{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MAGGIE   L ESTES","gend":1,"add":"756 CRESTVIEW DRIVE","city":"BASSET","state":"VA","zip":"24055-5624","dob":"1961-09-07","age":"","mstatus":"","insh":4277773,"cliId":"","pno":2762523620,"cno":2764212800,"email":"","ename":"","eno":"","pphy":"HAQ, AHMAD","ppno":3366239711,"pcpadd":"4055 Valley View Ln Ste 400, ","pcpcity":"Dallas","pcpstate":"TX","pcpzip":752445071,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":2764212800,"add2":"                                                            ","add3":"","madd1":"756 CRESTVIEW DRIVE","madd2":"                                                            ","madd3":"","mcity":"BASSET","mstate":"VA","mzip":"24055-5624","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z12.11","R07.89","R10.9","N39.46","N32.9","R20.0","E11.9","M54.2","Z71.89","Z71.3","Z13.6","R53.81","M54.5","M62.81","R68.89","R73.9","Z74.3","M54.17","R26.2","R26.81","R26.89","Z12.39","Z12.4","R25.3","Z12.31","Z79.899","R22.41","J44.9","J45.50","R06.09","F17.210","Z71.6","A41.9","J18.1","L03.115","N39.0","N17.9","E11.40","I13.10","J18.9","N17.0","E86.0","L03.116","R52","R21","I10","E87.2","E11.65","E87.1","A49.8","L03.119","R60.0","B35.6","R53.1","J44.0","Z72.0","Z79.4","N18.3","R80.9","M54.16","M48.062","I70.213","I70.223","I73.9","J44.1","M79.651","M79.643","E53.8","R10.12","R74.8","A59.9","N30.01","R10.32","F17.200","E27.9","Z79.84","M50.10","R05","J30.9","E66.3","J98.11","R35.0","M79.671","R93.6","M79.89","Z01.818","R10.11","M47.816","K21.9","R30.0","R31.9","R20.2","M54.41","H53.002","H04.123","M79.604","M46.96","M79.661","R42","D50.0","E11.42","Z79.82","D64.9","I95.9","M25.561","J06.9","B37.9","J15.9","E11.10","E83.42","B96.1","E66.01","Z11.59","E87.5","E83.51","L89.152","Z09","L03.90","R60.9","G56.02","R06.00","D12.5","M46.86","E11.8","E11.41","M79.2","L30.9","R06.2","J10.1","R06.02","J20.9","Z79.51","R00.0","Z23","D50.9","J09.X9","R41.82","Z00.00","G62.9","G56.22","R06.89","Z79.1","R32","R35.1","Z20.822","B37.3","M76.31","M15.0","S93.522A","M19.071","Z01.810","M25.551","J45.909","Z98.890","E11.43","F17.219","M79.642","E08.65","L98.9","L13.1","Z01.812","R53.83","K63.5","R06.9","L02.416","Z03.818","B35.1"],"date":["2021-03-26","2020-03-20","2019-09-14","2021-05-14","2021-05-14","2020-12-17","2021-04-14","2019-04-30","2021-03-26","2021-03-26","2021-04-13","2020-03-20","2020-07-27","2020-06-30","2021-01-22","2019-05-11","2019-05-11","2020-01-06","2020-06-29","2020-01-06","2020-01-06","2020-01-16","2020-01-16","2020-01-29","2021-03-26","2021-03-26","2020-03-03","2021-04-13","2020-08-12","2020-08-12","2021-05-06","2020-08-12","2020-06-30","2020-05-19","2020-06-30","2021-02-16","2020-06-08","2021-05-06","2021-05-06","2020-06-30","2020-10-06","2020-06-10","2020-05-29","2020-07-27","2021-04-13","2021-04-14","2020-06-10","2021-05-06","2020-06-10","2020-06-10","2020-06-10","2021-05-06","2020-06-16","2020-06-16","2020-06-30","2020-06-30","2020-12-07","2020-08-13","2020-08-13","2020-10-07","2020-08-28","2020-10-01","2020-10-01","2021-05-06","2021-04-14","2021-04-13","2020-12-17","2020-12-17","2019-04-01","2019-04-01","2019-04-01","2