{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KELSEY   M UNDERWOOD","gend":1,"add":"111 GEORGE STREET                                           ","city":"NARROWS                       ","state":"VA","zip":"24124-9998","dob":"2002-04-05","age":"","mstatus":"","insh":5078859,"cliId":"","pno":5402350023,"cno":5402350023,"email":"","ename":"","eno":"","pphy":"DEVEREAUX, ROBERT                                           ","ppno":"","pcpadd":"430 Boxwood Ln","pcpcity":"Pearisburg                    ","pcpstate":"VA","pcpzip":241341168,"pcpcounty":"","pcpid":"P0117831","pcpname":"CARILION CLINIC FAMILY MEDICINE GILES","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"111 GEORGE STREET                                           ","madd2":"                                                            ","madd3":"","mcity":"NARROWS                       ","mstate":"VA","mzip":"24124-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R11.0","R63.4","R10.9","F31.9","F43.10","F33.1","J30.1","R56.9","R41.0","F32.9","B34.9","J02.9","R11.2","F41.9","R07.81","R07.9","E73.9","K58.9","R55","F10.10","F41.1","F42.2","F17.210","F23","R46.81","F12.920","R47.89","J45.20","Z20.828","F41.0","F33.8","F33.9","Z91.030","F51.05","F51.5","F33.3","Z91.013","F99","R68.89","J45.21","R06.02","F10.20","Z3A.01","N92.6","Z36.87","Z3A.08","O26.891","Z3A.09","Z87.891","R40.2410","R51.9","G40.909","Z39.1","Z34.82","Z34.83","R30.0","Z36.89","O32.1XX0","Z3A.19","O09.892","O99.352","Z3A.21","O99.353","Z3A.23","Z04.3","W01.0XXA","O99.512","Y92.9","Z3A.31","O26.893","Z3A.33","Z3A.36","Z3A.38","Z37.0","Z3A.39","Z39.2","Z98.891","Z30.09","O09.899","Z3A.00","R25.9"],"date":["2020-05-27","2019-01-08","2019-01-08","2019-01-14","2021-09-16","2021-11-10","2021-06-04","2021-07-14","2019-04-19","2021-09-03","2019-05-13","2019-05-13","2019-05-13","2021-09-03","2020-04-06","2020-04-06","2020-04-29","2020-04-29","2020-08-12","2020-09-04","2020-09-03","2020-09-03","2020-10-31","2020-09-03","2020-09-03","2020-09-03","2020-09-03","2021-05-07","2020-09-03","2020-09-30","2020-09-04","2020-09-05","2020-09-16","2020-09-16","2020-10-15","2020-10-15","2020-09-16","2020-09-16","2020-10-29","2020-10-31","2020-10-31","2020-12-01","2020-12-21","2020-12-21","2021-01-20","2021-01-20","2021-07-14","2021-01-23","2021-01-23","2021-01-23","2021-01-23","2021-08-20","2021-09-03","2021-02-23","2021-02-23","2021-03-25","2021-04-05","2021-08-24","2021-04-05","2021-04-27","2021-04-27","2021-04-27","2021-08-20","2021-05-07","2021-05-07","2021-05-07","2021-05-07","2021-05-07","2021-06-29","2021-08-20","2021-07-15","2021-08-11","2021-08-20","2021-08-24","2021-08-24","2021-09-03","2021-09-03","2021-09-03","2021-08-01","2021-08-01","2021-07-14"],"priorHcc":["","","","","",null,"","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",null,"","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",null,null,null]}},{"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":[["","00548570100","MEDROXYPR","150MG\/ML","1","Select","Select",""],["","66993001968","ALBUTEROL","HFA","18","Select","Select",""],["","68382004101","PROMETHAZINE","25MG","20","Select","Select",""],["","59746017509","PREDNISONE","20MG","4","Select","Select",""],["","57237007710","ONDANSETRON","4MG ODT","10","Select","Select",""],["","60505328006","LEVETIRACETA","500MG ER","30","Select","Select",""],["","16714035101","FLUOXETINE","10MG","7","Select","Select",""],["","00185061505","HYDROXYZ","50MG","15","Select","Select",""],["","00093005405","BUSPIRONE","10MG","90","Select","Select",""],["","68382009716","PAROXETINE","10MG","15","Select","Select",""],["","50111033402","METRONIDAZOL","500MG","14","Select","Select",""],["","69315012710","FOLIC","1000MCG","90","Select","Select",""],["","00904686861","TRAZODONE","50MG","45","Select","Select",""],["","13668001990","VENLAFAXINE","75MG ER","30","Select","Select",""],["","00093598627","EPINEPHRINE","0.3MG","2","Select","Select",""],["","00093406701","PRAZOSIN","1MG","30","Select","Select",""],["","68645052254","SERTRALINE","50MG","30","Select","Select",""],["","42858000101","OXYCODONE","5MG","10","Select","Select",""],["","68645056259","IBUPROFEN","600MG","60","Select","Select",""],["","49035052660","STOOL","100MG","60","Select","Select",""],["","43547028111","ESCITALOPRAM","10MG","30","Select","Select",""],["","68645056954","CITALOPRAM","10MG","30","Select","Select",""],["","00536440601","VITAMIN","25MG","90","Select","Select",""],["","00548570100","MEDROXYPR ","INJ 150MG\/ML","1","Select","Select",""],["","59310057922","PROAIR ","AER ","8.5","Select","Select",""],["","66993001968","ALBUTEROL ","AER HFA","18","Select","Select",""],["","68382004101","PROMETHAZINE ","TAB 25MG","20","Select","Select",""],["","59746017509","PREDNISONE ","TAB 20MG","4","Select","Select",""],["","57237007710","ONDANSETRON ","TAB 4MG ODT","10","Select","Select",""],["","00781261305","AMOXICILLIN ","CAP 500MG","20","Select","Select",""],["","60505328006","LEVETIRACETA ","TAB 500MG ER","30","Select","Select",""],["","50111033402","METRONIDAZOL ","TAB 500MG","14","Select","Select",""],["","16714035101","FLUOXETINE ","CAP 10MG","7","Select","Select",""],["","00185061505","HYDROXYZ ","CAP 50MG","15","Select","Select",""],["","00093005405","BUSPIRONE ","TAB 10MG","90","Select","Select",""],["","68382009716","PAROXETINE ","TAB 10MG","15","Select","Select",""],["","69315012710","FOLIC ","TAB 1000MCG","90","Select","Select",""],["","00904686861","TRAZODONE ","TAB 50MG","45","Select","Select",""],["","13668001990","VENLAFAXINE ","CAP 75MG ER","30","Select","Select",""],["","00093598627","EPINEPHRINE ","INJ 0.3MG","2","Select","Select",""],["","00093406701","PRAZOSIN ","CAP 1MG","30","Select","Select",""],["","68645052254","SERTRALINE ","TAB 50MG","30","Select","Select",""],["","42858000101","OXYCODONE ","TAB 5MG","10","Select","Select",""],["","68645056259","IBUPROFEN ","TAB 600MG","60","Select","Select",""],["","49035052660","STOOL ","CAP 100MG","60","Select","Select",""],["","43547028111","ESCITALOPRAM ","TAB 10MG","30","Select","Select",""],["","57237001930","DULOXETINE ","CAP 60MG","30","Select","Select",""],["","68645056954","CITALOPRAM ","TAB 10MG","30","Select","Select",""],["","00536440601","VITAMIN ","TAB 25MG","90","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","",""],["No","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":""}]}]}