{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"G ADNELGHTIFFIR","gend":1,"add":"EERG 3622DR REIRBN","city":"HAYSI","state":"VA","zip":"24256-5283","dob":"1963-03-11","age":"","mstatus":"","insh":"50018619","cliId":"","pno":"1367213412","cno":2762310009,"email":"","ename":"","eno":"","pphy":"KEENE, MELISSA NICOLE","ppno":2769351760,"pcpadd":"162 Medical Center, ","pcpcity":"HAYSI","pcpstate":"VA","pcpzip":242561000,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"SOUTHWEST","aligned":"","ano":2762310009,"add2":"                                                            ","add3":"","madd1":"1066 Ruffled Leaf Rd","madd2":"                                                            ","madd3":"","mcity":"Oakwood","mstate":"VA","mzip":"24631-9633","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R91.8","I10","N28.9","J44.9","R10.32","R30.0","R10.9","M54.9","R35.0","F17.210","E11.40","F32.9","F41.9","Z86.73","Z88.5","Z79.4","E78.2","R73.02","J30.89","J32.8","H10.45","N95.1","M89.9","E11.9","R47.1","M62.830","M25.512","J20.9","R06.02","B34.9","R50.9","R51","Z79.82","Z86.12","Z87.891","R05","F33.3","J01.90","E11.42","F17.200","Z13.9","Z13.89","I63.9","J44.1","E11.49","R07.9","R53.1","G25.81","A80.9","F34.1","F60.3","R07.89","M54.5","F41.1","R29.898","E78.5","E03.9","D51.9","E55.9","R00.0","G40.409","Z79.899","Z00.8","Z03.818","K31.84","R41.82","I69.954","E87.6","E86.0","N39.0","Z82.49","Z83.3","R11.0","K21.9","R91.1","R06.00","Z72.0","G81.94","R47.81","R09.02","M62.89","B91","I12.9","N18.9","F41.8","E11.65","I67.9","G89.29","D64.9","G62.9","M25.50","R56.9","E10.42","K92.1","D72.829","E88.09","Z20.828","M54.89","R03.0","M51.36","M47.816"],"date":["2019-04-08","2020-10-21","2019-04-22","2021-03-31","2019-07-18","2020-06-25","2020-07-17","2020-01-18","2019-07-18","2020-06-13","2020-07-17","2020-06-14","2020-10-21","2020-07-17","2020-07-17","2020-10-21","2019-08-14","2019-08-14","2019-08-14","2019-08-14","2019-08-14","2019-08-14","2019-08-14","2020-10-21","2019-10-04","2019-10-04","2019-10-04","2020-06-25","2020-06-25","2020-07-17","2020-07-17","2020-07-17","2020-10-21","2020-07-17","2020-10-21","2020-09-11","2021-04-02","2019-03-14","2020-09-04","2020-09-04","2020-09-04","2020-09-04","2019-11-01","2019-04-22","2019-04-22","2020-10-21","2020-01-18","2019-08-06","2019-04-22","2020-02-12","2020-02-12","2020-06-13","2020-01-18","2020-11-03","2019-04-21","2019-11-01","2020-09-04","2020-09-04","2020-09-04","2019-07-14","2019-09-28","2020-01-18","2020-06-25","2020-07-17","2020-09-04","2019-08-07","2019-08-06","2019-08-06","2019-08-06","2019-08-06","2019-08-06","2019-08-06","2020-01-18","2020-09-04","2019-04-08","2020-06-13","2019-04-08","2019-04-19","2019-04-19","2019-04-19","2019-04-19","2019-04-19","2019-04-19","2019-04-19","2019-07-14","2019-04-19","2019-09-04","2020-01-18","2020-06-15","2020-06-15","2019-05-09","2019-09-28","2020-06-13","2020-06-13","2020-06-14","2020-06-13","2020-06-13","2019-07-14","2019-07-14","2020-01-18","2020-01-18"],"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":[["","68001041203","GABAPENTIN ","TAB 800MG","120","Select","Select",""],["","13668009290","PRAMIPEXOLE ","TAB 0.25MG","30","Select","Select",""],["","68382080605","TRAZODONE ","TAB 100MG","30","Select","Select",""],["","00904671740","CETIRIZINE ","TAB 10MG","30","Select","Select",""],["","00193731150","CONTOUR ","TES NEXT","100","Select","Select",""],["","68001036103","MONTELUKAST ","TAB 10MG","30","Select","Select",""],["","08222095633","PEN  NEEDLES  ","MIS 31GX6MM","100","Select","Select",""],["","64380080308","RANITIDINE ","TAB 150MG","60","Select","Select",""],["","65862050320","AMOX\/K ","TAB 875-125","20","Select","Select",""],["","00472082516","ALBUTEROL ","SYP 2MG\/5ML","240","Select","Select",""],["","00088222033","LANTUS ","INJ 100\/ML","20","Select","Select",""],["","08222094193","INSULIN ","MIS 1ML\/31G","100","Select","Select",""],["","56151014260","TRUPLUS ","MIS 28G","100","Select","Select",""],["","65862053750","LEVOFLOXACIN ","TAB 500MG","7","Select","Select",""],["","00603533715","PREDNISONE ","PAK 5MG","21","Select","Select",""],["","68462046699","RIZATRIPTAN ","TAB 10MG","10","Select","Select",""],["","00169633910","NOVOLOG ","INJ FLEXPEN","36","Select","Select",""],["","57237007630","ONDANSETRON ","TAB 8MG","60","Select","Select",""],["","68001011203","LANSOPRAZOLE ","CAP 30MG DR","30","Select","Select",""],["","29300011101","LAMOTRIGINE ","TAB 25MG","30","Select","Select",""],["","65862019299","FLUOXETINE ","CAP 10MG","30","Select","Select",""],["","16729020016","BUSPIRONE ","TAB 5MG","90","Select","Select",""],["","43547039950","CYCLOBENZAPR ","TAB 5MG","15","Select","Select",""],["","68001012203","METOPROL ","TAB 50MG ER","60","Select","Select",""],["","00406012310","HYDROCO\/APAP ","TAB 5-325MG","10","Select","Select",""],["","29300016910","TIZANIDINE ","TAB 4MG","90","Select","Select",""],["","60505082901","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","68001033200","LISINOPRIL ","TAB 2.5MG","30","Select","Select",""],["","00904623252","MUCUS ","TAB 400MG","30","Select","Select",""],["","46122018087","ASPIRIN ","TAB 81MG EC","90","Select","Select",""],["","00781808926","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","68001024000","FAMOTIDINE ","TAB 20MG","60","Select","Select",""],["","00591024110","LORAZEPAM ","TAB 1MG","15","Select","Select",""],["","68462039710","OMEPRAZOLE ","CAP 40MG","30","Select","Select",""],["","51991060401","VITAMIN ","CAP 50000UNT","4","Select","Select",""],["","59762372004","ALPRAZOLAM ","TAB 0.5MG","15","Select","Select",""],["","60505257808","ATORVASTATIN ","TAB 10MG","30","Select","Select",""],["","68001028100","DICLOFENAC ","TAB 75MG DR","60","Select","Select",""],["","68001036206","CEFDINIR ","CAP 300MG","14","Select","Select",""],["","53489012002","DOXYCYCL ","TAB 100MG","20","Select","Select",""],["","00378306677","FENOFIBRATE ","TAB 145MG","30","Select","Select",""],["","65862020299","LOSARTAN ","50MG","30","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":[[["Yes","Select","","","","","Select","",""],["Yes","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":""}]}]}