{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ORA   M FAIRFAX","gend":1,"add":"5530 WIPLEDALE DR","city":"ROANOKE","state":"VA","zip":"24019-9998","dob":"1958-08-12","age":"","mstatus":"","insh":"2175345*01","cliId":"","pno":"","cno":"","email":"","ename":"","eno":"","pphy":"KELLY, MATTHEW W DO","ppno":"540\/265-4210","pcpadd":"4910 VALLEY VIEW BLVD","pcpcity":"ROANOKE","pcpstate":"VA","pcpzip":24012,"pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"540\/265-4219","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M79.603","M20.011","M89.9","M89.50","S62.623A","D86.9","R06.00","R94.31","D86.0","K74.69","R76.8","D69.6","K74.60","I89.9","Z85.79","M25.50","M89.49","E55.9","H25.11","M54.2","R06.02","Z12.11","B18.2","K63.5","D17.5","K57.30","K64.8","K63.3","K31.89","K22.2","NO DATA","K76.6","I10.","D12.5","K62.5","Z20.822","C90.00","D72.819","Z86.2","Z96.1","Z98.890","V54.17","R94.02","J34.89","J39.2","Z12.12","I08.1","K22.4","K22.8","K29.50","K44.9","M20.021","Z79.899","M25.60","M62.81","R29.3","K40.20","K21.9","R11.2","R53.1","V54.22","M79.645","T30.0","F17.200","K63.89","D70.9","J18.9","R19.7","S90.32XA","W20.8XXA","S62.622A","T23.202A","T31.0","X12.XXXA","V58.89","Z48.00","T23.122A","Z12.31","D49.2","Z78.0","K40.90","R50.9","S62.662A","W23.1XXA","I08.8","Z71.1","R13.12"],"date":["2020-12-29","2020-12-29","2020-12-29","2020-12-29","2020-12-29","2022-09-15","2022-02-14","2022-09-15","2022-08-22","2020-11-30","2020-02-03","2021-10-13","2022-06-27","2020-09-23","2020-09-23","2020-11-30","2022-06-27","2022-06-27","2021-03-29","2021-12-06","2021-11-18","2022-06-10","2022-06-10","2022-06-10","2022-06-23","2022-06-10","2022-06-10","2022-06-10","2022-06-10","2022-06-10","2022-06-23","2022-06-10","2022-07-25","2022-06-10","2022-06-10","2022-09-19","2020-08-27","2021-10-13","2020-10-02","2022-05-04","2022-07-21","2020-09-05","2020-10-02","2020-10-02","2020-10-02","2020-12-23","2022-01-06","2020-04-14","2020-04-14","2020-04-14","2020-04-14","2020-10-02","2022-05-25","2021-12-06","2021-12-06","2021-12-06","2022-07-25","2022-07-25","2020-01-06","2020-01-06","2020-06-26","2020-08-12","2020-09-16","2021-11-08","2022-06-10","2020-01-08","2020-01-08","2020-01-13","2020-03-10","2020-03-10","2020-07-15","2020-09-01","2020-09-01","2020-09-01","2020-09-05","2020-09-05","2020-09-14","2020-09-14","2020-09-14","2021-05-14","2022-07-25","2020-01-06","2020-06-24","2020-06-24","2022-01-07","2022-05-18","2022-06-23"],"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":[]},{"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":[["","68382009601","HYDROXYCHLOR","TAB 200MG","30","Select","Select",""],["","68180051802","LISINOP\/HCTZ","TAB 10-12.5","30","Select","Select",""],["","65862086001","FAMOTIDINE","TAB 40MG","60","Select","Select",""],["","29300035505","TRAMADOL","TAB 50MG","30","Select","Select",""],["","68382005105","MELOXICAM","TAB 15MG","30","Select","Select",""],["","63304007601","POT  CHLORIDE","TAB 10MEQ ER","60","Select","Select",""],["","49281042050","FLUZONE","INJ 2020-21","0","Select","Select",""],["","59267100002","PFIZER","INJ COVID-19","0","Select","Select",""],["","80777027399","MODERNA","INJ COVID-19","0","Select","Select",""],["","68180072103","AMLODIPINE","TAB 10MG","30","Select","Select",""],["","52817032000","BACLOFEN","TAB 10MG","12","Select","Select",""],["","19515081852","FLULAVAL","INJ 2021-22","0","Select","Select",""],["","00406012301","HYDROCO\/APAP","TAB 5-325MG","12","Select","Select",""],["","57237007530","ONDANSETRON","TAB 4MG","12","Select","Select",""],["","33342002332","LEVOFLOXACIN","TAB 750MG","5","Select","Select",""],["","71369002030","DOPTELET","TAB 20MG","10","Select","Select",""],["","72626270101","SOFOS\/VELPAT","TAB 400-100","28","Select","Select",""],["","61958220101","EPCLUSA","TAB 400-100","28","Select","Select",""],["","61442010305","DICLOFENAC","TAB 75MG DR","20","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":""}]}]}