{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SHANE PARKER","gend":0,"add":"360 OLD NICKLESVILLE ROAD","city":"GATE CITY","state":"VA","zip":"24251-3253","dob":"1977-12-07","age":"","mstatus":"","insh":3228002,"cliId":"","pno":2545921666,"cno":2765940018,"email":"","ename":"","eno":"","pphy":"ARNETTE, BRYAN THOMAS","ppno":2763869771,"pcpadd":"1754 US Highway 23 N, ","pcpcity":"Weber City","pcpstate":"VA","pcpzip":242907071,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"SOUTHWEST","aligned":"","ano":2765940018,"add2":"                                                            ","add3":"","madd1":"360 OLD NICKLESVILLE ROAD","madd2":"                                                            ","madd3":"","mcity":"GATE CITY","mstate":"VA","mzip":"24251-3253","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R10.9","L73.9","E29.1","M47.817","F33.1","F43.12","K64.2","I80.8","D64.9","Z79.899","R14.0","I95.9","J20.9","F43.10","E03.9","F31.9","R74.8","R73.9","M25.50","F41.9","F11.20","R39.11","R20.0","K64.4","K64.8","M54.5","E78.00","R07.89","R06.02","F10.129","R07.9","M54.9","M54.6","K04.7","M25.562","G60.9","G56.00","L30.9","V89.2XXA","S02.5XXA","R79.89","R10.31","K35.20","R06.81","J30.9","M46.96","G56.01","G56.02","Z01.812","E79.0","J32.9","B96.89","M1A.00X0","R76.0","R73.09","G89.29","F10.20","R10.12","B35.6","R07.2","F10.10","E87.6","Z09","K21.9","B37.9","F41.0","R94.6","K35.80","F13.20","T17.910A","R06.2","B37.0","K12.1","G47.00","M53.3","R41.3","R19.7","I89.1","Z87.891","K57.30","K76.0","R16.0","Z28.21","Z79.891","I10","E07.9","R51","L08.9","J06.9","L72.9","M25.551","M25.552","R10.811","K82.8","G89.18","R00.2","Z90.49","R06.00","R60.9","M19.90","Z23","R68.84","R20.2","R53.83"],"date":["2020-08-20","2019-09-17","2021-05-07","2019-01-24","2021-04-30","2021-04-30","2019-04-11","2019-07-19","2020-03-02","2021-05-08","2020-09-22","2019-11-07","2019-11-08","2021-03-05","2021-05-07","2021-01-06","2020-09-22","2020-03-02","2020-06-04","2020-06-01","2021-01-06","2020-09-22","2021-05-07","2019-02-28","2019-02-28","2021-05-19","2021-04-08","2019-03-19","2021-05-13","2019-03-12","2021-05-08","2021-05-08","2019-10-22","2019-11-05","2020-01-02","2020-09-16","2019-11-04","2019-11-04","2019-11-04","2019-11-11","2021-05-13","2020-08-06","2020-08-06","2021-05-06","2019-01-15","2019-04-11","2019-11-05","2019-11-05","2019-12-02","2020-06-01","2020-04-09","2020-04-09","2020-06-04","2020-06-04","2020-12-21","2021-04-08","2021-04-08","2019-01-29","2019-01-29","2019-03-12","2019-03-12","2019-03-19","2019-03-19","2021-05-08","2019-09-17","2019-07-09","2020-06-15","2020-08-07","2021-01-06","2019-02-05","2019-02-05","2019-02-05","2019-02-05","2019-02-05","2020-06-01","2019-08-12","2019-10-11","2020-06-15","2020-08-06","2020-08-06","2020-08-06","2020-08-06","2020-08-06","2020-08-06","2021-05-08","2021-05-08","2019-07-15","2019-07-16","2019-07-16","2019-12-02","2020-06-01","2020-06-01","2019-06-05","2019-07-15","2019-07-15","2019-07-15","2019-07-15","2019-08-01","2019-08-01","2019-03-12","2019-03-12","2019-10-22","2019-10-22","2020-09-22"],"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":[["","00378180010","LEVOTHYROXIN ","TAB 25MCG","30","Select","Select",""],["","43547034006","RISPERIDONE ","TAB 0.5MG","60","Select","Select",""],["","70710113908","FLUCONAZOLE ","TAB 150MG","2","Select","Select",""],["","47781060730","DISULFIRAM ","TAB 250MG","60","Select","Select",""],["","53746010901","HYDROCO\/APAP ","TAB 5-325MG","90","Select","Select",""],["","68682010301","DICLOFENAC ","TAB 100MG ER","30","Select","Select",""],["","00228300350","CLONAZEPAM ","TAB 0.5MG","90","Select","Select",""],["","67877032105","IBUPROFEN ","TAB 800MG","90","Select","Select",""],["","00093770198","LEVOCETIRIZI ","TAB 5MG","30","Select","Select",""],["","68462010530","ONDANSETRON ","TAB 4MG","18","Select","Select",""],["","00093221001","SUCRALFATE ","TAB 1GM","120","Select","Select",""],["","70710120901","ALLOPURINOL ","TAB 100MG","120","Select","Select",""],["","62175061743","PANTOPRAZOLE ","TAB 40MG","60","Select","Select",""],["","43199001301","HYOSCYAMINE ","TAB 0.125MG","12","Select","Select",""],["","66993066330","DULOXETINE ","CAP 30MG","60","Select","Select",""],["","43598029390","PREGABALIN ","CAP 75MG","90","Select","Select",""],["","65162052110","PROMETHAZINE ","TAB 25MG","15","Select","Select",""],["","49281042050","FLUZONE ","INJ 2020-21","0.5","Select","Select",""],["","00591293201","CLINDAMYCIN ","CAP 300MG","40","Select","Select",""],["","00536100901","FERROUS ","TAB 325MG","30","Select","Select",""],["","00185094097","CHOLESTYRAM ","POW 4GM","378","Select","Select",""],["","24658031205","DOXYCYCL ","TAB 100MG","14","Select","Select",""],["","64764075030","TRINTELLIX ","TAB 20MG","30","Select","Select",""],["","69097015807","MELOXICAM ","TAB 7.5MG","60","Select","Select",""],["","68382031818","MINOCYCLINE ","CAP 100MG","42","Select","Select",""],["","31722054501","LITHIUM ","CAP 300MG","120","Select","Select",""],["","50428049435","VITAMIN ","TAB 250MG","30","Select","Select",""],["","00378020810","FUROSEMIDE ","TAB 20MG","30","Select","Select",""],["","59267100002","PFIZER ","INJ COVID-19","0.3","Select","Select",""],["","68180016013","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","00093101042","MUPIROCIN ","OIN 0.02","22","Select","Select",""],["","50428030129","MELATONIN ","SUB QUIK DIS","30","Select","Select",""],["","33332031901","AFLURIA ","INJ 2019-20","0.5","Select","Select",""],["","68180071160","CEFDINIR ","CAP 300MG","20","Select","Select",""],["","00245531711","KLOR-CON ","TAB 10MEQ ER","30","Select","Select",""],["","68462043518","ACAMPRO ","TAB 333MG","180","Select","Select",""],["","10702005601","OXYCODONE ","TAB 10MG","60","Select","Select",""],["","00143965901","TESTOST ","INJ 200MG\/ML","1","Select","Select",""],["","51672404806","CLOTRIM\/BETA ","CRE DIPROP","45","Select","Select",""],["","65862067899","ALPRAZOLAM ","TAB 1MG","30","Select","Select",""],["","00115169449","EPINEPHRINE ","INJ 0.3MG","2","Select","Select",""],["","65862053750","LEVOFLOXACIN ","TAB 500MG","10","Select","Select",""],["","54436020004","XYOSTED ","INJ 100\/0.5","2","Select","Select",""],["","00781185220","AMOX\/K ","TAB 875-125","28","Select","Select",""],["","69547035302","NARCAN ","SPR ","2","Select","Select",""],["","00378110101","PRAZOSIN ","CAP 1MG","60","Select","Select",""],["","68382002210","ATENOLOL ","25MG","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":[[["No","Select","","","","","Select","",""],["No","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":""}]}]}