{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ROBIN   S ARGUETA","gend":1,"add":"1026 BARROWS MILL ROAD","city":"MARTINSVILLE","state":"VA","zip":"24112-9998","dob":"1984-10-17","age":"","mstatus":"","insh":4790801,"cliId":"","pno":2763361840,"cno":"               ","email":"","ename":"","eno":"","pphy":"CHAN M PARK FAMILY PRACTICE","ppno":2769562047,"pcpadd":"6460 Greensboro Rd, ","pcpcity":"Ridgeway","pcpstate":"VA","pcpzip":241483478,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":2767902106,"add2":"APARTMENT 135","add3":"","madd1":"1026 BARROWS MILL ROAD","madd2":"APARTMENT 135","madd3":"","mcity":"MARTINSVILLE","mstate":"VA","mzip":"24112-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["O76","Z3A.29","Z37.0","D62","R40.2420","E87.2","T88.4XXA","Z97.8","O72.2","J80","K92.0","E83.42","I82.611","O87.0","O99.53","J45.909","O72.1","N71.9","I51.7","O90.81","Z87.891","F10.129","F10.239","R44.3","F10.180","E87.6","Z86.718","Z79.899","F17.210","E87.1","K70.31","K70.11","F10.20","R07.9","K76.9","I50.89","K92.2","R41.0","D50.0","E72.20","F10.10","K92.1","N17.9","R57.9","D64.9","R40.20","K74.60","K72.90","R16.0","R18.8","R00.1","T86.49","R94.5","Z94.4","K76.7","Z46.59","K63.89","K31.89","J90","R91.8","J98.4","J98.19","J81.1","J96.91","E87.70","N18.9","J98.09","K75.9","R60.0","F41.9","Z99.2","K91.870","R06.02","R50.9","R06.00","R00.0","I10","D72.829","Z48.23","Z51.81","Z79.52","B25.9","D61.818","N39.0","N93.9","Z32.02","J98.11","J96.01","R11.2","R11.10","K29.00","K70.30","K20.9","R07.89","R74.0","K70.10","K29.70","R68.89","D68.9","D69.59","R09.89","D50.9","F19.10","Z72.0","I95.89","K74.69","K62.5","Z87.19","A41.9","R65.21","K72.00","E87.5","K72.10","R79.9","N19","R16.2","K76.6","Z01.810","Z48.22","R74.8","Z46.82","R57.1","R65.10","R45.1","J18.9","E88.09","K76.89","Z45.2","D59.2","E86.0","D84.9","R19.7","K59.00","G47.00","M54.9","Z20.822","I42.9","Z99.11","R41.82","D69.6","R04.0","F10.99","R10.32","J18.1","R79.89","N32.89","F10.21","Z30.09","J96.00","R03.0","R17","R10.84","K60.2","R79.1","K64.4","D63.8","R11.0","R94.31","Z98.890","N18.6","S31.109A","Z48.01","M79.89","R34","J96.90","F39","L08.9","K91.83","O42.913","O68","E66.01","O99.214","O74.7","O62.1","F12.90","I95.9","I36.1","T86.12","G93.40","Z20.828","R09.02","Z90.49","Z30.013","O09.33","O36.5930","O26.873","Z3A.36","O43.813","O99.03","I49.8","O72.3","J01.10","M25.551","V89.2XXA","K82.4","D53.9","I31.3","R06.89","E87.8","I49.9","R51","K25.4","E80.6","D68.4","R10.13","Y83.1","R10.0","R57.8","K56.7","J69.0","K75.81","T86.41","F32.9","F53.0","O42.113","O47.03","Z3A.34","N80.9","I50.20","R10.12","R53.83","N17.0","D65","Z11.59","K70.40","Z01.811","Z76.82","Z94.9","Z48.298","Z79.82","Z30.8"],"date":["2019-07-23","2019-07-23","2019-07-23","2020-10-26","2019-07-24","2021-05-02","2019-07-24","2020-09-25","2019-08-17","2019-08-17","2020-08-02","2020-10-26","2019-08-13","2019-08-13","2019-08-13","2019-08-13","2019-08-12","2019-08-09","2020-09-06","2019-08-09","2021-05-10","2019-09-15