{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"  ELOCINKNIWS M ","gend":1,"add":"LRUC 161ENAL YE","city":"COLONIAL BEACH","state":"VA","zip":"22443-4031","dob":"1984-09-26","age":"","mstatus":"","insh":"9834296","cliId":"","pno":"6304503491","cno":5403619430,"email":"","ename":"","eno":"","pphy":"HILLMAN, JASON P","ppno":5403745200,"pcpadd":"120 Executive Center Pkwy Ste 121, ","pcpcity":"Fredericksburg","pcpstate":"VA","pcpzip":224013100,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"CENTRAL","aligned":"","ano":"","add2":"APT 1","add3":"","madd1":"161 CURLEY LANE","madd2":"APT 1","madd3":"","mcity":"COLONIAL BEACH","mstate":"VA","mzip":"22443-4031","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R00.2","R20.0","R20.2","Z00.01","Z01.89","Z71.3","Z71.89","Z13.31","M54.5","F17.210","G45.9","R51","D35.2","D51.9","M54.41","G93.2","G43.109","R42","Q21.0","R55","R06.02","E78.2","Z71.2","E53.8","Z11.59","Z20.828","R05","J06.9","Z80.3","F17.290","R19.7","R10.30","R53.1","Z13.0","Z13.1","N63.21","N64.4","F32.2","H53.19","J20.9","H61.22","N60.02","N64.3","F32.1","Z76.0","R51.9","M54.16","M54.30","M47.816","S33.5XXA","F41.1","J45.20","N64.52","Z91.89","N92.0","C53.9","J01.00","J30.9","R68.89","M54.31","J32.9","B37.3","H53.8","K08.89","F17.200","Z86.73","Z88.2","Z85.41","Z79.82","Z90.49","E78.00","Z13.220","R92.8","H40.003","H52.03","H52.203","R93.89","E23.7","R22.0","M79.604","M79.605","N63.0","M47.9","E23.6","M51.17","M48.061","D50.9","K31.89","N60.09","R79.89","R50.9","J10.1","Z88.7","E66.09","Z68.33","G43.719","Z01.411","Z80.41"],"date":["2020-08-28","2020-11-19","2020-05-21","2020-06-23","2020-06-23","2020-09-09","2021-05-11","2020-06-23","2020-12-18","2021-03-16","2020-06-23","2020-09-09","2020-12-18","2021-03-27","2020-06-24","2020-07-24","2020-07-16","2020-08-28","2020-08-28","2020-08-28","2020-08-28","2021-03-27","2020-09-09","2021-03-27","2020-09-09","2020-09-09","2020-12-08","2020-09-09","2021-05-17","2020-12-28","2021-01-13","2021-01-13","2020-05-20","2020-09-01","2020-09-01","2020-10-01","2021-01-06","2021-03-15","2020-07-13","2020-09-23","2020-09-23","2020-12-11","2020-10-09","2021-03-16","2021-03-16","2021-03-16","2020-12-18","2020-12-18","2020-12-18","2020-12-18","2021-03-16","2021-03-16","2021-01-11","2021-01-11","2021-05-24","2021-01-11","2021-05-17","2021-05-17","2021-05-17","2020-06-16","2021-05-11","2021-05-11","2020-05-20","2020-05-20","2020-05-20","2020-05-20","2020-07-24","2020-05-20","2020-05-20","2020-05-20","2020-07-07","2020-07-07","2021-03-16","2020-12-08","2020-12-08","2020-12-08","2020-05-27","2020-05-27","2020-06-04","2020-08-05","2020-08-05","2020-09-28","2020-12-15","2020-12-18","2020-12-18","2020-12-18","2020-12-23","2020-12-23","2021-01-06","2021-03-27","2019-10-08","2019-10-08","2020-07-24","2020-07-28","2020-07-28","2020-10-30","2020-11-13","2021-05-17"],"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":[["","50111056101","TRAZODONE ","TAB 100MG","30","Select","Select",""],["","69680011225","CYANOCOBALAM ","INJ 1000MCG","8","Select","Select",""],["","69097012203","TOPIRAMATE ","TAB 25MG","90","Select","Select",""],["","00185094098","CHOLESTYRAM ","POW 4GM","30","Select","Select",""],["","51991081701","PROPRANOLOL ","CAP 60MG ER","30","Select","Select",""],["","49100040007","CULTURELLE ","CAP ","30","Select","Select",""],["","71930005552","APAP\/CODEINE ","TAB 300-30MG","21","Select","Select",""],["","16571020106","DICLOFENAC ","TAB 75MG DR","60","Select","Select",""],["","00093310905","AMOXICILLIN ","CAP 500MG","21","Select","Select",""],["","80681009900","FOLIC ","TAB 400MCG","30","Select","Select",""],["","08290329622","INSULIN ","MIS 1ML\/25G","3","Select","Select",""],["","49483060450","IBUPROFEN ","TAB 800MG","21","Select","Select",""],["","00591565810","CYCLOBENZAPR ","TAB 10MG","14","Select","Select",""],["","59779044574","CVS ","DIS 14MG\/24H","28","Select","Select",""],["","08290305125","HYPO  NEEDLE  M","MIS 25GX1\"","10","Select","Select",""],["","70710113908","FLUCONAZOLE ","TAB 150MG","2","Select","Select",""],["","65862001205","SERTRALINE ","TAB 50MG","30","Select","Select",""],["","10702025350","BUT\/APAP\/CAF ","TAB ","20","Select","Select",""],["","00172392670","DIAZEPAM ","TAB 5MG","2","Select","Select",""],["","65862050320","AMOX\/K ","TAB 875-125","18","Select","Select",""],["","00378064205","PREDNISONE ","TAB 20MG","15","Select","Select",""],["","00093317431","ALBUTEROL ","FAT E","8.5","Select","Select",""],["","00054327099","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","08290305270","3ML ","MIS 25GX1\"","12","Select","Select",""],["","00002143611","EMGALITY ","INJ 120MG\/ML","1","Select","Select",""],["","68180016013","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","69238126601","OSELTAMIVIR ","CAP 75MG","10","Select","Select",""],["","00116200116","CHLORHEX ","SOL 0.0012","473","Select","Select",""],["","70710122701","AMITRIPTYLIN ","TAB 50MG","30","Select","Select",""],["","51991036378","RIZATRIPTAN ","TAB 10MG ODT","9","Select","Select",""],["","50428460442","PROBIOTIC ","CAP ","30","Select","Select",""],["","50428085942","PREP ","PAD ","100","Select","Select",""],["","63824000832","MUCINEX ","TAB 600MG ER","60","Select","Select",""],["","42806016105","HYDROXYZ ","50MG","90","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","",""],["N\/A","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":""}]}]}