{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"AMY   L HARGIS","gend":1,"add":"10528 REDBUD HIGHWAY                                        ","city":"HONAKER                       ","state":"VA","zip":"24260-7223","dob":"1999-07-09","age":"","mstatus":"","insh":7509409,"cliId":"","pno":2768734479,"cno":2768734479,"email":"","ename":"","eno":"","pphy":"CHAUDHRY, FAISAL W                                          ","ppno":"","pcpadd":"5705 Redbud Hwy","pcpcity":"Honaker                       ","pcpstate":"VA","pcpzip":24260,"pcpcounty":"","pcpid":"P0060177","pcpname":"COMMUNITY HEALTH CLINIC","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"SOUTHWEST","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"10528 REDBUD HIGHWAY                                        ","madd2":"                                                            ","madd3":"","mcity":"HONAKER                       ","mstate":"VA","mzip":"24260-7223","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["O35.0XX0","Z34.82","Z36.89","Z3A.17","Z13.228","Z36.0","Z11.59","N39.0","O99.89","R10.30","Z3A.16","R10.31","R10.9","R30.0","N83.201","O34.82","O26.892","M32.9","N94.9","Z3A.18","O99.119","Z14.1","Z34.02","Z87.898","Z68.23","Z68.24","Z3A.25","Z13.1","O46.92","Z3A.27","Z34.03","R63.5","R21","N13.30","O23.03","O23.43","O26.893","L23.9","Z77.121","Z3A.31","O26.853","R35.0","M54.5","T78.40XA","M54.9","Z3A.33","N12","Z74.3","O26.53","N11.1","O99.343","F41.9","F32.9","K59.00","Z45.2","R50.9","Z36.9","Z3A.35","Z34.83","O99.345","Z39.2","Z68.53","I10","J01.90","M13.0","F41.1","R42","R11.0","H81.313","R01.1","E78.2","J31.0","R06.02","R06.00","M51.17","M35.9","K21.9","Z03.818","J20.8","Z23","Z00.00","K11.21","Z30.09","G56.03","M54.12","G56.00","B35.4","R31.29","R19.7","R10.2","Z01.419","R87.613","N88.8","N87.1","N94.10","Z32.02","N87.9","R39.15","N94.12","Z11.3","Z01.812","Z20.822","Z79.818","N92.6","R89.9","K44.9","Z79.899","R19.5","E66.9","M54.16","N80.9","R87.612"],"date":["2019-06-27","2019-05-07","2019-05-02","2019-08-27","2019-05-02","2019-05-02","2019-05-02","2021-04-15","2019-08-27","2019-05-06","2019-05-06","2019-05-06","2021-08-13","2021-02-15","2019-05-06","2019-05-06","2019-08-27","2019-09-19","2019-05-07","2019-05-07","2019-06-05","2019-06-05","2019-06-27","2019-05-22","2019-05-22","2019-06-05","2019-06-27","2019-06-27","2019-07-11","2019-07-11","2019-09-11","2020-05-13","2019-08-10","2019-08-27","2019-08-26","2019-08-13","2019-08-30","2019-08-12","2019-08-12","2019-08-13","2019-08-12","2019-08-12","2021-09-15","2019-08-13","2021-08-16","2019-08-30","2019-08-28","2019-08-26","2019-08-26","2019-08-30","2019-08-27","2019-08-27","2019-08-27","2019-08-27","2019-08-27","2019-08-27","2019-09-11","2019-09-11","2019-09-19","2020-02-05","2019-12-04","2020-02-05","2020-02-13","2020-02-13","2020-03-11","2020-12-30","2020-04-09","2021-08-13","2020-04-09","2020-05-11","2020-04-09","2020-04-09","2020-04-18","2020-05-11","2020-05-13","2020-10-12","2021-08-13","2020-09-23","2020-09-16","2020-10-12","2020-10-12","2020-12-30","2020-12-30","2021-01-06","2021-01-06","2021-01-06","2021-01-06","2021-02-15","2021-08-13","2021-11-11","2021-11-11","2021-11-11","2021-03-05","2021-03-05","2021-03-05","2021