{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" J EIRDENOILLUG","gend":1,"add":"NIXEL E  053TEERTS NOTG","city":"WYTHEVILLE","state":"VA","zip":24382,"dob":"1981-02-17","age":"","mstatus":"","insh":"50019685","cliId":"","pno":"3267283002","cno":"","email":"","ename":"","eno":"","pphy":"COCHRAN, DONALD L","ppno":2762320038,"pcpadd":"12997 WARWICK BLVD,","pcpcity":"NEWPORT NEWS","pcpstate":"VA","pcpzip":23602,"pcpcounty":"","pcpid":"","pcpname":"MD EXPRESS","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"ROANOKE\/ALLEGHANY","aligned":"","ano":"","add2":"350  E LEXINGTON STREET","add3":"","madd1":"350 E LEXINGTON STREET","madd2":"APT 3","madd3":"","mcity":"WYTHEVILLE","mstate":"VA","mzip":"24382-3932","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F31.77","F25.0","F32.9","R45.851","F17.210","Z63.8","F41.1","F12.10","F60.9","F19.11","F25.1","I25.10","G40.909","M79.7","K21.9","I10","J45.909","J44.9","F31.10","E11.9","Z79.84","I50.9","G89.29","Z86.718","Z79.899","F31.12","F33.2","J81.1","R68.89","J01.00","R05","Z79.4","I11.0","J30.2","K59.09","Z68.43","F43.10","K58.1","Z72.0","R56.9","E66.9","R07.9","M79.602","R11.0","Z53.29","J06.9","R51","F31.9","I25.2","Z88.5","S09.90XA","S29.9XXA","F60.3","R19.7","N20.0","K76.0","N39.0","R10.13","K43.9","R10.30","N23","E11.65","M54.5","Z79.82","I21.9","S61.216A","W26.0XXA","Y92.89","I40.9","Z88.0","R39.81","I95.9","R50.9","R41.82","Z20.828","E55.9","M79.606","W18.30XA","R57.1","Y92.9","I13.0","N17.9","E87.1","R55","E11.22","N18.9","D72.829","G89.4","S06.0X0A","I95.1","R42","I36.1","S39.91XA","S39.93XA","S99.922A","S99.912A","N28.9","F41.9","S19.9XXA","N18.2","R73.03","F20.9","G43.709","M79.672","S82.52XA","M25.572","X50.1XXA","S93.402A","S82.62XA","S92.152A","Z87.01","H60.509","M79.605","Z88.8","Z79.891","Z86.79","Z86.39","R00.0","S93.492A","S93.412A","S93.422A","M65.862","F19.10","F15.90","Z88.3","F11.20","S93.402D","B37.3","Z11.3","Z11.8","R06.00","R10.11","R10.9","R22.2","E86.0","F17.200","N19","Z86.73","Z68.41","R10.2","N81.89","N81.2","R32","E66.01","R53.1","R07.89","R10.12","R11.10","Z13.9","N32.89","K42.9","J98.11","N10","R57.9","N18.30","Z95.9","I27.20","E87.6","E83.42","J18.9","Z98.62","R33.9","E87.2","K59.00","Z95.5","Z82.49","T50.1X5A","N39.9","R33.8","M54.9","Z76.5","R39.198","Z74.3","Z87.448","R31.9","Z96.0","T83.028A","T83.83XA","N30.00","N76.0","R30.9","R30.0","F06.30","F99","F39","N89.8","R06.2","N81.4","N39.3","N81.11","N81.6","N92.1","Z79.51","Z20.822","R52","R06.9","R09.02","Z76.89","F41.8","Z13.220","Z13.31","F12.20","F15.10","F51.04","Z62.810","Z81.8","F25.9","R10.84","F31.5","R41.0","R47.81","G43.909","G25.81","J44.1","R05.9","R09.81","E78.5","Z68.37","M94.0","J20.9","R06.02","Z87.891","Y04.8XXA","R51.9","M54.50","Y09","R43.8","R46.89","Z76.0","F10.20","R45.850","F14.10","R44.0","F33.3","F60.89","Z87.440","R44.1","Z88.9","Z90.49","R73.9","F31.2","F19.90","Z09","Z72.820","E22.1","M15.9","E78.2","Z59.0","M79.604","M79.89","F10.21","R60.0","R60.9","R91.8","R09.89","M25.552","R53.83","Z12.4","M16.12","J98.01","J40","G47.00","J98.4","J90","I31.3","H60.512","Z68.42","R60.1","R22.43","M62.830","F31.4","Z88.6","F12.90","J98.09","J18.1","Z83.3","Z32.02","J18.8","R07.81","F03.90","I24.0","E11.69","F31.64","