{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DERECK   L WILSON","gend":0,"add":"3402 BENNETT DRIVE","city":"ROANOKE","state":"VA","zip":"24017-4555","dob":"1989-12-03","age":"","mstatus":"","insh":8081366,"cliId":"","pno":5406764853,"cno":5407281888,"email":"","ename":"","eno":"","pphy":"LEONG, APOLLO Y","ppno":5407765656,"pcpadd":"1818 ELECTRIC ROAD, ","pcpcity":"ROANOKE","pcpstate":"VA","pcpzip":240181619,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":5406764858,"add2":"APT 4","add3":"","madd1":"3402 BENNETT DRIVE","madd2":"APT 4","madd3":"","mcity":"ROANOKE","mstate":"VA","mzip":"24017-4555","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R68.89","R91.8","R59.0","R05","E11.65","Z79.4","E78.5","G40.409","G40.909","R56.9","R51","E11.9","I10","G40.919","E66.01","Z68.36","E83.42","G40.319","R41.3","R47.9","J18.9","R04.2","R07.9","M25.569","R93.89","R41.82","N18.9","E10.9","R82.5","E66.9","Z87.891","Z91.14","R40.0","R11.2","Z87.01","R80.9","Z00.00","G40.211","G40.A09","R59.1","R07.81","Y92.9","T42.6X6A","Z91.128","Z79.899","F12.90","I48.91","E46","R51.9","Z79.82","K20.9","K29.50","R07.89","Z53.21","E44.1","E03.9","R40.20","Z91.11","N52.9","K20.8","R10.13","R11.0","K31.89","Z68.34","M25.561","M25.562","G89.29","S01.512A","J69.0","J18.1","A49.9","W18.30XA","Z91.19","R00.0","R94.31","R53.1","R40.4","R41.0","Y92.238","E11.10","D72.829","R06.89","T38.3X6A","T42.5X6A","Z91.138","G40.89","F17.200","R63.4","J96.00","D72.819","E87.2","E11.22","I12.9","I37.1","I51.7"],"date":["2020-03-20","2020-01-10","2019-06-08","2020-01-10","2020-12-10","2021-01-01","2020-12-10","2020-05-13","2021-01-01","2021-01-01","2020-03-17","2021-01-01","2021-01-01","2020-10-09","2020-10-09","2020-10-08","2019-10-12","2020-12-10","2020-03-17","2019-10-29","2020-01-10","2020-01-10","2020-01-10","2020-02-24","2020-12-10","2020-03-17","2020-07-01","2019-01-07","2019-02-18","2019-02-18","2020-05-13","2021-01-01","2019-02-19","2019-01-10","2019-10-12","2019-01-03","2019-01-03","2020-10-09","2019-02-19","2019-06-07","2019-06-07","2019-10-12","2019-10-12","2019-10-12","2019-10-12","2019-10-12","2020-10-09","2020-10-09","2021-01-01","2021-01-01","2019-01-08","2019-01-08","2019-05-23","2020-06-30","2020-10-08","2020-10-08","2020-12-07","2020-12-10","2020-12-10","2019-01-08","2019-01-08","2019-01-10","2019-01-08","2019-01-08","2019-04-11","2019-04-11","2019-04-11","2019-08-27","2019-06-10","2019-06-10","2019-06-10","2019-08-27","2020-08-08","2021-01-01","2019-10-11","2020-03-17","2021-01-01","2021-01-01","2020-05-13","2020-05-14","2020-05-13","2020-05-13","2020-05-13","2020-05-13","2020-05-13","2020-08-08","2020-08-08","2019-01-07","2020-05-13","2020-05-13","2020-05-13","2020-07-01","2020-07-01","2020-10-09","2020-10-09"],"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":[["","00169643810","LEVEMIR ","INJ FLEXTOUC","15","Select","Select",""],["","62756079888","DIVALPROEX ","TAB 500MG DR","240","Select","Select",""],["","65162019050","NAPROXEN ","TAB 500MG","30","Select","Select",""],["","00169633910","NOVOLOG ","INJ FLEXPEN","15","Select","Select",""],["","69097012303","TOPIRAMATE ","TAB 50MG","60","Select","Select",""],["","65862024608","LEVETIRACETA ","TAB 500MG","180","Select","Select",""],["","65862050320","AMOX\/K ","TAB 875-125","20","Select","Select",""],["","68180016006","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","68682099398","DILTIAZEM ","CAP 120MG ER","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","",""],["No","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":""}]}]}