{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SOPHIA MOSS","gend":1,"add":"1212 PRILLAMAN AVENUE APT A 3834 VERMONT AVENUE NW","city":"ROANOKE","state":"VA","zip":"24017-9998","dob":"1972-06-24","age":"","mstatus":"","insh":"20055532*01","cliId":"","pno":"540\/345-6958","cno":"540\/345-6958","email":"","ename":"","eno":"","pphy":"DAUGHERTY, JOHN MD","ppno":"540\/265-1607","pcpadd":"4910 VALLEY VIEW BLVD","pcpcity":"ROANOKE","pcpstate":"VA","pcpzip":24012,"pcpcounty":"","pcpid":135516,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"ROANOKE ALLEGHANY","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"540\/725-4554","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M51.27","M51.26","R10.13","R11.0","Z00.00","R41.3","I35.0","R32.","M54.40","G89.29","K21.9","I10.","M54.5","I16.9","N94.6","R20.0","R20.2","E87.6","R82.90","Z28.21","M62.81","Z23.","F33.2","M54.42","E66.01","R39.15","B35.6","M54.41","NO DATA","M54.16","F41.8","F06.30","F31.81","F33.3","G47.09","F12.10","F41.9","F41.0","R68.89","F39.","Z79.899","M51.17","M47.27","R06.83","R06.81","G47.19","J42.","Z68.41","G56.21","J45.20","G56.01","J30.9","R51.","Z79.1","M47.817","M54.6"],"date":["2020-05-29","2020-05-29","2020-09-21","2020-09-08","2020-12-11","2020-12-11","2020-12-11","2020-12-11","2020-12-11","2021-10-08","2021-10-08","2021-04-29","2021-04-29","2021-04-29","2021-04-29","2020-09-16","2020-09-16","2020-09-21","2020-09-21","2020-09-21","2020-10-19","2021-09-01","2020-05-29","2020-05-15","2020-05-15","2020-05-15","2020-05-15","2020-05-15","2020-08-04","2021-10-08","2020-05-29","2020-05-29","2020-09-08","2020-06-30","2020-06-30","2020-06-30","2020-06-30","2020-06-30","2020-06-23","2020-09-08","2020-09-29","2021-09-24","2021-09-10","2020-03-06","2020-03-06","2020-03-06","2020-03-06","2020-03-06","2020-11-09","2020-09-08","2020-09-08","2020-09-08","2020-09-08","2020-09-08","2021-09-24","2021-09-10"],"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":[["","43598029390","PREGABALIN ","75MG","60","Select","Select",""],["","00781286810","OMEPRAZOLE ","20MG DR","30","Select","Select",""],["","00173068220","VENTOLIN ","","18","Select","Select",""],["","00536113428","MICONAZOLE ","2%","30","Select","Select",""],["","65197010305","MICATIN ","2%","14","Select","Select",""],["","68645014059","FAMOTIDINE ","20MG","60","Select","Select",""],["","00085113204","PROVENTIL ","HFA","7","Select","Select",""],["","45802008801","ALBUTEROL ","HFA","8","Select","Select",""],["","31722054501","LITHIUM ","300MG","20","Select","Select",""],["","00603188016","LIDOCAINE ","5%","30","Select","Select",""],["","00472073556","ANTIFUNGAL ","2%","14","Select","Select",""],["","55111015330","ONDANSETRON ","4MG","10","Select","Select",""],["","49035065082","EQ ","20MG","180","Select","Select",""],["","70010075401","METHOCARBAM ","500MG","60","Select","Select",""],["","00054327099","FLUTICASONE ","50MCG","16","Select","Select",""],["","59746017509","PREDNISONE ","20MG","12","Select","Select",""],["","16571020150","DICLOFENAC ","75MG DR","60","Select","Select",""],["","00093005805","TRAMADOL ","50MG","28","Select","Select",""],["","70069013101","TOBRAMYCIN ","0.3% OP","5","Select","Select",""],["","43598029390","PREGABALIN","75MG","60","Select","Select",""],["","55111015810","OMEPRAZOLE","20MG","30","Select","Select",""],["","00472073556","ANTIFUNGAL","2%","14","Select","Select",""],["","65197010305","MICATIN","2%","14","Select","Select",""],["","00536113428","MICONAZOLE","2%","30","Select","Select",""],["","00603188016","LIDOCAINE","5%","30","Select","Select",""],["","00254100752","ALBUTEROL","HFA","7","Select","Select",""],["","68645014059","FAMOTIDINE","20MG","60","Select","Select",""],["","00173068220","VENTOLIN","","18","Select","Select",""],["","31722054501","LITHIUM","300MG","20","Select","Select",""],["","16571020150","DICLOFENAC","75MG DR","60","Select","Select",""],["","70010075401","METHOCARBAM","500MG","60","Select","Select",""],["","49035065082","EQ","20MG","180","Select","Select",""],["","55111015330","ONDANSETRON","4MG","10","Select","Select",""],["","00054327099","FLUTICASONE","50MCG","16","Select","Select",""],["","59746017509","PREDNISONE","20MG","12","Select","Select",""],["","00093005805","TRAMADOL","50MG","30","Select","Select",""],["","70069013101","TOBRAMYCIN","0.3% OP","5","Select","Select",""],["","29300011516","TOPIRAMATE","25MG","30","Select","Select",""],["","00085113204","PROVENTIL","HFA","7","Select","Select",""],["","59310057922","PROAIR ","AER ","8","Select","Select",""],["","29300011516","TOPIRAMATE ","TAB 25MG","30","Select","Select",""],["","16714089802","LORATADINE ","TAB 10MG","90","Select","Select",""],["","49035026045",""," ","90","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":""}]}]}