H60.503","G43.009"],"date":["2020-08-14","2021-06-29","2021-01-19","2021-06-29","2022-01-26","2020-01-02","2020-01-04","2020-01-04","2020-01-02","2020-12-04","2020-01-04","2020-11-12","2021-12-04","2021-10-12","2021-12-09","2021-10-12","2020-04-30","2021-12-09","2020-01-02","2022-01-26","2020-05-17","2021-12-29","2021-12-29","2022-01-26","2022-01-26","2020-01-02","2021-07-28","2020-01-02","2021-06-10","2020-01-07","2021-06-10","2020-01-09","2021-12-09","2020-02-21","2020-01-09","2020-05-03","2020-01-10","2020-01-09","2021-12-04","2021-10-12","2021-12-09","2021-12-09","2020-01-09","2021-01-04","2022-01-19","2022-01-28","2020-05-03","2022-01-26","2022-01-26","2022-01-26","2020-05-04","2020-05-04","2020-01-10","2020-01-26","2020-01-26","2020-01-26","2020-01-26","2020-01-26","2020-01-26","2020-01-27","2020-01-27","2020-11-12","2020-12-12","2020-01-28","2020-01-28","2020-01-31","2020-01-31","2020-05-12","2020-01-31","2020-01-31","2020-07-30","2020-11-20","2021-06-10","2021-08-06","2020-11-16","2021-10-12","2020-05-03","2020-05-03","2020-05-03","2020-05-03","2020-12-04","2020-12-05","2020-12-04","2021-08-06","2020-11-11","2020-12-05","2020-05-03","2020-05-03","2020-05-03","2020-11-20","2022-01-19","2020-11-12","2020-05-04","2020-05-04","2020-05-04","2020-06-23","2020-12-04","2021-06-29","2020-05-04","2020-12-05","2020-05-12","2020-05-07","2020-05-07","2020-05-19","2020-05-12","2020-07-02","2020-05-12","2020-05-12","2020-05-12","2020-05-12","2022-01-26","2020-05-19","2020-06-20","2022-01-26","2020-11-20","2020-06-20","2020-06-20","2022-01-19","2020-07-02","2020-07-02","2020-07-02","2020-07-02","2021-12-29","2020-07-18","2020-07-18","2021-08-06","2020-07-27","2020-07-29","2020-07-29","2020-07-29","2020-08-06","2021-08-06","2020-11-19","2020-10-20","2020-10-21","2021-12-04","2021-12-09","2021-12-09","2021-06-10","2021-05-25","2021-01-20","2021-01-20","2020-10-21","2020-10-21","2020-12-05","2022-01-27","2020-10-29","2020-10-29","2020-11-10","2020-11-11","2020-11-11","2020-11-11","2020-11-11","2020-11-11","2020-12-21","2020-11-11","2020-11-12","2021-07-23","2020-12-01","2021-06-10","2022-01-19","2021-06-16","2020-11-21","2020-11-21","2021-06-29","2020-11-21","2020-11-21","2020-11-21","2020-12-01","2020-12-01","2020-12-04","2020-12-04","2020-12-04","2020-12-05","2020-12-12","2021-01-04","2020-12-12","2020-12-12","2020-12-21","2020-12-21","2021-01-04","2021-06-10","2021-01-19","2021-01-19","2021-01-19","2021-01-20","2021-05-21","2021-05-25","2021-05-25","2021-05-25","2021-05-25","2021-05-25","2021-12-04","2022-01-28","2021-06-10","2021-06-10","2021-12-09","2021-06-10","2021-10-12","2021-06-10","2021-10-12","2021-06-29","2021-06-29","2021-06-29","2021-06-29","2021-06-29","2021-06-29","2021-07-23","2022-03-11","2021-08-06","2021-08-06","2021-10-12","2021-10-12","2021-12-04","2022-01-26","2021-12-04","2021-12-09","2021-12-09","2021-12-09","2021-12-09","2021-12-29","2021-12-29","2022-01-19","2022-01-19","2022-01-19","2022-01-19","2022-01-26","2019-01-01","2019-05-17","2019-01-11","2019-07-04","2019-01-02","2019-09-03","2019-07-01","2019-01-11","2019-01-11","2019-01-23","2019-01-24","2019-01-24","2019-01-24","2019-06-10","2019-02-15","2019-03-27","2019-02-15","2019-02-15","2019-04-08","2019