{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KARI   E RATCLIFF","gend":1,"add":"6495 HAZEL WOOD DRIVE","city":"DUBLIN","state":"VA","zip":"24084-4203","dob":"1980-07-25","age":"","mstatus":"","insh":4108937,"cliId":"","pno":5403368647,"cno":5403368647,"email":"","ename":"","eno":"","pphy":"STEWART, KNOTRESHA F","ppno":5408350500,"pcpadd":"28 Town Center Dr, ","pcpcity":"Dublin","pcpstate":"VA","pcpzip":240846069,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"6495 HAZEL WOOD DRIVE","madd2":"                                                            ","madd3":"","mcity":"DUBLIN","mstate":"VA","mzip":"24084-4203","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R94.31","R50.9","D62","G89.29","C54.1","Z12.4","R52","N93.8","D64.9","C53.9","Z51.0","C53.8","R23.2","N93.9","N88.8","R53.83","R63.5","K59.00","E04.1","F41.1","R10.2","C76.0","Z85.41","K62.5","N89.5","Z53.20","Z01.812","Z32.02","D50.0","D50.9","M51.36","Z92.89","Z51.11","R11.0","K42.9","Z92.3","R93.5","F41.8","R53.82","Z79.899","I95.9","R10.9","Z20.828","G47.00","M25.561","I10","Z01.818","M62.838","F41.9","R53.1","M54.5","M54.30","M54.31","D63.0","Z08","N95.1","E32.0","R93.89","N89.8","F32.9","Z79.890","Z92.21","N39.3","R65.10","Z45.2","D06.7","R93.2","Z85.89","D26.0","N99.2","N76.1","D72.819","D06.9","R60.0","K04.7","E61.1","Z86.2","R79.89","Z20.822","R07.89","R07.9","R32","R30.0","R50.81","Z03.89","K08.89","E04.2","Z85.9","R09.89","I08.1","R87.614","R06.00","E07.9","R89.6","C43.9"],"date":["2019-10-24","2019-12-10","2019-10-26","2020-08-20","2019-10-30","2019-11-26","2021-05-19","2019-11-27","2019-11-27","2021-05-19","2020-02-05","2020-09-22","2020-04-22","2020-10-08","2019-12-12","2021-03-12","2021-05-19","2020-08-13","2020-09-22","2020-08-13","2020-08-21","2020-08-20","2021-03-17","2021-03-17","2021-03-17","2019-06-18","2019-10-30","2019-10-30","2019-10-30","2020-04-22","2019-12-02","2020-04-22","2019-12-02","2020-04-22","2020-08-25","2020-10-02","2020-09-30","2020-09-30","2021-03-12","2021-03-12","2021-03-12","2021-03-12","2021-05-19","2019-11-26","2019-11-26","2019-11-26","2020-10-03","2019-11-26","2020-10-02","2019-05-10","2020-08-20","2019-08-05","2019-08-05","2020-01-16","2020-08-10","2020-06-08","2020-05-19","2020-10-02","2020-10-02","2020-10-02","2020-10-02","2020-10-02","2019-10-24","2019-10-24","2019-11-25","2020-01-29","2020-08-20","2020-08-20","2020-10-08","2020-10-08","2020-10-08","2019-05-10","2019-10-24","2019-12-28","2019-12-28","2020-04-22","2020-04-22","2020-08-25","2021-01-07","2019-01-04","2019-01-04","2019-09-16","2019-09-16","2019-10-23","2019-10-24","2019-12-28","2020-07-07","2020-07-07","2021-01-07","2019-05-10","2019-10-22","2019-10-24","2019-11-07","2020-07-23","2020-01-17"],"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":[["","69547035302","NARCAN ","SPR ","2","Select","Select",""],["","47781023063","OXYCOD\/APAP ","TAB 10-325MG","150","Select","Select",""],["","42858000201","OXYCODONE ","TAB 10MG","56","Select","Select",""],["","65162080710","PROGESTERONE ","CAP 100MG","30","Select","Select",""],["","00781713354","ESTRADIOL ","DIS 0.05MG","4","Select","Select",""],["","10135013805","DOCUSATE ","CAP 240MG","60","Select","Select",""],["","57237007810","ONDANSETRON ","TAB 8MG ODT","180","Select","Select",""],["","70069000510","CYANOCOBALAM ","INJ 1000MCG","2","Select","Select",""],["","00143993905","AMOXICILLIN ","CAP 500MG","14","Select","Select",""],["","63868026401","SENNA-S ","TAB 8.6-50MG","60","Select","Select",""],["","55111068301","IBU ","TAB 600MG","30","Select","Select",""],["","10702000310","PROMETHAZINE ","TAB 25MG","40","Select","Select",""],["","00591079401","DICYCLOMINE ","CAP 10MG","120","Select","Select",""],["","69543038330","OLANZAPINE ","TAB 10MG","24","Select","Select",""],["","42571025201","CLINDAMYCIN ","CAP 300MG","42","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","14","Select","Select",""],["","59746011506","PROCHLORPER ","TAB 10MG","30","Select","Select",""],["","11917010573","PROBIOTIC ","CAP SUPER","30","Select","Select",""],["","00054418425","DEXAMETHASON ","TAB 4MG","36","Select","Select",""],["","54838000180","FERROUS ","ELX 220\/5ML","250","Select","Select",""],["","63868034801","FIBER ","CAP 0.52GM","60","Select","Select",""],["","08290329622","INSULIN ","MIS 1ML\/25G","4","Select","Select",""],["","49100036374","CULTURELLE ","CAP IMMUNITY","7","Select","Select",""],["","42571016142","AMOX\/K ","TAB 500-125","14","Select","Select",""],["","59746017509","PREDNISONE ","TAB 20MG","5","Select","Select",""],["","51991070510","ALPRAZOLAM ","TAB 0.5MG","60","Select","Select",""],["","16729020016","BUSPIRONE ","TAB 5MG","60","Select","Select",""],["","51224012230","AZITHROMYCIN ","TAB 500MG","7","Select","Select",""],["","00046087221","PREMARIN ","0.625MG","30","Select","Select",""],["","00536124801","STIMULANT ","8.6-50MG","25","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":""}]}]}