{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" AHTERODSDNOMMAH","gend":1,"add":"IALC .TS 987DR KEERC SR","city":"CHILHOWIE","state":"VA","zip":"24319-5905","dob":"1968-03-04","age":"","mstatus":"","insh":"50017189","cliId":"","pno":"7367201408","cno":2765210441,"email":"","ename":"","eno":"","pphy":"MOSIER, GABRIEL L","ppno":2762288686,"pcpadd":"1375 W Ridge Rd, ","pcpcity":"Wytheville","pcpstate":"VA","pcpzip":243825011,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"SOUTHWEST","aligned":"","ano":2767592001,"add2":"APARTMENT 4","add3":"","madd1":"789 ST. CLAIRS CREEK RD","madd2":"APARTMENT 4","madd3":"","mcity":"CHILHOWIE","mstate":"VA","mzip":"24319-5905","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R00.0","B20","R11.2","R50.9","K22.2","D89.9","R07.9","Z79.01","N39.0","R68.89","S90.512A","R69","W01.0XXA","R60.0","K92.0","R13.10","R11.10","Z87.19","R13.19","K92.1","E87.6","M25.551","M25.531","M24.812","K52.9","E78.5","I47.2","Z86.711","R06.02","M79.605","K92.2","I50.32","D84.9","Z21","M79.89","T50.B95A","I11.0","Z86.718","Z87.11","R78.81","M79.644","Z79.899","I10","S63.286A","W10.9XXA","E55.9","Z23","S79.911A","S70.12XA","S80.12XA","S89.92XA","W19.XXXA","I25.2","Z88.8","R07.81","R10.9","Z85.828","I50.9","Z86.73","K21.9","E78.00","Z85.42","R10.13","N20.0","K86.2","K29.60","K29.71","K25.4","E66.9","Z68.36","I25.10","F41.8","H91.91","S69.91XD","E78.2","N17.9","E87.2","D69.6","I47.1","F43.10","Y93.A9","F33.1","M79.641","R93.3","R07.89","K29.50","K64.0","K29.00","E78.01","Z03.89","Z98.890","Z01.419","R30.9","R39.9","S69.91XA","E86.0","K20.9","A41.9","M79.662","M19.071","M79.674","R74.0","R11.0","Z53.29","I45.81","R94.31","B49","I95.9","B17.9","J96.01","S60.571A","W55.01XA","S96.911A","S99.921A","W22.09XA","Y93.89","Y92.009","Z95.5","K25.9","K29.70","J18.9","M25.512","H60.90","G89.29","L20.84","D22.61","L82.1","A08.4","D62","Z16.21","C44.611","E83.39","F31.9","I50.30","R00.2","I82.409","K83.8","Z90.49","Z90.710","I70.0","I51.7","K62.5","R19.7","M25.572","R22.42","Y93.02","Y92.9","S90.02XA","R10.11","R10.31","N83.9","M79.671","M85.89","E66.01","K21.0","N28.89","K42.9","W01.0XXD","J01.00","J02.9","Z04.3","M54.5","S46.012A","K76.0","R91.1","H16.223","Z86.79","N93.9","Z92.89","J96.90","G45.9","H04.123","S20.219A","R07.1","M79.652","W18.30XA","S93.504A","X58.XXXA","D64.9","R94.5","S92.504D","Z88.1","Z88.5","Z88.6","X50.0XXA","Z47.89"],"date":["2020-02-06","2021-02-25","2021-04-16","2019-08-15","2019-06-11","2019-06-11","2019-12-18","2021-04-17","2019-07-01","2021-02-16","2019-08-05","2020-02-20","2019-12-18","2021-04-16","2021-04-17","2020-02-05","2020-02-05","2020-02-05","2020-02-05","2020-02-07","2021-04-16","2020-02-20","2020-02-24","2020-06-23","2021-02-26","2021-04-16","2021-02-25","2021-04-16","2021-02-24","2021-02-24","2021-04-17","2021-04-16","2021-04-16","2021-04-16","2021-04-16","2021-04-16","2021-04-16","2021-04-16","2021-04-16","2019-03-14","2020-06-02","2020-06-02","2021-02-26","2019-05-08","2019-05-08","2020-12-15","2019-06-27","2019-08-05","2019-08-05","2019-08-05","2019-08-05","2020-06-02","2020-02-06","2020-06-02","2019-08-15","2020-02-06","2019-08-15","2020-02-07","2019-08-15","2020-02-07","2020-02-06","2019-08-15","2019-12-31","2019-12-31","2019-12-31","2021-02-26","2020-02-06","2020-02-06","2020-02-06","2020-02-06","2021-02-26","2020-02-06","2020-02-06","2020-06-22","2021-02-02","2021-02-26","2021-02-26","2021-02-26","2021-02-26","2021-02-24","2019-02-11","2019-03-18","2020-06-15","2019-06-08","2019-12-18","2019-06-03","2019-06-03","2019-06-04","2019-07-09","2019-07-09","2020-02-06","2019-07-19","2019-07-19","2021-01-07","2020-06-03","2019-06-02","2019-06-04","2019-06-24","2019-08-02","2019-10-22","2019-12-28","2019-12-31","2019-12-31","2019-12-31","2020-02-06","2020-02-06","2019-06-04","2019-06-04","2019-06-04","2019-06-04","2019-10-03","2019-10-03","2019-12-28","2019-12-30","2019-12-28","2019-12-28","2019-12-28","2019-12-28","2020-02-07","2020-02-07","2020-02-07","2020-07-14","2020-07-14","2020-07-14","2020-08-17","2020-08-17","2020-08-17","2021-02-24","2021