-08-11","2021-11-11","2021-04-15","2021-07-29","2021-06-16","2021-08-09","2021-08-09","2021-08-11","2021-07-29","2021-07-29","2021-08-13","2021-08-13","2021-08-13","2021-08-16","2021-09-15","2021-11-11","2021-11-11"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",null,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":[["","00074364103","LUPRON","3.75MG","1","Select","Select",""],["","65862042005","SMZ\/TMP","800-160","20","Select","Select",""],["","00555901658","SPRINTEC","28 DAY","28","Select","Select",""],["","00603533715","PREDNISONE","5MG","21","Select","Select",""],["","59746012110","MECLIZINE","25MG","30","Select","Select",""],["","57237007710","ONDANSETRON","4MG ODT","30","Select","Select",""],["","69097015815","MELOXICAM","7.5MG","60","Select","Select",""],["","29300016815","TIZANIDINE","2MG","60","Select","Select",""],["","16729016901","ESCITALOPRAM","10MG","30","Select","Select",""],["","69543010250","CEPHALEXIN","500MG","20","Select","Select",""],["","69097028781","LEVOFLOXACIN","750MG","10","Select","Select",""],["","16729017117","AMITRIPTYLIN","10MG","30","Select","Select",""],["","68382079101","ACYCLOVIR","400MG","30","Select","Select",""],["","68180035302","SERTRALINE","100MG","30","Select","Select",""],["","00143924920","AMOX\/K","875-125","20","Select","Select",""],["","16729020101","BUSPIRONE","7.5MG","60","Select","Select",""],["","52817033200","CYCLOBENZAPR","10MG","20","Select","Select",""],["","64380080707","IBUPROFEN","800MG","21","Select","Select",""],["","00603158658","PROMETHAZINE","DM","120","Select","Select",""],["","65862017760","CEFDINIR","300MG","20","Select","Select",""],["","43386033001","TRIMETHOPRIM","100MG","30","Select","Select",""],["","00074364103","LUPRON ","INJ 3.75MG","1","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","20","Select","Select",""],["","00555901658","SPRINTEC ","TAB 28 DAY","28","Select","Select",""],["","00603533715","PREDNISONE ","PAK 5MG","21","Select","Select",""],["","59746012110","MECLIZINE ","TAB 25MG","30","Select","Select",""],["","57237007710","ONDANSETRON ","TAB 4MG ODT","30","Select","Select",""],["","69097015815","MELOXICAM ","TAB 7.5MG","60","Select","Select",""],["","29300016815","TIZANIDINE ","TAB 2MG","60","Select","Select",""],["","16729016901","ESCITALOPRAM ","TAB 10MG","30","Select","Select",""],["","69543010250","CEPHALEXIN ","CAP 500MG","20","Select","Select",""],["","69097028781","LEVOFLOXACIN ","TAB 750MG","10","Select","Select",""],["","16729017117","AMITRIPTYLIN ","TAB 10MG","30","Select","Select",""],["","68382079101","ACYCLOVIR ","TAB 400MG","30","Select","Select",""],["","68180035302","SERTRALINE ","TAB 100MG","30","Select","Select",""],["","00143924920","AMOX\/K ","TAB 875-125","20","Select","Select",""],["","16729020101","BUSPIRONE ","TAB 7.5MG","60","Select","Select",""],["","52817033200","CYCLOBENZAPR ","TAB 10MG","20","Select","Select",""],["","64380080707","IBUPROFEN ","TAB 800MG","21","Select","Select",""],["","00603158658","PROMETHAZINE ","SYP DM","120","Select","Select",""],["","65862017760","CEFDINIR ","CAP 300MG","20","Select","Select",""],["","43386033001","TRIMETHOPRIM ","TAB 100MG","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":""}]}]}