{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ALVIN   W ROACH","gend":0,"add":"6871 IRISBURG ROAD","city":"AXTON","state":"VA","zip":"24054-9998","dob":"1971-06-28","age":"","mstatus":"","insh":"2267390*01","cliId":"","pno":"434\/483-8115","cno":"434\/483-8115","email":"","ename":"","eno":"","pphy":"YEATTS, BRADLEY NP","ppno":"434\/656-2224","pcpadd":"305 NORTH MAIN STREET","pcpcity":"GRETNA","pcpstate":"VA","pcpzip":24557,"pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/656-3988","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F11.20","F19.90","F11.21","E87.1","F13.239","F17.200","Z20.822","F41.9","F31.9","N50.82","Z90.49","F41.1","F15.10","R07.9","F19.10","R53.1","F41.8","R10.84","R10.13","K21.9","R00.0","F13.10","F11.10","E87.6","R45.851","F33.1","Z72.0","N50.89","F17.210","Z88.8","N50.811","R52.","I10.","R11.0","Z20.828","R68.89","F13.20","Z71.6","Z71.51","F12.10","F10.10","M54.89","R09.02","F32.9","Z51.81","Z81.1","Z81.4","F10.20","Z76.0","F11.23","K62.89","Z04.9","N49.2","N50.9","K58.9","F90.9","R35.0","M25.511","S06.9X9A","W14.XXXA","G47.9","F33.41","Z79.899","F33.0","H10.10","N40.1","R39.11","Z12.5","F33.40","G47.00","T42.3X1A","T42.4X1A","Z91.14","J02.9","R10.10","K31.89","R10.0","F19.20","Z88.1","R73.9","F19.239","H05.229","R23.3","I20.9","I49.8","R10.2","T50.901A","R10.9","NO DATA","F33.2","F17.290","F90.0","K46.9","J31.0","S05.11XA","F19.980","E44.0","K85.90","K40.90","V62.84"],"date":["2022-11-04","2021-01-31","2022-04-06","2021-02-06","2021-02-06","2022-04-06","2021-02-06","2021-06-07","2021-02-06","2021-02-27","2021-02-06","2022-04-06","2021-02-26","2021-03-10","2021-08-24","2021-04-13","2021-02-13","2021-07-30","2021-07-30","2022-03-15","2021-03-10","2022-02-17","2022-03-23","2021-04-14","2021-06-03","2022-04-06","2022-11-02","2021-06-24","2021-06-24","2021-06-24","2021-06-24","2021-07-30","2021-07-30","2021-07-30","2021-11-22","2021-11-22","2022-03-15","2022-04-06","2022-04-06","2022-02-17","2022-04-06","2021-06-22","2021-06-22","2021-08-24","2022-03-15","2022-03-15","2022-03-15","2022-02-10","2020-11-28","2021-02-01","2021-03-03","2021-04-08","2021-06-24","2021-06-28","2021-08-24","2021-08-24","2021-08-24","2021-10-11","2020-11-06","2020-11-06","2021-05-11","2020-11-17","2021-02-01","2022-01-06","2020-04-01","2020-04-01","2020-04-01","2020-04-01","2021-03-12","2021-03-12","2021-04-13","2021-04-13","2020-12-04","2020-12-11","2021-02-25","2021-02-25","2021-03-03","2021-04-09","2020-11-19","2021-02-01","2021-02-01","2021-02-01","2021-02-01","2021-02-06","2021-02-16","2021-02-27","2021-04-13","2021-08-04","2021-08-04","2021-08-04","2021-08-04","2021-08-04","2021-08-04","2021-02-01","2021-02-01","2021-02-01","2021-05-11","2021-05-11","2021-06-22","2021-08-03"],"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":[["","51991074890","DULOXETINE","CAP 60MG","30","Select","Select",""],["","57664050083","MIRTAZAPINE","TAB 30MG","30","Select","Select",""],["","12496120203","SUBOXONE","MIS 2-0.5MG","21","Select","Select",""],["","68382080510","TRAZODONE","TAB 50MG","10","Select","Select",""],["","00054018913","BUPREN\/NALOX","SUB 8-2MG","45","Select","Select",""],["","16729020201","BUSPIRONE","TAB 10MG","90","Select","Select",""],["","65862048901","QUETIAPINE","TAB 25MG","60","Select","Select",""],["","49483060501","GABAPENTIN","CAP 100MG","90","Select","Select",""],["","43547028211","ESCITALOPRAM","TAB 20MG","30","Select","Select",""],["","00456111030","VIIBRYD","TAB 10MG","30","Select","Select",""],["","62332023230","VILAZODONE","TAB 10MG","30","Select","Select",""],["","42806016005","HYDROXYZ","TAB 25MG","90","Select","Select",""],["","49483060450","IBUPROFEN","TAB 800MG","21","Select","Select",""],["","69097083512","SERTRALINE","TAB 100MG","45","Select","Select",""],["","59651000305","OMEPRAZOLE","CAP 40MG","90","Select","Select",""],["","65862056099","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","65162006205","SUCRALFATE","SUS 1GM\/10ML","560","Select","Select",""],["","00591079401","DICYCLOMINE","CAP 10MG","30","Select","Select",""],["","00121086816","NYSTATIN","SUS 100000","200","Select","Select",""],["","43598044874","NICOTINE","DIS 21MG\/24H","21","Select","Select",""],["","49884023069","MEGESTROL","SUS 625MG\/5M","30","Select","Select",""],["","00093220401","METOCLOPRAM","TAB 5MG","40","Select","Select",""],["","13668000805","ZOLPIDEM","TAB 10MG","10","Select","Select",""],["","65162019050","NAPROXEN","TAB 500MG","30","Select","Select",""],["","00228206710","OXAZEPAM","CAP 10MG","13","Select","Select",""],["","67877021905","CEPHALEXIN","CAP 500MG","14","Select","Select",""],["","69238110005","DOXYCYCL","CAP 100MG","20","Select","Select",""],["","65862039010","ONDANSETRON","TAB 4MG ODT","12","Select","Select",""],["","50428050854","CVS","PAK ","1","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","10","Select","Select",""],["","80681009800","VITAMIN","TAB 100MG","30","Select","Select",""],["","71093014105","METHOCARBAM","TAB 750MG","28","Select","Select",""],["","59417010110","VYVANSE","CAP 10MG","60","Select","Select",""],["","80681004002","MELATONIN","TAB 5MG","30","Select","Select",""],["","55111016305","OLANZAPINE","TAB 2.5MG","30","Select","Select",""],["","69842057803","STOOL","CAP 100MG","14","Select","Select",""],["","65862059805","TAMSULOSIN","CAP 0.4MG","30","Select","Select",""],["","00536466110","THEREMS-M","TAB ","30","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","00228315603","BUPRENORPHIN","SUB 2MG","21","Select","Select",""],["","68382089806","TADALAFIL","TAB 10MG","20","Select","Select",""],["","00002446330","CIALIS","TAB 10MG","10","Select","Select",""],["","47335077991","AZELASTINE","SPR 0.001","30","Select","Select",""],["","17478071710","KETOTIF","DRO 0.025%OP","5","Select","Select",""],["","00527217037","DICLOFENAC","TAB 100MG ER","30","Select","Select",""],["","42806040021","METHYLPRED","TAB 4MG","21","Select","Select",""],["","51991070610","ALPRAZOLAM","TAB 1MG","15","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":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"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":""}]}]}