-02-24","2021-02-24","2021-02-24","2021-02-24","2021-02-24","2019-01-08","2019-01-08","2019-01-08","2019-06-06","2019-06-01","2019-06-06","2019-06-01","2019-06-04","2019-06-08","2019-06-11","2019-08-02","2019-08-02","2019-08-02","2019-08-02","2019-08-02","2019-08-15","2019-08-15","2019-08-15","2019-10-22","2020-10-06","2019-06-02","2019-06-02","2019-06-06","2019-06-06","2020-01-08","2020-01-30","2020-01-30","2020-02-20","2020-02-20","2020-06-25","2021-04-17","2021-04-17","2021-04-21","2019-01-02","2019-01-10","2019-01-10","2019-06-04","2019-06-11","2019-07-03","2019-12-18","2019-12-18","2019-12-18","2019-12-18","2019-12-28","2020-06-25","2019-12-31","2019-12-31","2020-01-08","2020-06-02","2020-06-02","2020-06-02","2020-06-02","2020-06-25"],"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":[["","00093317431","ALBUTEROL ","FAT E HFA INH","8.5","Select","Select",""],["","00054429731","FUROSEMIDE ","TAB 20MG","60","Select","Select",""],["","61958250101","BIKTARVY ","TAB ","30","Select","Select",""],["","65862001305","SERTRALINE ","TAB 100MG","45","Select","Select",""],["","00378110101","PRAZOSIN ","CAP 1MG","30","Select","Select",""],["","65862056090","PANTOPRAZOLE ","TAB 40MG","60","Select","Select",""],["","00003089321","ELIQUIS ","TAB 2.5MG","60","Select","Select",""],["","62037099901","POT  CL MICRO","TAB 20MEQ ER","30","Select","Select",""],["","13668010401","ISOSORB ","TAB 30MG ER","30","Select","Select",""],["","62037059990","CARTIA ","CAP 240\/24HR","30","Select","Select",""],["","31722088390","ROSUVASTATIN ","TAB 10MG","30","Select","Select",""],["","59310057922","PROAIR ","AER ","8.5","Select","Select",""],["","61958190101","GENVOYA ","TAB ","30","Select","Select",""],["","65862017760","CEFDINIR ","CAP 300MG","4","Select","Select",""],["","00406012305","HYDROCO\/APAP ","TAB 5-325MG","20","Select","Select",""],["","63304071890","DILTIAZEM ","CAP 120MG ER","60","Select","Select",""],["","64380071206","BENZONATATE ","CAP 100MG","15","Select","Select",""],["","00904053913","THERA ","TAB ","30","Select","Select",""],["","23155050201","HYDROXYZ ","TAB 50MG","60","Select","Select",""],["","64980032430","PROCTOZONE ","CRE -HC 2.5%","30","Select","Select",""],["","31604002683","D3 ","TAB 1000UNIT","30","Select","Select",""],["","60505024901","MIRTAZAPINE ","TAB 45MG","30","Select","Select",""],["","39423011048","FLORAJEN ","CAP ACIDOPHI","30","Select","Select",""],["","00172572860","FAMOTIDINE ","TAB 20MG","60","Select","Select",""],["","00378623301","CITALOPRAM ","TAB 40MG","30","Select","Select",""],["","57237000430","FLUCONAZOLE ","TAB 100MG","14","Select","Select",""],["","61314064610","NEO\/POLY\/HC ","SOL 1% OTIC","10","Select","Select",""],["","65862089230","VORICONAZOLE ","TAB 200MG","20","Select","Select",""],["","68585000612","MAGNESIUM-OX ","TAB 400MG","30","Select","Select",""],["","67877025115","TRIAMCINOLON ","CRE 0.001","15","Select","Select",""],["","11917001257","SALINE ","SPR 0.0065","88","Select","Select",""],["","68462010530","ONDANSETRON ","TAB 4MG","12","Select","Select",""],["","00363078522","SENNA-S ","TAB S","30","Select","Select",""],["","43386048024","ORPHENADRINE ","TAB 100MG ER","20","Select","Select",""],["","00904759080","FEROSUL ","TAB 325MG","60","Select","Select",""],["","39423066048","FLORAJEN3 ","CAP ","60","Select","Select",""],["","66685100100","AMOX\/K ","TAB 875-125","20","Select","Select",""],["","69452015120","VITAMIN ","CAP 50000UNT","12","Select","Select",""],["","51293081001","PHENAZOPYRID ","TAB 100MG","9","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","20","Select","Select",""],["","68382031910","TRAMADOL ","TAB 50MG","10","Select","Select",""],["","49281042050","FLUZONE ","INJ 2020-21","0.5","Select","Select",""],["","29300022705","METRONIDAZOL ","TAB 500MG","6","Select","Select",""],["","80777027399","MODERNA ","INJ COVID-19","0.5","Select","Select",""],["","33332031901","AFLURIA ","INJ 2019-20","0.5","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","",""],["Yes","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":""}]}]}