019-04-01","2019-04-01","2020-03-08","2019-04-01","2020-03-20","2019-04-27","2020-10-20","2020-01-09","2019-06-26","2019-09-16","2020-07-07","2020-10-22","2020-08-06","2021-05-20","2020-12-02","2020-10-06","2021-01-11","2020-12-07","2021-02-16","2021-02-16","2021-02-16","2021-02-16","2021-04-07","2021-04-07","2020-04-29","2019-05-10","2019-04-28","2019-09-14","2019-09-14","2020-06-26","2019-09-14","2020-10-20","2020-05-19","2019-12-17","2020-01-09","2020-04-13","2020-05-19","2020-05-19","2020-05-19","2020-05-19","2020-05-19","2020-05-19","2020-06-04","2020-06-04","2020-06-04","2020-06-08","2020-06-08","2020-07-21","2021-01-22","2020-10-20","2020-01-16","2019-04-28","2019-05-11","2019-05-22","2019-11-14","2020-06-29","2020-03-20","2020-03-20","2021-04-14","2020-03-20","2020-03-20","2020-05-19","2021-05-06","2021-04-14","2021-04-14","2019-09-14","2020-01-16","2020-01-16","2021-01-04","2020-06-04","2020-10-07","2021-05-06","2021-05-06","2021-04-14","2021-05-06","2019-05-23","2019-12-17","2020-08-26","2020-08-26","2021-01-22","2019-05-22","2019-05-22","2019-05-22","2019-09-13","2019-09-13","2020-02-20","2020-03-20","2020-06-17","2020-06-17","2021-01-06","2021-04-14","2019-03-22","2020-03-20","2020-05-28","2020-06-29","2021-01-05"],"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":[["","53746010901","HYDROCO\/APAP ","TAB 5-325MG","60","Select","Select",""],["","00093742698","MONTELUKAST ","TAB 10MG","30","Select","Select",""],["","49884093547","DICLOFENAC ","GEL 0.01","100","Select","Select",""],["","50428031180","SALINE ","SPR 0.0065","44","Select","Select",""],["","65862053820","LEVOFLOXACIN ","TAB 750MG","10","Select","Select",""],["","00378020810","FUROSEMIDE ","TAB 20MG","30","Select","Select",""],["","60505014101","GLIPIZIDE ","TAB 5MG","60","Select","Select",""],["","68382075810","METFORMIN ","TAB 500MG","60","Select","Select",""],["","00088222033","LANTUS ","INJ 100\/ML","10","Select","Select",""],["","00603533821","PREDNISONE ","TAB 10MG","41","Select","Select",""],["","00536589588","NICOTINE ","DIS 14MG\/24H","28","Select","Select",""],["","45802025742","MOMETASONE ","CRE 0.001","45","Select","Select",""],["","57896066116","GERI-TUSSIN ","SYP DM","60","Select","Select",""],["","43598029590","PREGABALIN ","CAP 150MG","60","Select","Select",""],["","67877032105","IBUPROFEN ","TAB 800MG","90","Select","Select",""],["","69097081507","GABAPENTIN ","CAP 400MG","90","Select","Select",""],["","65862020390","LOSARTAN ","TAB 100MG","30","Select","Select",""],["","70710122600","AMITRIPTYLIN ","TAB 25MG","60","Select","Select",""],["","00054327099","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","00193731025","CONTOUR ","TES NEXT","25","Select","Select",""],["","00093317431","ALBUTEROL ","FAT E","8.5","Select","Select",""],["","68180072003","AMLODIPINE ","TAB 5MG","30","Select","Select",""],["","45802065078","LORATADINE ","TAB 10MG","30","Select","Select",""],["","60432060416","PROMETHAZINE ","SYP DM","120","Select","Select",""],["","08290324911","INSULIN ","MIS 0.5\/31G","100","Select","Select",""],["","00378235093","ESOMEPRA ","CAP 20MG DR","30","Select","Select",""],["","00093321992","KETOCONAZOLE ","CRE 0.02","60","Select","Select",""],["","00603154258","POT  CHLORIDE","SOL 0.1","473","Select","Select",""],["","58657050016","CODEINE\/GG ","SOL 10-100\/5","200","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","14","Select","Select",""],["","50428028945","CVS ","TAB 100MG","30","Select","Select",""],["","00536100901","FERROUS ","TAB 325MG","90","Select","Select",""],["","79854020062","VITAMIN ","1,0 00 MCG TA","90","Select","Select",""],["","00378967130","IPRATROPIUM\/ ","SOL ALBUTER","180","Select","Select",""],["","68180098003","LISINOPRIL ","TAB 10MG","30","Select","Select",""],["","70461031903","FLUCLVX ","INJ 2019-20","0.5","Select","Select",""],["","67877057305","BENZONATATE ","CAP 100MG","30","Select","Select",""],["","53489011905","DOXYCYCL ","CAP 100MG","20","Select","Select",""],["","00536121388","MUCUS ","TAB 60-1200","28","Select","Select",""],["","51672126303","NYSTAT\/TRIAM ","CRE ","60","Select","Select",""],["","59779052301","JOCK ","CRE 0.01","15","Select","Select",""],["","68382000514","TOPIRAMATE ","CAP 25MG","60","Select","Select",""],["","10702000710","CYCLOBENZAPR ","TAB 10MG","15","Select","Select",""],["","68180071160","CEFDINIR ","CAP 300MG","20","Select","Select",""],["","66689000802","NYSTATIN ","SUS 100000","240","Select","Select",""],["","68180046707","LOVASTATIN ","TAB 10MG","90","Select","Select",""],["","69238126601","OSELTAMIVIR ","CAP 75MG","10","Select","Select",""],["","00904679489","ASPIRIN ","CHW 81MG","90","Select","Select",""],["","68180016013","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","57599080300","FREESTY ","MIS 2 READER","1","Select","Select",""],["","70710113908","FLUCONAZOLE ","TAB 150MG","2","Select","Select",""],["","00245531911","KLOR-CON ","TAB 20MEQ ER","90","Select","Select",""],["","68180065001","DOXYCYC ","CAP 50MG","20","Select","Select",""],["","65862007701","CIPROFLOXACN ","TAB 500MG","14","Select","Select",""],["","00536104710","SODIUM ","TAB 650MG","270","Select","Select",""],["","68462050166","CALCIPOTRIEN ","CRE 0.00005","120","Select","Select",""],["","00093101042","MUPIROCIN ","OIN 0.02","44","Select","Select",""],["","60432027516","BROM\/PSE\/DM ","SYP ","200","Select","Select",""],["","45802091987","CETIRIZINE ","TAB 10MG","30","Select","Select",""],["","57896045506","SENNA ","TAB 8.6-50MG","30","Select","Select",""],["","00173088210","BREO ","INH 200-25","60","Select","Select",""],["","76385012350","METHOCARBAM ","TAB 500MG","15","Select","Select",""],["","00904323252","CALCIUM ","TAB 600MG","30","Select","Select",""],["","42858010201","OXYCOD\/APAP ","TAB 5-325MG","10","Select","Select",""],["","68180012202","CEPHALEXIN ","CAP 500MG","30","Select","Select",""],["","69097015907","MELOXICAM ","TAB 15MG","30","Select","Select",""],["","31604002730","B-12 ","1000 MCG","90","Select","Select",""],["","63304069301","CLINDAMYCIN ","300MG","30","Select","Select",""],["","70377002811","ATORVASTATIN ","20MG","90","Select","Select",""],["","00173086910","ANORO ","62.5-25","180","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","",""],["Yes","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":""}]}]}