{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MARGIE   E DILL","gend":1,"add":"1139 VIRGINIA AVENUE","city":"GOSHEN","state":"VA","zip":"24439-2038","dob":"1980-08-29","age":"","mstatus":"","insh":4118394,"cliId":"","pno":5408494473,"cno":5406888775,"email":"","ename":"","eno":"","pphy":"GUEDES DE MORAIS, AMANDA","ppno":"               ","pcpadd":"22 N Medical Park Dr, ","pcpcity":"Fishersville","pcpstate":"VA","pcpzip":229392344,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":5408494773,"add2":"APT 4302","add3":"","madd1":"1139 VIRGINIA AVENUE","madd2":"                                                            ","madd3":"","mcity":"GOSHEN","mstate":"VA","mzip":"24439-2038","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N39.0","R35.0","R30.0","R11.0","N18.3","Z72.0","Z79.899","Z88.2","Z88.3","Z88.0","Z88.5","Z91.018","Z88.8","E86.0","E87.6","I95.1","I45.81","F32.9","F41.9","D47.2","G25.81","G43.909","R07.89","I12.9","I10","R73.01","R55","R19.7","R58","R94.31","R10.9","R23.2","R06.02","R42","R00.2","N18.9","Z88.1","M54.5","R11.2","I49.3","D63.1","E87.2","K21.9","H81.10","R53.1","F33.1","F17.200","N25.81","R20.2","R07.9","N17.9","E66.9","F17.210","K14.0","N64.3","R06.00","E83.42","E55.9","K08.89","R33.9","F34.1","R10.11","M54.2","R00.0","F43.21","N18.31","D75.89","Z12.31","R07.2","M54.9","E87.1","B00.2","M79.602","R40.0","B37.0","R31.9","R00.8","R79.89","S50.11XA","S09.90XA","S29.8XXA","S80.211A","W10.9XXA","T14.8XXA","S80.212A","M54.6"],"date":["2019-10-13","2019-06-19","2020-04-03","2019-04-22","2020-08-11","2020-08-25","2020-08-25","2020-07-08","2019-02-01","2020-07-08","2020-07-08","2019-02-01","2020-08-25","2019-05-14","2020-07-08","2020-02-05","2020-07-02","2020-07-08","2020-10-15","2020-10-15","2020-07-08","2020-10-15","2020-07-08","2020-08-25","2020-10-15","2019-05-14","2020-07-01","2020-07-02","2020-10-15","2020-07-02","2019-02-01","2019-04-22","2020-07-01","2020-07-01","2020-07-02","2020-08-25","2020-07-08","2019-10-13","2019-12-30","2020-07-02","2020-08-11","2020-08-11","2020-08-25","2019-05-15","2019-12-17","2020-09-03","2020-10-15","2019-02-12","2020-07-01","2020-07-08","2019-05-14","2019-05-14","2020-07-02","2020-02-05","2020-05-27","2019-04-22","2020-07-01","2019-12-17","2020-05-26","2020-05-26","2020-05-26","2020-07-02","2020-07-08","2020-07-08","2020-10-15","2020-10-15","2020-10-15","2020-10-15","2019-05-14","2019-12-17","2020-07-01","2020-07-08","2020-07-08","2019-06-04","2019-12-19","2019-01-09","2020-07-01","2020-07-02","2020-08-25","2020-08-25","2020-08-25","2020-08-25","2020-08-25","2020-08-25","2020-08-25","2020-08-25"],"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":[["","68462026001","VERAPAMIL ","TAB 240MG ER","30","Select","Select",""],["","27808003502","HYDROCO\/APAP ","TAB 5-325MG","105","Select","Select",""],["","65162052110","PROMETHAZINE ","TAB 25MG","30","Select","Select",""],["","00093719801","FLUOXETINE ","CAP 40MG","30","Select","Select",""],["","68180029606","DULOXETINE ","CAP 60MG","30","Select","Select",""],["","52817033200","CYCLOBENZAPR ","TAB 10MG","60","Select","Select",""],["","00093520006","BUSPIRONE ","TAB 30MG","60","Select","Select",""],["","68462015305","TOPIRAMATE ","TAB 50MG","180","Select","Select",""],["","57237000511","FLUCONAZOLE ","TAB 150MG","1","Select","Select",""],["","00093506105","HYDROXYZ ","TAB 25MG","90","Select","Select",""],["","60432053760","NYSTATIN ","SUS 100000","60","Select","Select",""],["","60505009600","DOXAZOSIN ","TAB 8MG","30","Select","Select",""],["","00574018101","POT  CHLORIDE","CAP 10MEQ ER","60","Select","Select",""],["","59746012106","MECLIZINE ","TAB 25MG","90","Select","Select",""],["","00603020922","MAG ","TAB 400MG","30","Select","Select",""],["","68462039710","OMEPRAZOLE ","CAP 40MG","60","Select","Select",""],["","62037071001","POT  CL MICRO","TAB 10MEQ CR","60","Select","Select",""],["","60505530601","ACYCLOVIR ","TAB 400MG","30","Select","Select",""],["","68462025601","ROPINIROLE ","TAB 2MG","30","Select","Select",""],["","00093314705","CEPHALEXIN ","CAP 500MG","14","Select","Select",""],["","45802065087","LORATADINE ","TAB 10MG","30","Select","Select",""],["","57237005920","CEFUROXIME ","TAB 500MG","14","Select","Select",""],["","49502050002","EPIPEN ","INJ 0.3MG","2","Select","Select",""],["","00245531911","KLOR-CON ","TAB 20MEQ ER","90","Select","Select",""],["","00228257111","INDAPAMIDE ","TAB 2.5MG","30","Select","Select",""],["","53489014305","SPIRONOLACT ","TAB 25MG","30","Select","Select",""],["","50428026496","CVS ","TAB 8.6MG","120","Select","Select",""],["","68180037603","LOSARTAN ","TAB 25MG","90","Select","Select",""],["","11822222600","RA ","4 M G\/24HR PA","30","Select","Select",""],["","00054414622","CLOTRIMAZOLE ","TRO 10MG","70","Select","Select",""],["","31722071390","PANTOPRAZOLE ","TAB 40MG","30","Select","Select",""],["","00527143501","METAXALONE ","TAB 800MG","90","Select","Select",""],["","00536589588","NICOTINE ","DIS 14MG\/24H","28","Select","Select",""],["","51293081001","PHENAZOPYRID ","TAB 100MG","12","Select","Select",""],["","64980033912","MAGNESIUM-OX ","TAB 400MG","30","Select","Select",""],["","00000000000",""," ","150","Select","Select",""],["","00093598627","EPINEPHRINE ","0.3MG","2","Select","Select",""],["","00591544305","PREDNISONE ","20MG","12","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":""}]}]}