{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SARAH FAIN","gend":1,"add":"3536 RAVEN ROCK ROAD","city":"ARARAT","state":"VA","zip":"24053-3967","dob":"1980-11-11","age":"","mstatus":"","insh":4476716,"cliId":"","pno":2762515798,"cno":2762515798,"email":"","ename":"","eno":"","pphy":"TATE, GLEN E","ppno":2763982292,"pcpadd":"40 Wiley Dr, ","pcpcity":"Ferrum","pcpstate":"VA","pcpzip":240881100,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":3366487020,"add2":"                                                            ","add3":"","madd1":"3536 RAVEN ROCK ROAD","madd2":"                                                            ","madd3":"","mcity":"ARARAT","mstate":"VA","mzip":"24053-3967","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M51.9","M79.604","M79.605","Z79.899","Z79.891","E66.9","Z68.36","Z98.84","F41.8","F32.3","M19.011","M19.012","M75.41","M75.42","M25.511","M25.512","M25.561","M25.562","Z68.32","Z30.430","Z30.49","M79.675","R22.1","K11.20","K11.5","Q89.2","E03.9","I15.1","R73.09","F41.9","E56.9","E55.9","Z86.2","D50.8","N20.0","K58.1","Q62.11","N13.30","N39.0","N12","F33.42","N90.9","N30.01","M54.5","G89.29","J02.9","R82.90","F15.10","F31.9","Z32.02","F11.20","F60.3","M25.612","J45.30","K59.00","Z23","N30.00","R10.9","N94.9","D50.9","I10","Z87.442","E07.9","M51.37","Z13.89","N10","G89.4","S46.812A","X58.XXXA","S43.432A","M75.52","J45.20","Z86.39","Z01.419","M54.16","Z30.431","R35.0","Z68.31","M21.619","Z00.00","Z91.89","R30.0","Z68.30","R87.612","F32.4","Z20.822","G89.18","Z12.4","Z68.35","R87.810","J40","R53.83","J01.00","M47.817","R11.0","R50.9","R87.610","M75.122","N87.0","K59.03","T40.2X5D","N89.8","Z68.29","B37.3","S46.012A","F33.41","M25.569","M79.2","M79.671","M79.672","N28.1","Z90.49","R10.30","M79.18","R10.33","N13.2","J31.0","R09.82","E11.9","N20.1"],"date":["2020-10-20","2020-10-20","2020-10-20","2020-11-10","2020-10-20","2019-11-08","2019-03-18","2020-06-05","2021-05-13","2021-05-13","2021-03-11","2021-04-07","2021-03-11","2021-04-07","2021-02-10","2021-05-20","2020-08-27","2020-07-02","2019-05-28","2019-08-15","2019-08-15","2021-02-05","2020-02-13","2020-02-13","2020-02-13","2020-02-13","2021-03-17","2020-08-27","2020-08-27","2020-04-17","2020-06-05","2020-06-05","2020-06-05","2020-08-27","2021-03-28","2019-12-27","2020-04-02","2020-04-02","2021-03-28","2020-02-06","2020-04-22","2020-03-07","2020-03-13","2020-10-22","2020-06-04","2020-08-27","2020-08-27","2020-11-05","2020-11-05","2020-11-05","2020-11-10","2020-11-05","2021-03-02","2021-02-25","2021-02-25","2021-03-17","2021-03-28","2021-03-28","2019-11-27","2019-12-17","2021-04-07","2020-02-25","2020-02-05","2020-10-13","2020-10-13","2020-02-05","2020-10-20","2021-04-07","2021-04-07","2021-04-07","2021-04-07","2021-04-07","2021-04-07","2020-05-21","2020-10-13","2019-09-06","2019-09-06","2019-09-06","2019-09-17","2020-05-21","2020-05-21","2020-05-21","2020-06-30","2020-06-30","2020-12-28","2021-04-01","2021-04-07","2019-04-05","2019-04-05","2020-06-30","2019-06-20","2019-06-20","2019-06-20","2019-06-25","2020-02-05","2020-02-05","2021-03-17","2021-03-17","2019-05-08","2019-07-25","2019-07-25","2020-07-08","2019-11-27","2020-08-27","2021-04-07","2019-07-09","2020-06-04","2020-10-13","2020-10-20","2020-10-20","2020-02-25","2021-03-28","2021-03-28","2020-07-31","2021-03-28","2019-12-17","2020-02-13","2020-02-13","2020-02-25","2020-03-24"],"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":[["","00093005405","BUSPIRONE ","TAB 10MG","120","Select","Select",""],["","16714070001","LAMOTRIGINE ","TAB 25MG","240","Select","Select",""],["","43547035311","LISINOPRIL ","TAB 10MG","30","Select","Select",""],["","52817033200","CYCLOBENZAPR ","TAB 10MG","60","Select","Select",""],["","00193730850","BAYER ","NE XT 50CT","35","Select","Select",""],["","65862039110","ONDANSETRON ","TAB 8MG ODT","6","Select","Select",""],["","63739047848","DOCUSATE ","CAP 100MG","30","Select","Select",""],["","76282066339","DICLOFENAC ","GEL 0.01","100","Select","Select",""],["","68382080505","TRAZODONE ","TAB 50MG","30","Select","Select",""],["","65862052890","VENLAFAXINE ","CAP 75MG ER","30","Select","Select",""],["","68001025320","FLUCONAZOLE ","TAB 150MG","2","Select","Select",""],["","59310057922","PROAIR ","AER ","8.5","Select","Select",""],["","13107004605","OXYCOD\/APAP ","TAB 10-325MG","120","Select","Select",""],["","16714087801","LIDOCAINE ","OIN 0.05","30","Select","Select",""],["","51293061201","PHENAZOPYRID ","TAB 200MG","6","Select","Select",""],["","00093314705","CEPHALEXIN ","CAP 500MG","30","Select","Select",""],["","16714080001","CHLORTHALID ","TAB 25MG","30","Select","Select",""],["","69543038810","KETOROLAC ","TAB 10MG","15","Select","Select",""],["","59310030480","QVAR ","AER 80MCG","10.6","Select","Select",""],["","00193709021","CONTOUR ","TES BLD GLUC","100","Select","Select",""],["","16714078301","ARIPIPRAZOLE ","TAB 2MG","90","Select","Select",""],["","57896070310","IRON ","TAB 325MG","30","Select","Select",""],["","67877056105","METFORMIN ","TAB 500MG","60","Select","Select",""],["","16714065202","CIPROFLOXACN ","TAB 500MG","20","Select","Select",""],["","69238183401","LEVOTHYROXIN ","TAB 100MCG","30","Select","Select",""],["","45802086803","POLYETH ","POW 3350 NF","510","Select","Select",""],["","00054001729","PREDNISONE ","TAB 10MG","120","Select","Select",""],["","00456120230","LINZESS ","CAP 290MCG","90","Select","Select",""],["","16714029904","AMOXICILLIN ","CAP 500MG","32","Select","Select",""],["","68180096301","ALBUTEROL ","AER HFA","8.5","Select","Select",""],["","16714053211","SUMATRIPTAN ","TAB 50MG","9","Select","Select",""],["","00173071920","FLOVENT ","AER 110MCG","12","Select","Select",""],["","69452017113","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","16714043901","NITROFURANTN ","CAP 100MG","14","Select","Select",""],["","00781708035","METRONIDAZOL ","GEL 0.01","60","Select","Select",""],["","00245086070","VANDAZOLE ","GEL 0.0075","70","Select","Select",""],["","16714047801","AMOX\/K ","TAB 875-125","14","Select","Select",""],["","57237023305","SMZ-TMP ","TAB 800-160","14","Select","Select",""],["","16714040102","CEFUROXIME ","TAB 500MG","20","Select","Select",""],["","00781520992","VALACYCLOVIR ","TAB 1GM","14","Select","Select",""],["","46122045178","STOOL ","CAP 100MG","90","Select","Select",""],["","00406012305","HYDROCO\/APAP ","TAB 5-325MG","20","Select","Select",""],["","50383008716","GUAIATUSS ","SYP 100-10\/5","140","Select","Select",""],["","00713065540","TRIAMCINOLON ","PST DEN 0.1%","5","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","",""],["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":""}]}]}