{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ROBERT   P WILLIAMS","gend":0,"add":"285 SPRING DR APT 4","city":"COLLINSVILLE","state":"VA","zip":"24078-9998","dob":"1983-01-23","age":"","mstatus":"","insh":"2159385*01","cliId":"","pno":"276\/224-0587","cno":"","email":"","ename":"","eno":"","pphy":"FQHC-FAMILY PRACTICE, BASSETT FQHC","ppno":"276\/629-1076","pcpadd":"324 T B STANLEY HWY","pcpcity":"BASSETT","pcpstate":"VA","pcpzip":24055,"pcpcounty":"","pcpid":"","pcpname":"MARTINSVILLE HENRY COUNTY COALITION FOR HEALTH AND WELLNESS","plan":"OHP","program":"MEDICAID","lob":"M4","region":"ROANOKE ALLEGHANY","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"276\/629-2695","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F15.10","F33.1","M23.612","R26.2","M62.81","M25.562","R29.6","G89.18","F41.9","F39.","J06.9","Z71.89","Z71.3","Z48.89","Z11.52","G47.00","Z03.818","V58.89","Z98.890","Z01.818","S83.512A","M21.162","S83.232A","Z47.2","Z00.00","G56.01","M17.12","G56.03","Z20.828","Z47.89","K21.9","R13.10","M25.531","R13.13","R26.9","R25.2","M65.862","S83.242A","F17.210","F41.0","Z79.899","Z20.822"],"date":["2021-01-21","2021-12-08","2020-08-26","2020-08-26","2020-08-26","2020-08-26","2020-08-26","2020-05-15","2021-12-06","2021-02-15","2022-10-28","2021-12-06","2021-12-06","2021-05-25","2021-08-10","2020-11-11","2021-08-11","2020-08-25","2020-05-12","2020-05-12","2020-05-15","2020-05-15","2020-05-15","2020-05-15","2020-07-14","2022-05-26","2020-03-04","2022-05-03","2021-12-01","2020-08-25","2021-06-09","2021-06-09","2022-11-22","2021-07-22","2019-06-28","2019-06-28","2019-01-18","2019-01-18","2022-05-20","2022-05-20","2022-05-20","2022-10-28"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}}]},{"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":[]},{"a":[]},{"a":{"indx":[false,false],"comment":["",""],"score":["",""]}},{"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":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","","NAPROXEN","TAB 500MG","","Select","Select",""],["","68382050010","OMEPRAZOLE","CAP 40MG","30","Select","Select",""],["","00363035926","WAL-TUSSIN","LIQ DM","60","Select","Select",""],["","69784050101","EC-NAPROXEN","TAB 375MG","60","Select","Select",""],["","","BUSPIRONE","TAB 5MG","","Select","Select",""],["","00406012305","HYDROCO\/APAP","TAB 5-325MG","30","Select","Select",""],["","70954006020","PREDNISONE","TAB 20MG","5","Select","Select",""],["","","AMITRIPTYLIN","TAB 50MG","","Select","Select",""],["","80777027399","MODERNA","INJ COVID-19","0","Select","Select",""],["","00781808926","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","16571020150","DICLOFENAC","TAB 75MG DR","30","Select","Select",""],["","","NARCAN","SPR ","","Select","Select",""],["","57237007710","ONDANSETRON","TAB 4MG ODT","5","Select","Select",""],["","","LIDOCAINE","PAD 0.05","","Select","Select",""],["","00363022714","ASPIRIN","TAB 325MG EC","30","Select","Select",""],["","00406051205","OXYCOD\/APAP","TAB 5-325MG","40","Select","Select",""],["","29300012510","MELOXICAM","TAB 15MG","30","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","64380071206","BENZONATATE","CAP 100MG","15","Select","Select",""],["","45802057178","FEXOFENADINE","TAB 180MG","30","Select","Select",""],["","00093005805","TRAMADOL","TAB 50MG","30","Select","Select",""]]}},{"a":[]},{"a":[]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":[]}]},{"t":"Mini-Cog","q":[{"a":[]},{"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":"","a13":""}]}]}