{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SINDUSTY   L HARRISON","gend":1,"add":"PO BOX 683","city":"RAVEN","state":"VA","zip":"24639-0683","dob":"1986-09-02","age":"","mstatus":"","insh":7793112,"cliId":"","pno":2769700424,"cno":2769797083,"email":"","ename":"","eno":"","pphy":"GOODMAN, ASHLEY D","ppno":2769646771,"pcpadd":"295 Wharton Ln NE, ","pcpcity":"Norton","pcpstate":"VA","pcpzip":242731541,"pcpcounty":"","pcpid":"","pcpname":"CLINCH VALLEY URGENT CARE","ano":2762102949,"add2":"                                                            ","add3":"","madd1":"PO BOX 683","madd2":"                                                            ","madd3":"","mcity":"RAVEN","mstate":"VA","mzip":"24639-0683","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"SOUTHWEST","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G47.33","R00.0","J69.0","K21.9","R13.10","Z11.59","K44.9","K29.60","F41.9","F32.9","Z88.5","Z88.8","Z79.51","Z79.899","K22.9","K29.50","R09.89","Z20.828","R11.0","R00.2","I10","R06.2","F90.0","F51.01","B34.9","R68.89","R53.83","N91.2","E04.9","J18.9","E88.81","Z01.812","F33.1","D06.0","R87.612","N92.6","K21.0","T18.2XXA","Z01.411","N92.0","R63.8","E66.01","Z68.42","E11.65","F41.1","F33.2","R63.5","H53.021","E03.9","R11.2","F41.8","R73.9","U07.1","Z68.43","R94.7","R06.02","Z87.01","Z09","Z71.2","F32.1","R13.19","G47.30","Z87.891","E66.9","B97.7","Z30.09","A60.04","B37.3","E11.9","Z01.818","R68.81","I49.8","Z83.3","Z82.49","Z12.4"],"date":["2021-04-27","2020-12-18","2020-06-30","2021-05-06","2020-07-21","2020-07-20","2020-10-02","2020-07-21","2021-04-20","2020-07-21","2020-07-21","2020-07-21","2020-07-21","2020-09-04","2020-07-21","2020-09-04","2020-08-03","2021-04-15","2021-02-12","2021-01-27","2021-05-06","2021-04-15","2021-04-20","2021-04-20","2019-01-13","2019-01-13","2019-02-19","2020-06-19","2021-03-16","2021-04-17","2021-02-01","2020-07-20","2021-03-31","2021-05-06","2021-05-06","2021-05-06","2020-09-04","2020-09-04","2021-02-01","2021-02-01","2021-02-01","2021-03-16","2021-02-02","2021-02-02","2021-03-19","2021-03-19","2019-02-19","2020-06-08","2020-06-25","2020-10-07","2021-03-16","2020-12-16","2021-01-02","2021-03-16","2021-03-16","2020-06-25","2020-06-25","2020-06-30","2021-01-27","2021-03-15","2020-09-04","2020-09-04","2021-05-06","2021-02-12","2021-05-06","2021-05-06","2021-05-06","2021-05-06","2021-05-06","2020-08-15","2020-09-11","2020-12-18","2020-06-25","2020-06-25","2021-02-01"],"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":[["","00093083301","CLONAZEPAM ","TAB 1MG","60","Select","Select",""],["","00093738001","VENLAFAXINE ","TAB 37.5MG","60","Select","Select",""],["","60505530701","ACYCLOVIR ","TAB 800MG","40","Select","Select",""],["","57664050318","TIZANIDINE ","TAB 4MG","60","Select","Select",""],["","50111043302","TRAZODONE ","TAB 50MG","30","Select","Select",""],["","65862001205","SERTRALINE ","TAB 50MG","30","Select","Select",""],["","00002143480","TRULICITY ","INJ 1.5\/0.5","2","Select","Select",""],["","16729014601","QUETIAPINE ","TAB 50MG","30","Select","Select",""],["","51991074790","DULOXETINE ","CAP 30MG","60","Select","Select",""],["","49281042050","FLUZONE ","INJ 2020-21","0.5","Select","Select",""],["","69238126601","OSELTAMIVIR ","CAP 75MG","10","Select","Select",""],["","65862056090","PANTOPRAZOLE ","TAB 40MG","30","Select","Select",""],["","67877057505","BENZONATATE ","CAP 200MG","30","Select","Select",""],["","60505006502","OMEPRAZOLE ","CAP 20MG","30","Select","Select",""],["","00254100752","ALBUTEROL ","AER HFA","6.7","Select","Select",""],["","31722072250","LEVOFLOXACIN ","TAB 500MG","10","Select","Select",""],["","00378001801","METOPROL ","TAB 25MG","30","Select","Select",""],["","00054001825","PREDNISONE ","TAB 20MG","10","Select","Select",""],["","58657050916","GUAIFENESIN ","LIQ 100\/5ML","300","Select","Select",""],["","16729018317","HYDROCHLOROT ","TAB 25MG","30","Select","Select",""],["","68462010340","FLUCONAZOLE ","TAB 150MG","2","Select","Select",""],["","00781502207","METHYLPRED ","TAB 4MG","21","Select","Select",""],["","00781523964","ONDANSETRON ","TAB 8MG ODT","30","Select","Select",""],["","51672130200","TERCONAZOLE ","CRE 0.008","20","Select","Select",""],["","50111078751","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","68180087613","NORETHINDRON ","TAB 0.35MG","28","Select","Select",""],["","00597015330","JARDIANCE ","TAB 25MG","30","Select","Select",""],["","00378180077","LEVOTHYROXIN ","TAB 25MCG","15","Select","Select",""],["","63304090430","VALACYCLOVIR ","TAB 500MG","30","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","14","Select","Select",""],["","51293081001","PHENAZOPYRID ","TAB 100MG","10","Select","Select",""],["","60432060416","PROMETHAZINE ","SYP DM","118","Select","Select",""],["","62756014202","METFORMIN ","TAB 500MG ER","30","Select","Select",""],["","13107003134","MIRTAZAPINE ","TAB 15MG","30","Select","Select",""],["","69238110005","DOXYCYCL ","CAP 100MG","20","Select","Select",""],["","65162071110","GUANFACINE ","TAB 1MG","30","Select","Select",""],["","65862050320","AMOX\/K ","TAB 875-125","14","Select","Select",""],["","65162046610","IBUPROFEN ","TAB 800MG","21","Select","Select",""],["","53746014501","HYDROCOD\/IBU ","TAB 7.5-200","40","Select","Select",""],["","00186037220","SYMBICORT ","80-4.5","10.2","Select","Select",""],["","59417010310","VYVANSE ","30MG","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":[[["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":""}]}]}