{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KASIE   D AMOS","gend":1,"add":"PO BOX 44","city":"NEW CASTLE","state":"VA","zip":"24127-0044","dob":"1975-11-16","age":"","mstatus":"","insh":6997597,"cliId":"","pno":4346109944,"cno":4346109944,"email":"","ename":"","eno":"","pphy":"HAAG, MATTHEW J","ppno":3047723064,"pcpadd":"226 Market St, ","pcpcity":"New Castle","pcpstate":"VA","pcpzip":241276080,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"PO BOX 44","madd2":"                                                            ","madd3":"","mcity":"NEW CASTLE","mstate":"VA","mzip":"24127-0044","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z30.430","Z32.02","F41.1","F39","F31.71","I10","M54.17","F52.9","M54.40","G89.29","M17.11","M17.12","R29.898","M71.21","M25.461","E66.09","M54.42","M54.41","F33.1","N93.9","N94.6","N88.8","N83.8","F41.9","F31.9","K21.9","H91.90","R56.9","J45.909","E66.9","Z88.5","Z88.0","Z88.8","M54.12","M48.02","M46.02","M46.96","M99.81","M48.03","N13.30","N20.0","N13.4","R31.9","N21.0","M54.5","S30.0XXA","Z98.1","Z96.89","X58.XXXA","J45.901","T78.40XA","F31.81","L30.9","M54.16","F31.77","H90.3","J30.9","Z23","R51","J45.30","J32.9","Z91.030","Z88.9","L30.8","E55.9","K02.9","J30.89","J30.81","J30.1","M48.061","M47.892","M54.9","W19.XXXA","R10.9","W11.XXXA","Z95.828","Z91.041","M96.1","M51.36","Q05.7","M51.26","M99.83","Z97.5","M79.7","Z79.899","Z01.818","M54.10","K04.7","H60.501","R11.2","N80.0","Z01.810","R07.9","M54.2","Z30.431","M17.10","M25.562","M25.561","M17.9","F31.70","G47.00","M62.838","R06.02","Z87.09","F31.75","W17.89XA","N80.9","N93.8","M50.10"],"date":["2019-07-19","2019-07-19","2021-03-02","2021-03-02","2020-01-07","2021-05-11","2021-02-02","2019-10-01","2019-10-29","2021-03-02","2020-02-20","2020-02-20","2020-01-24","2020-01-24","2020-01-24","2020-01-24","2021-03-02","2021-03-02","2021-02-02","2020-06-12","2020-06-12","2020-06-12","2020-06-12","2020-06-12","2020-06-12","2020-06-12","2020-06-12","2020-06-12","2020-06-12","2020-06-12","2020-06-12","2020-06-12","2020-06-12","2020-07-01","2020-01-20","2020-01-20","2020-01-20","2020-01-20","2020-01-20","2019-04-04","2019-04-04","2019-04-04","2019-04-04","2019-04-04","2020-09-10","2019-04-04","2019-07-02","2019-04-04","2019-04-04","2019-06-17","2019-06-17","2019-07-09","2019-07-09","2020-09-10","2021-04-06","2019-07-02","2019-07-30","2019-07-30","2019-07-30","2019-10-15","2019-10-15","2019-10-15","2019-10-15","2019-07-30","2019-07-30","2019-07-30","2019-10-15","2019-10-15","2019-10-15","2020-01-10","2020-01-20","2019-04-04","2019-04-04","2019-04-04","2019-04-04","2019-04-04","2019-04-04","2019-06-11","2019-07-02","2019-07-02","2019-07-02","2019-07-02","2019-09-10","2020-01-07","2021-05-11","2020-06-08","2020-09-10","2021-04-06","2021-04-05","2021-04-06","2019-06-28","2020-06-04","2020-06-12","2020-07-01","2019-09-10","2020-02-20","2020-02-20","2020-02-20","2020-02-20","2021-03-02","2021-03-02","2021-03-02","2020-03-31","2020-03-31","2021-03-02","2019-04-04","2019-10-29","2019-10-29","2020-07-01"],"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":[["","49781014851","SENNA ","TAB 8.6MG","30","Select","Select",""],["","65862001501","AMOXICILLIN ","TAB 875MG","10","Select","Select",""],["","50111044101","TRAZODONE ","TAB 150MG","30","Select","Select",""],["","00185067405","HYDROXYZ ","CAP 25MG","90","Select","Select",""],["","51991074710","DULOXETINE ","CAP 30MG","30","Select","Select",""],["","16729011917","MONTELUKAST ","TAB 10MG","30","Select","Select",""],["","45802016000","DICLOFENAC ","GEL 0.01","100","Select","Select",""],["","51672413101","LAMOTRIGINE ","TAB 100MG","120","Select","Select",""],["","16729020216","BUSPIRONE ","TAB 10MG","90","Select","Select",""],["","64380080308","RANITIDINE ","TAB 150MG","60","Select","Select",""],["","68180051703","LISINOPRIL ","TAB 40MG","30","Select","Select",""],["","69315011610","FUROSEMIDE ","TAB 20MG","30","Select","Select",""],["","51991081901","PROPRANOLOL ","CAP 120MG ER","30","Select","Select",""],["","00172572970","FAMOTIDINE ","TAB 40MG","30","Select","Select",""],["","65862019299","FLUOXETINE ","CAP 10MG","30","Select","Select",""],["","51672129802","KETOCONAZOLE ","CRE 0.02","30","Select","Select",""],["","65162010211","GABAPENTIN ","CAP 300MG","180","Select","Select",""],["","43547028111","ESCITALOPRAM ","TAB 10MG","30","Select","Select",""],["","00904671772","CETIRIZINE ","TAB 10MG","30","Select","Select",""],["","00093598627","EPINEPHRINE ","INJ 0.3MG","2","Select","Select",""],["","00173088210","BREO ","INH 200-25","60","Select","Select",""],["","72140063608","AQUAPHOR ","OIN ADVANCED","30","Select","Select",""],["","65862052730","VENLAFAXINE ","CAP 37.5 ER","30","Select","Select",""],["","68180096301","ALBUTEROL ","AER HFA","8.5","Select","Select",""],["","51672129003","HC ","CRE 0.002","60","Select","Select",""],["","41167005820","ASPERCREME ","CRE LIDOCAIN","76.5","Select","Select",""],["","43386043201","OXYCODONE ","TAB 5MG","15","Select","Select",""],["","67877032005","IBUPROFEN ","TAB 600MG","30","Select","Select",""],["","65162052111","PROMETHAZINE ","TAB 25MG","12","Select","Select",""],["","31722054501","LITHIUM ","CAP 300MG","90","Select","Select",""],["","57664050318","TIZANIDINE ","TAB 4MG","90","Select","Select",""],["","00536106229","STOOL ","CAP 100MG","30","Select","Select",""],["","10702000650","CYCLOBENZAPR ","TAB 5MG","90","Select","Select",""],["","42571025201","CLINDAMYCIN ","CAP 300MG","40","Select","Select",""],["","24208063562","NEO\/POLY\/HC ","SUS 1% OTIC","10","Select","Select",""],["","69238131109","PREGABALIN ","CAP 50MG","90","Select","Select",""],["","55111025660","ZIPRASIDONE ","CAP 20MG","60","Select","Select",""],["","00591544301","PREDNISONE ","TAB 20MG","10","Select","Select",""],["","13668026801","CARBAMAZEPIN ","TAB 200MG","60","Select","Select",""],["","60505082901","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","59310021012","QNASL ","AER 80MCG","8.7","Select","Select",""],["","69097015915","MELOXICAM ","TAB 15MG","30","Select","Select",""],["","00168008031","HYDROCORT ","CRE 0.025","30","Select","Select",""],["","68180031906","BUPROPN ","TAB 150MG XL","30","Select","Select",""],["","00904530680","BANOPHEN ","CAP 25MG","2","Select","Select",""],["","59746000103","METHYLPRED ","TAB 4MG","16","Select","Select",""],["","51672400201","NORTRIPTYLIN ","CAP 25MG","30","Select","Select",""],["","16729013616","CLONAZEPAM ","0.5MG","30","Select","Select",""],["","16729017217","AMITRIPTYLIN ","25MG","30","Select","Select",""],["","13107015599","PAROXETINE ","20MG","30","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":""}]}]}