","2019-11-01","2019-09-15","2019-09-15","2020-08-05","2021-03-13","2021-03-13","2019-09-15","2020-08-08","2020-07-28","2020-08-05","2020-12-02","2020-01-15","2020-01-15","2020-01-16","2020-08-04","2020-04-05","2020-04-05","2020-07-27","2021-02-24","2020-10-01","2021-05-16","2020-08-13","2021-03-13","2020-07-28","2020-08-07","2020-10-09","2020-08-23","2020-09-21","2020-07-29","2021-05-10","2020-08-06","2021-05-25","2020-08-23","2020-09-03","2020-08-31","2020-08-31","2020-09-23","2020-09-10","2020-09-21","2020-09-21","2020-09-10","2020-09-03","2020-09-03","2020-09-10","2020-09-10","2020-09-21","2020-10-15","2020-10-10","2020-10-10","2020-09-25","2020-10-01","2020-10-01","2020-10-06","2020-10-06","2021-05-16","2020-10-13","2020-11-19","2020-11-19","2021-05-10","2021-05-16","2021-05-16","2021-05-15","2019-08-09","2019-08-09","2020-09-02","2020-09-06","2020-02-26","2019-09-14","2019-09-14","2020-10-10","2019-11-01","2019-11-01","2020-09-30","2021-02-24","2019-11-01","2020-02-10","2020-08-04","2020-01-15","2020-09-09","2020-01-15","2020-11-04","2020-02-08","2020-01-16","2020-07-27","2020-04-04","2020-04-04","2020-07-31","2020-09-08","2020-08-04","2021-03-13","2020-08-04","2020-08-04","2020-08-06","2020-07-31","2020-08-03","2020-08-04","2020-08-12","2020-09-24","2020-09-06","2020-08-31","2020-08-31","2020-09-06","2020-09-23","2020-09-06","2020-09-29","2020-10-26","2021-03-14","2021-03-14","2021-05-10","2021-05-10","2021-05-10","2021-05-10","2021-05-10","2021-05-10","2019-08-10","2020-08-01","2020-07-31","2020-08-05","2020-07-31","2020-07-31","2020-08-23","2020-09-02","2020-10-03","2020-09-23","2021-01-13","2020-11-04","2020-07-30","2019-08-12","2019-11-01","2020-02-26","2020-04-04","2020-04-04","2020-04-04","2020-04-04","2020-04-04","2020-07-28","2020-08-06","2020-08-31","2020-08-19","2020-08-19","2020-08-24","2020-08-26","2020-09-03","2020-09-11","2020-09-30","2020-10-10","2019-07-23","2019-07-23","2020-09-05","2019-07-23","2019-07-23","2019-07-23","2020-02-08","2020-07-28","2020-07-29","2020-08-15","2020-08-23","2020-08-23","2020-08-30","2020-08-30","2020-12-02","2019-07-23","2019-07-23","2019-07-23","2019-07-23","2019-07-23","2019-07-26","2019-08-09","2019-08-09","2020-02-08","2020-07-27","2020-07-27","2020-07-28","2020-07-29","2020-08-23","2020-09-07","2020-09-09","2020-09-24","2020-02-08","2020-07-27","2020-07-27","2020-07-27","2020-07-27","2020-07-28","2020-07-28","2020-07-28","2020-07-30","2020-08-03","2020-08-05","2020-10-05","2020-12-02","2020-12-02","2019-07-23","2019-07-23","2019-07-23","2019-08-17","2020-01-15","2020-02-26","2020-02-26","2020-07-28","2020-07-28","2020-07-28","2020-07-28","2020-08-03","2020-08-04","2020-08-06","2020-08-14","2020-08-14","2021-01-13"],"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":[["","68585000612","MAGNESIUM-OX ","TAB 400MG","10","Select","Select",""],["","68462035701","POT  CHLORIDE","CAP 10MEQ ER","10","Select","Select",""],["","57237007710","ONDANSETRON ","TAB 4MG ODT","12","Select","Select",""],["","31722071390","PANTOPRAZOLE ","TAB 40MG","30","Select","Select",""],["","00904759080","FEROSUL ","TAB 325MG","30","Select","Select",""],["","00591024105","LORAZEPAM ","TAB 1MG","12","Select","Select",""],["","00121057716","LACTULOSE ","SOL 10GM\/15","225","Select","Select",""],["","11534016503","FOLIC ","TAB 1MG","30","Select","Select",""],["","00054430125","FUROSEMIDE ","TAB 80MG","60","Select","Select",""],["","16729026129","MYCOPHENOLIC ","TAB 180MG DR","120","Select","Select",""],["","00406055201","OXYCODONE ","TAB 5MG","28","Select","Select",""],["","31604001281","VITAMIN ","TAB 100MG","30","Select","Select",""],["","00603533832","PREDNISONE ","TAB 10MG","100","Select","Select",""],["","55111076260","VALGANCICLOV ","TAB 450MG","30","Select","Select",""],["","00904672580","SENNA ","TAB 8.6MG","60","Select","Select",""],["","65162027110","SMZ-TMP ","TAB 400-80MG","30","Select","Select",""],["","59762501801","FLUCONAZOLE ","TAB 200MG","7","Select","Select",""],["","57896098110","ASPIRIN ","TAB 81MG EC","30","Select","Select",""],["","67877019910","AMLODIPINE ","TAB 10MG","30","Select","Select",""],["","16729031801","OXYBUTYNIN ","TAB 10MG ER","30","Select","Select",""],["","67877022201","GABAPENTIN ","CAP 100MG","90","Select","Select",""],["","68180035106","SERTRALINE ","TAB 25MG","5","Select","Select",""],["","59762453701","MEDROXYPR ","INJ 150MG\/ML","1","Select","Select",""],["","00603020922","MAG ","TAB 400MG","60","Select","Select",""],["","00093314701","CEPHALEXIN ","CAP 500MG","21","Select","Select",""],["","50428707932","STOOL ","TAB 8.6-50MG","60","Select","Select",""],["","65862007701","CIPROFLOXACN ","TAB 500MG","10","Select","Select",""],["","55111052601","TACROLIMUS ","CAP 1MG","240","Select","Select",""],["","60505024701","MIRTAZAPINE ","TAB 15MG","30","Select","Select",""],["","67877032005","IBUPROFEN ","TAB 600MG","60","Select","Select",""],["","51862088403","CAMILA ","TAB 0.35MG","28","Select","Select",""],["","00591315901","URSODIOL ","CAP 300MG","60","Select","Select",""],["","50844011222","QP ","30 TAB","24","Select","Select",""],["","65862050220","AMOX\/K ","TAB 500-125","30","Select","Select",""],["","65862053750","LEVOFLOXACIN ","TAB 500MG","5","Select","Select",""],["","37205061465","ACID ","TAB 10MG","60","Select","Select",""],["","65162069388","ATOVAQUONE ","SUS 750\/5ML","300","Select","Select",""],["","59779076678","PAIN ","TAB 325MG","60","Select","Select",""],["","08290320122","BD  PEN NEEDL","32GX4MM","100","Select","Select",""],["","00121086816","NYSTATIN ","100000","280","Select","Select",""],["","99073013001","FREESTYLE    MIS LANCETS","LANCETS","100","Select","Select",""],["","00088221905","LANTUS ","100\/ML","9","Select","Select",""],["","00169633910","NOVOLOG ","FLEXPEN","9","Select","Select",""],["","99073070827","FREESTYLE    TES LITE","LITE","100","Select","Select",""],["","99073070805","FREESTYLE    MIS LITE","LITE","1","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":""}]}]}