","2020-04-23","2020-04-23","2020-12-07","2020-12-28","2020-04-23","2020-05-08","2020-05-08","2020-10-26","2020-11-04","2020-12-08","2021-03-02","2021-03-02","2021-03-02","2020-12-08","2021-03-02","2021-03-01","2020-12-28","2020-12-28","2021-05-19","2021-01-12","2021-03-02","2021-03-02","2021-03-02","2020-03-23","2020-04-23","2020-05-04","2020-04-23","2020-04-23","2020-04-23","2020-04-23","2020-04-23","2021-01-22","2020-11-09","2020-12-09","2021-03-01","2020-12-09","2020-12-09","2020-12-28","2020-12-28","2021-01-07","2021-02-01","2021-03-03","2020-12-28","2021-01-07","2021-03-01","2020-03-16","2020-12-08","2020-03-16","2020-03-16","2020-12-28","2020-12-28","2021-01-22","2021-01-22","2021-05-19","2021-01-22","2021-03-11","2021-03-11","2021-03-01","2020-01-27","2020-01-27","2020-04-23","2020-11-09","2021-03-01","2020-12-08","2020-12-08","2020-12-08","2020-12-08","2020-12-08","2020-12-08","2020-02-03","2020-02-03","2020-03-16","2020-03-16","2020-03-16","2020-03-16","2020-12-08","2020-04-28","2020-05-08","2020-12-27","2020-12-27","2021-01-28","2021-01-28","2020-03-23","2020-03-23","2020-03-23","2020-11-09","2020-12-07","2020-04-24","2020-04-24","2020-12-27","2020-12-27","2020-12-27","2020-12-27","2020-12-27","2020-12-27","2021-01-07","2021-01-07","2021-03-01","2021-03-01","2021-03-03"],"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":[["","14539067501","HYDROXYZ ","CAP 50MG","180","Select","Select",""],["","59779065034","CVS ","N-D ROWSY TUS","237","Select","Select",""],["","65862039010","ONDANSETRON ","TAB 4MG ODT","10","Select","Select",""],["","00378021610","FUROSEMIDE ","TAB 40MG","30","Select","Select",""],["","68180098003","LISINOPRIL ","TAB 10MG","30","Select","Select",""],["","00169633910","NOVOLOG ","INJ FLEXPEN","15","Select","Select",""],["","69097014260","ALBUTEROL ","AER HFA","6.7","Select","Select",""],["","68382076010","METFORMIN ","TAB 1000MG","60","Select","Select",""],["","10370010150","BUPROPN ","TAB 150MG XL","30","Select","Select",""],["","60258019601","PRENATAL ","TAB ","30","Select","Select",""],["","57664050658","METOPROL ","TAB 25MG","60","Select","Select",""],["","70377002911","ATORVASTATIN ","TAB 40MG","30","Select","Select",""],["","00536589588","NICOTINE ","DIS 14MG\/24H","14","Select","Select",""],["","50742062101","NIFEDIPINE ","TAB 60MG ER","60","Select","Select",""],["","08290320119","BD  PEN NEEDL","MIS 31GX5MM","100","Select","Select",""],["","16729020201","BUSPIRONE ","TAB 10MG","90","Select","Select",""],["","47781030301","NITROFURANTN ","CAP 100MG","14","Select","Select",""],["","70710113908","FLUCONAZOLE ","TAB 150MG","1","Select","Select",""],["","00088221905","LANTUS ","INJ 100\/ML","15","Select","Select",""],["","50111033401","METRONIDAZOL ","TAB 500MG","4","Select","Select",""],["","51672300302","HYDROCORT ","CRE 0.025","28.35","Select","Select",""],["","00169413212","OZEMPIC ","INJ 2\/1.5ML","1.5","Select","Select",""],["","99073013001","FREESTYLE    MIS LANCETS","MIS LANCETS","100","Select","Select",""],["","65862085901","FAMOTIDINE ","TAB 20MG","60","Select","Select",""],["","11845009611","MAGNESIUM ","TAB 200MG","60","Select","Select",""],["","68180016006","AZITHROMYCIN ","TAB 250MG","3","Select","Select",""],["","99073070805","FREESTYLE    MIS LITE","MIS LITE","1","Select","Select",""],["","99073070827","FREESTYLE    TES LITE","TES LITE","100","Select","Select",""],["","49483060450","IBUPROFEN ","800MG","20","Select","Select",""],["","65162052110","PROMETHAZINE ","25MG","10","Select","Select",""],["","59762500801","MISOPROSTOL ","200MCG","4","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":""}]}]}