{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"STEPHEN   L WEST SR","gend":0,"add":"125   VAUGHN CIRCLE                                         ","city":"CHRISTIANSBURG                ","state":"VA","zip":"24073-5230","dob":"1981-10-27","age":"","mstatus":"","insh":10261688,"cliId":"","pno":5402508475,"cno":5402508475,"email":"","ename":"","eno":"","pphy":"SNOW, JULIANNA                                              ","ppno":"","pcpadd":"2900 LAMB CIRCLE","pcpcity":"CHRISTIANSBURG                ","pcpstate":"VA","pcpzip":240736344,"pcpcounty":"","pcpid":"P0117368","pcpname":"CARILION FAMILY MEDICINE CHRISTIANBURG","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"LOT 125                                                     ","add3":"","madd1":"125   VAUGHN CIRCLE                                         ","madd2":"LOT 125                                                     ","madd3":"","mcity":"CHRISTIANSBURG                ","mstate":"VA","mzip":"24073-5230","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J06.9","Z20.828","B19.20","Z00.00","Z23","M54.9","R09.81","Z87.898","G89.29","M54.2","M54.5","J32.8","J34.2","J34.3","J34.89","J32.9","D36.9","D14.0","M95.0","F17.200","D23.39","G89.18","E11.9","Z86.73","L98.9","L98.1","L01.01","B18.2","R11.0","R19.7","R10.9","K82.0","R93.2","S05.01XA","X58.XXXA","Z86.19","W55.89XA","F45.8","L60.8","S30.92XA","S50.912A","S50.911A","S00.80XA","F15.10","H92.01","R21","R51.9","R10.84","F12.10","R11.2","F12.90","L29.9","R10.11","I70.0","R45.1","B86","F19.10","L08.9"],"date":["2020-09-24","2020-11-05","2021-07-29","2020-10-05","2020-10-05","2020-10-13","2020-11-23","2021-07-29","2020-10-13","2020-10-13","2020-10-13","2020-11-23","2020-11-23","2020-11-23","2020-11-23","2020-10-23","2020-11-23","2020-11-09","2020-11-09","2021-07-28","2020-11-09","2020-11-10","2021-04-11","2021-04-11","2020-11-23","2020-11-24","2020-11-24","2020-12-01","2020-12-01","2020-12-01","2020-12-01","2020-12-11","2020-12-11","2020-12-29","2020-12-29","2020-12-29","2020-12-29","2021-02-16","2021-02-16","2021-02-16","2021-02-16","2021-02-16","2021-02-16","2021-07-28","2021-04-11","2021-04-11","2021-04-11","2021-07-28","2021-07-28","2021-07-28","2021-07-28","2021-07-29","2021-07-29","2021-07-29","2021-07-29","2021-07-29","2021-07-29","2021-07-29"],"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":[["","00093101042","MUPIROCIN","2%","22","Select","Select",""],["","69238110005","DOXYCYCL","100MG","14","Select","Select",""],["","00472024260","PERMETHRIN","5%","60","Select","Select",""],["","17478007035","ERYTHROMYCIN","5MG\/GM","3.5","Select","Select",""],["","67877021905","CEPHALEXIN","500MG","21","Select","Select",""],["","68645056259","IBUPROFEN","600MG","30","Select","Select",""],["","57237007710","ONDANSETRON","4MG ODT","12","Select","Select",""],["","00093005805","TRAMADOL","50MG","15","Select","Select",""],["","24208041005","OFLOXACIN","0.3%OTIC","5","Select","Select",""],["","00555032302","HYDROXYZ","25MG","30","Select","Select",""],["","00093101042","MUPIROCIN ","OIN 0.02","22","Select","Select",""],["","69238110005","DOXYCYCL ","CAP 100MG","14","Select","Select",""],["","00555032302","HYDROXYZ ","CAP 25MG","30","Select","Select",""],["","00472024260","PERMETHRIN ","CRE 0.05","60","Select","Select",""],["","68462015713","ONDANSETRON ","TAB 4MG ODT","10","Select","Select",""],["","17478007035","ERYTHROMYCIN ","OIN 5MG\/GM","3.5","Select","Select",""],["","67877021905","CEPHALEXIN ","CAP 500MG","21","Select","Select",""],["","68645056259","IBUPROFEN ","TAB 600MG","30","Select","Select",""],["","00093005805","TRAMADOL ","TAB 50MG","15","Select","Select",""],["","24208041005","OFLOXACIN ","DRO 0.3%OTIC","5","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":""}]}]}