{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MISTY   D AVILES","gend":1,"add":"5289 RIDGECREST AVENUE","city":"PULASKI","state":"VA","zip":"24301-7105","dob":"1984-11-21","age":"","mstatus":"","insh":4651004,"cliId":"","pno":5405771815,"cno":5405771815,"email":"","ename":"","eno":"","pphy":"BROCHERO, ALFONSO D","ppno":5407693964,"pcpadd":"2900 LAMB CIRCLE, ","pcpcity":"CHRISTIANSBURG","pcpstate":"VA","pcpzip":240736344,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"5289 RIDGECREST AVENUE","madd2":"                                                            ","madd3":"","mcity":"PULASKI","mstate":"VA","mzip":"24301-7105","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z23","K85.90","K52.9","R10.9","Z30.2","N83.8","E66.9","Z68.35","R10.13","N92.6","R10.11","K51.011","E55.9","R51.9","L98.9","R10.84","K63.89","N20.0","E27.9","Z36.9","R82.71","R73.9","Z34.82","O80","Z37.0","Z3A.00","P09","R19.7","R63.4","R11.2","Z36.82","Z3A.12","Z36.89","Z3A.20","O26.13","O24.410","Z3A.35","J98.11","K21.9","R11.10","Z20.822","Z34.91","Z83.49","E74.21","N72","Z12.4","Z30.8","Z20.828","Z3A.38","O99.824","Z34.83","O99.214","O24.420","O69.81X0","R21","F43.9"],"date":["2019-03-05","2020-04-02","2021-05-20","2021-05-20","2020-01-22","2021-05-20","2020-01-22","2020-01-22","2020-04-02","2020-03-31","2020-04-02","2021-04-09","2020-08-25","2021-01-01","2021-01-01","2021-05-20","2021-05-20","2021-05-20","2021-05-20","2019-02-04","2019-03-05","2019-05-31","2019-05-31","2019-08-07","2019-08-07","2019-08-07","2019-08-15","2021-05-20","2020-05-15","2020-04-20","2019-02-04","2019-02-04","2019-04-01","2019-04-01","2019-08-07","2019-09-19","2019-07-09","2020-04-02","2020-05-19","2021-05-20","2021-05-20","2019-02-11","2019-02-11","2019-08-14","2019-12-23","2019-12-24","2019-12-23","2021-02-03","2019-08-07","2019-08-07","2019-08-07","2019-08-07","2019-08-07","2019-08-07","2021-04-09","2021-04-09"],"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":[["","00143122701","DICYCLOMINE ","TAB 20MG","90","Select","Select",""],["","68382071119","MESALAMINE ","TAB 1.2GM","60","Select","Select",""],["","00193658621","MICROLET ","MIS LANCETS","100","Select","Select",""],["","67877032105","IBUPROFEN ","TAB 800MG","30","Select","Select",""],["","59267100001","PFIZER ","INJ COVID-19","0.3","Select","Select",""],["","53746010901","HYDROCO\/APAP ","TAB 5-325MG","20","Select","Select",""],["","65862085901","FAMOTIDINE ","TAB 20MG","60","Select","Select",""],["","57237000511","FLUCONAZOLE ","TAB 150MG","3","Select","Select",""],["","42806000501","OXYCODONE ","TAB 5MG","10","Select","Select",""],["","00378064205","PREDNISONE ","TAB 20MG","5","Select","Select",""],["","00093101042","MUPIROCIN ","OIN 0.02","22","Select","Select",""],["","70461042010","FLUCLVX ","INJ 2020-21","0.5","Select","Select",""],["","00193731221","CONTOUR ","TES NEXT","100","Select","Select",""],["","65862039010","ONDANSETRON ","TAB 4MG ODT","20","Select","Select",""],["","42858010201","OXYCOD\/APAP ","TAB 5-325MG","10","Select","Select",""],["","86790001930","SLOW ","TAB 45MG","30","Select","Select",""],["","65162052110","PROMETHAZINE ","TAB 25MG","10","Select","Select",""],["","50111033401","METRONIDAZOL ","TAB 500MG","30","Select","Select",""],["","65862007701","CIPROFLOXACN ","TAB 500MG","20","Select","Select",""],["","00093221001","SUCRALFATE ","1GM","60","Select","Select",""],["","00378041510","DIPHEN\/ATROP ","2.5MG","80","Select","Select",""],["","69452015120","VITAMIN ","50000UNT","4","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":""}]}]}