{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"WANDA   F YOUNG","gend":1,"add":"535 HENRY ROAD","city":"FERRUM","state":"VA","zip":"24088-3055","dob":"1969-11-06","age":"","mstatus":"","insh":7583945,"cliId":"","pno":5404200074,"cno":5404200074,"email":"","ename":"","eno":"","pphy":"DULANEY, KIMBERLY A","ppno":5404844800,"pcpadd":"390 S Main St Ste 201, ","pcpcity":"Rocky Mount","pcpstate":"VA","pcpzip":241511767,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"535 HENRY ROAD","madd2":"                                                            ","madd3":"","mcity":"FERRUM","mstate":"VA","mzip":"24088-3055","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["L97.522","L03.116","F17.210","L97.529","L02.612","M86.9","M86.172","J44.9","I10","F32.9","G62.9","M79.672","Z89.422","Z23","K21.9","Z01.812","E11.69","G89.18","G57.93","G60.3","M79.671","B35.1","L60.0","G60.9","Z12.31","N17.9","F41.9","F17.200","Z79.2","M89.8X7","M79.89","R93.6","K29.00","R19.7","R11.2","R05","J30.9","L97.422","L02.416","K21.0","E66.01","R73.9","A41.9","R65.20","N18.3","L08.9","Z01.810","Z98.890","J45.30","J41.0","G47.33","F41.0","N39.46","J30.89","E51.9","E53.8","Z12.11","L97.519","A41.01","B95.2","I12.9","I73.9","E11.9","E11.621","R06.02","E66.9","E11.622","E11.22","N18.9","D64.9","N63.0","R32","M65.332","M25.572","L53.9","J34.0","F41.8","F15.11","F12.10","L02.421","Z01.419","B37.2","L97.528"],"date":["2020-10-14","2020-06-02","2021-03-22","2020-07-30","2020-05-28","2020-05-28","2020-10-14","2021-03-22","2020-11-19","2020-07-23","2020-07-23","2020-11-19","2020-11-19","2021-04-28","2020-10-14","2020-10-03","2020-10-14","2020-11-19","2021-03-16","2019-03-12","2020-09-15","2021-03-11","2019-07-02","2020-06-02","2019-07-02","2020-06-15","2020-06-15","2020-06-02","2020-05-29","2020-10-01","2020-10-01","2020-10-01","2021-01-11","2021-01-11","2021-01-11","2021-03-16","2021-03-22","2020-05-27","2020-06-15","2020-06-02","2020-06-02","2020-06-02","2020-06-15","2020-06-15","2020-06-15","2020-10-14","2020-10-14","2021-03-11","2020-01-24","2020-01-24","2020-05-27","2020-01-24","2020-01-24","2020-01-24","2020-01-24","2020-01-24","2020-01-24","2020-02-17","2020-05-27","2020-05-27","2020-10-14","2020-05-27","2020-06-01","2020-10-01","2020-08-20","2020-08-20","2020-10-14","2020-10-14","2020-10-14","2020-10-14","2019-01-09","2019-04-26","2019-04-26","2020-05-27","2020-05-28","2020-12-10","2020-12-10","2020-12-10","2020-12-10","2021-04-21","2019-07-29","2019-07-29","2020-10-14"],"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":[["","00228212750","CLONIDINE ","TAB 0.1MG","30","Select","Select",""],["","67877022305","GABAPENTIN ","CAP 300MG","90","Select","Select",""],["","51672128901","NYSTATIN ","CRE 100000","60","Select","Select",""],["","13668042990","PANTOPRAZOLE ","TAB 40MG","30","Select","Select",""],["","00536467801","VITAMIN ","TAB 50MG","30","Select","Select",""],["","57664037718","TRAMADOL ","TAB 50MG","12","Select","Select",""],["","00591354160","BUPROPION ","TAB 150MG SR","60","Select","Select",""],["","00713028031","BACITRACIN ","OIN 500\/GM","28.4","Select","Select",""],["","00093317431","ALBUTEROL ","FAT E","8.5","Select","Select",""],["","45802065087","LORATADINE ","TAB 10MG","30","Select","Select",""],["","68382009805","PAROXETINE ","TAB 20MG","60","Select","Select",""],["","50383070016","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","64980043101","OXYBUTYNIN ","TAB 5MG","60","Select","Select",""],["","68001016200","PROMETHAZINE ","TAB 25MG","40","Select","Select",""],["","00597007541","SPIRIVA ","CAP HANDIHLR","30","Select","Select",""],["","66993058697","FLUTIC\/SALME ","AER 500\/50","60","Select","Select",""],["","65162046510","IBUPROFEN ","TAB 600MG","30","Select","Select",""],["","00591024010","LORAZEPAM ","TAB 0.5MG","60","Select","Select",""],["","51862033401","ESTRADIOL ","TAB 2MG","30","Select","Select",""],["","00168025815","CLOTRIM\/BETA ","CRE DIPROP","45","Select","Select",""],["","64380080308","RANITIDINE ","TAB 150MG","60","Select","Select",""],["","67877024601","QUETIAPINE ","TAB 200MG","30","Select","Select",""],["","63824005632","MUCINEX ","TAB 30-600ER","30","Select","Select",""],["","65862001901","CEPHALEXIN ","CAP 500MG","21","Select","Select",""],["","59310057922","PROAIR ","AER ","8.5","Select","Select",""],["","51672530200","CICLOPIROX ","SOL 0.08","6.6","Select","Select",""],["","68462018022","MUPIROCIN ","OIN 0.02","22","Select","Select",""],["","68462039610","OMEPRAZOLE ","CAP 20MG","30","Select","Select",""],["","69315012701","FOLIC ","TAB 1000MCG","30","Select","Select",""],["","00904759160","FERROUS ","TAB 325MG","90","Select","Select",""],["","16729018317","HYDROCHLOROT ","TAB 25MG","30","Select","Select",""],["","00173069700","ADVAIR ","AER 500\/50","60","Select","Select",""],["","00472024260","PERMETHRIN ","CRE 0.05","60","Select","Select",""],["","68001033408","LISINOPRIL ","TAB 10MG","10","Select","Select",""],["","00378932232","WIXELA ","AER 500\/50","60","Select","Select",""],["","58160082311","SHINGRIX ","INJ 50\/0.5ML","1","Select","Select",""],["","45802006436","TRIAMCINOLON ","CRE 0.001","80","Select","Select",""],["","60505530701","ACYCLOVIR ","TAB 800MG","20","Select","Select",""],["","00406012301","HYDROCO\/APAP ","TAB 5-325MG","18","Select","Select",""],["","46122035374","GNP ","DIS 21MG\/24H","28","Select","Select",""],["","46122010846","LICE ","LIQ 0.01","59","Select","Select",""],["","49100040021","CULTURELLE ","CAP DIGESTIV","10","Select","Select",""],["","10702001801","OXYCODONE ","TAB 5MG","20","Select","Select",""],["","65862050320","AMOX\/K ","TAB 875-125","6","Select","Select",""],["","00904759160","FEROSUL ","325MG","100","Select","Select",""],["","50111078810","AZITHROMYCIN ","500MG","3","Select","Select",""],["","00054001825","PREDNISONE ","20MG","30","Select","Select",""],["","76204060030","IPRATROPIUM\/ ","ALBUTER","180","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":""}]}]}