{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ASHLEY   L REEVES","gend":1,"add":"503 VIRGINIAN DRIVE","city":"CHRISTIANSBURG","state":"VA","zip":"24073-6590","dob":"1984-08-04","age":"","mstatus":"","insh":4225199,"cliId":"","pno":5406412010,"cno":5406412010,"email":"","ename":"","eno":"","pphy":"TSUI, CAMILLA K","ppno":5409510352,"pcpadd":"901 Plantation Rd Ste 3, ","pcpcity":"Blacksburg","pcpstate":"VA","pcpzip":240603821,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"503 VIRGINIAN DRIVE","madd2":"                                                            ","madd3":"","mcity":"CHRISTIANSBURG","mstate":"VA","mzip":"24073-6590","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N20.0","L40.0","L40.8","R07.9","F33.1","H66.92","R42","R51","H92.12","R11.2","H92.02","G40.909","R07.89","R40.4","G56.41","G44.52","G37.9","K50.018","R19.7","D89.9","K21.9","E55.9","R10.84","R11.0","D48.5","B34.9","R05","Z86.73","M94.0","R10.12","J20.9","R10.11","Z79.899","K50.00","Z51.81","F41.1","H92.09","K50.90","F32.9","H93.92","Z20.828","Z88.0","Z88.1","K29.50","K21.00","K31.7","K62.89","Z80.3","Z80.0","Z87.19","B02.9","S63.501A","E78.00","Z23","K59.00","R10.9","F41.9","J06.9","R11.10","R10.13","Z01.419","R87.610","Z11.3","Z30.433","T83.32XD","H69.83","R07.81","R43.9","Z20.822","R63.4","J22","N64.52","R06.00","Z13.228","E87.1","R56.9","K58.1","G43.009","G96.00","K63.89","K50.10","K64.8","K22.8","K31.89","K50.818","T83.32XA","R32","R10.10","K92.1","J45.909","B37.9","M19.011","Z00.00","H91.8X2","F17.200","Z71.83","K50.012","R19.07","Z13.31","Z11.1","Z76.89","L02.91","L73.2","R29.6","R94.31","G43.909","Z79.51","E66.01"],"date":["2020-01-27","2019-10-01","2019-10-17","2021-01-15","2020-08-18","2020-08-23","2020-09-18","2020-09-21","2020-11-02","2020-09-21","2020-09-28","2021-01-12","2021-01-12","2021-04-13","2021-04-13","2021-04-13","2021-04-13","2021-01-25","2021-01-19","2020-03-31","2021-01-12","2019-03-11","2019-06-17","2019-06-11","2019-09-17","2020-02-05","2021-01-15","2021-01-15","2020-02-26","2020-02-26","2020-02-26","2020-02-26","2020-03-31","2020-03-31","2020-03-31","2021-05-10","2020-04-29","2021-05-10","2021-05-10","2020-08-23","2020-08-23","2020-08-23","2020-08-23","2021-01-27","2021-01-27","2021-01-27","2021-03-01","2021-02-26","2021-02-26","2021-02-10","2019-05-08","2019-11-04","2020-01-21","2020-01-21","2020-01-27","2020-01-27","2021-01-25","2020-02-02","2021-01-12","2021-01-27","2020-05-04","2020-05-04","2020-05-13","2020-05-13","2020-05-13","2020-09-18","2021-01-15","2021-01-15","2021-01-15","2021-01-27","2020-02-01","2021-02-17","2020-02-26","2020-09-15","2020-09-15","2021-05-10","2021-01-25","2020-12-07","2020-12-07","2021-01-27","2021-01-27","2021-01-27","2021-01-27","2021-01-27","2021-03-05","2020-05-04","2020-12-07","2021-01-19","2021-01-19","2021-03-01","2021-03-06","2019-01-07","2020-01-06","2020-05-08","2021-01-12","2021-02-26","2019-06-11","2019-06-17","2020-01-06","2020-01-06","2020-01-06","2020-01-06","2020-01-06","2020-11-02","2021-01-15","2021-01-25","2021-01-25","2021-01-25"],"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":[["","00574985510","BUDESONIDE ","CAP 3MG DR","90","Select","Select",""],["","68462010630","ONDANSETRON ","TAB 8MG","15","Select","Select",""],["","65862052830","VENLAFAXINE ","CAP 75MG ER","30","Select","Select",""],["","31722071390","PANTOPRAZOLE ","TAB 40MG","30","Select","Select",""],["","00115166001","PROPRANOLOL ","TAB 20MG","60","Select","Select",""],["","69452015120","VITAMIN ","CAP 50000UNT","4","Select","Select",""],["","43547028910","BUPROPION ","TAB 150MG SR","60","Select","Select",""],["","00781317207","SUMATRIPTAN ","INJ 6MG\/0.5","2","Select","Select",""],["","00555057202","METHOTREXATE ","TAB 2.5MG","20","Select","Select",""],["","45802048526","FLUOCIN ","OIL 0.01% SC","118.28","Select","Select",""],["","69315012710","FOLIC ","TAB 1000MCG","90","Select","Select",""],["","68462034690","LEVOCETIRIZI ","TAB 5MG","30","Select","Select",""],["","68462013001","ZONISAMIDE ","CAP 100MG","90","Select","Select",""],["","51672129303","CLOBETASOL ","SOL 0.0005","50","Select","Select",""],["","65862001905","CEPHALEXIN ","CAP 500MG","28","Select","Select",""],["","60505082901","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","00406012305","HYDROCO\/APAP ","TAB 5-325MG","10","Select","Select",""],["","52817033200","CYCLOBENZAPR ","TAB 10MG","30","Select","Select",""],["","55111017915","TIZANIDINE ","TAB 2MG","60","Select","Select",""],["","68382079201","ACYCLOVIR ","TAB 800MG","35","Select","Select",""],["","00456120230","LINZESS ","CAP 290MCG","30","Select","Select",""],["","57894006103","STELARA ","INJ 90MG\/ML","1","Select","Select",""],["","59746011506","PROCHLORPER ","TAB 10MG","12","Select","Select",""],["","00074433902","HUMIRA ","INJ 40MG\/0.8","2","Select","Select",""],["","24208041005","OFLOXACIN ","DRO 0.3%OTIC","5","Select","Select",""],["","00591544210","PREDNISONE ","TAB 10MG","32","Select","Select",""],["","33342009441","RIZATRIPTAN ","TAB 10MG ODT","9","Select","Select",""],["","11917013941","D3 ","CAP 2000UNIT","30","Select","Select",""],["","69543025216","VIRTUSSIN ","SOL 100-10\/5","120","Select","Select",""],["","68462019005","NAPROXEN ","TAB 500MG","20","Select","Select",""],["","00781808926","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","00093317431","ALBUTEROL ","FAT E","8.5","Select","Select",""],["","00574110404","BROM\/PSE\/DM ","SYP ","120","Select","Select",""],["","60432060416","PROMETHAZINE ","SYP DM","120","Select","Select",""],["","00406051205","OXYCOD\/APAP ","TAB 5-325MG","20","Select","Select",""],["","57237000511","FLUCONAZOLE ","TAB 150MG","7","Select","Select",""],["","00472037915","CLOTRIM\/BETA ","CRE DIPROP","45","Select","Select",""],["","81421002204","DULCOLAX ","CAP 100MG","10","Select","Select",""],["","00363022714","ASPIRIN ","325MG EC","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":""}]}]}