-09-26","2019-02-15","2019-04-08","2019-03-26","2019-03-26","2019-06-19","2019-03-26","2019-05-09","2019-03-23","2019-04-08","2019-04-08","2019-03-27","2019-04-01","2019-04-23","2019-04-23","2019-05-09","2019-05-09","2019-05-09","2019-05-09","2019-05-17","2019-05-18","2019-06-19","2019-06-19","2019-07-04","2019-07-08","2019-09-04","2019-09-03","2019-09-15","2019-09-26","2019-09-15","2019-09-18","2019-09-19","2019-09-19","2019-09-19","2019-09-26","2019-09-26","2019-09-26","2019-09-26","2019-11-25"],"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":{"indx":[false,false],"comment":["",""],"score":["",""]}},{"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":[["","55111052230","ATOMOXETINE","55111052230 ATOMOXETINE ","30","Select","Select",""],["","58657070501","HALOPERIDOL","58657070501 HALOPERIDOL ","45","Select","Select",""],["","16571041210","CIPROFLOXACN","16571041210 CIPROFLOXACN ","14","Select","Select",""],["","50111033402","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","69367016304","PHENAZOPYRID","69367016304 PHENAZOPYRID ","12","Select","Select",""],["","68180021509","LOSARTAN\/HCT","68180021509 LOSARTAN\/HCT ","28","Select","Select",""],["","74312019491","MELATONIN","74312019491 MELATONIN ","84","Select","Select",""],["","00193731150","CONTOUR","00193731150 CONTOUR ","50","Select","Select",""],["","00193658621","MICROLET","00193658621 MICROLET ","100","Select","Select",""],["","65862052401","GABAPENTIN","65862052401 GABAPENTIN ","90","Select","Select",""],["","00378037201","CIMETIDINE","00378037201 CIMETIDINE ","28","Select","Select",""],["","70010006301","METFORMIN","70010006301 METFORMIN ","56","Select","Select",""],["","13668008130","MONTELUKAST","13668008130 MONTELUKAST ","28","Select","Select",""],["","00781223410","OMEPRAZOLE","00781223410 OMEPRAZOLE ","56","Select","Select",""],["","45802091987","CETIRIZINE","45802091987 CETIRIZINE ","28","Select","Select",""],["","43547040210","FUROSEMIDE","43547040210 FUROSEMIDE ","28","Select","Select",""],["","69315013810","BENZTROPINE","69315013810 BENZTROPINE ","28","Select","Select",""],["","68382013905","TOPIRAMATE","68382013905 TOPIRAMATE ","56","Select","Select",""],["","75834022101","CARBAMAZEPIN","75834022101 CARBAMAZEPIN ","56","Select","Select",""],["","00832030300","CHLORPROMAZ","00832030300 CHLORPROMAZ ","56","Select","Select",""],["","00228300350","CLONAZEPAM","TAB 0.5MG","60","Select","Select",""],["","12496120803","SUBOXONE","12496120803 SUBOXONE ","56","Select","Select",""],["","69315090401","LORAZEPAM","69315090401 LORAZEPAM ","75","Select","Select",""],["","00487950125","ALBUTEROL","00487950125 ALBUTEROL ","75","Select","Select",""],["","50742061710","METOPROL","50742061710 METOPROL ","30","Select","Select",""],["","68180051701","LISINOPRIL","TAB 40MG","28","Select","Select",""],["","70010077005","METHOCARBAM","TAB 750MG","84","Select","Select",""],["","00186037020","SYMBICORT","00186037020 SYMBICORT ","10.2","Select","Select",""],["","65862052890","VENLAFAXINE","65862052890 VENLAFAXINE ","28","Select","Select",""],["","50111056102","TRAZODONE","50111056102 TRAZODONE ","56","Select","Select",""],["","55111025960","ZIPRASIDONE","55111025960 ZIPRASIDONE ","56","Select","Select",""],["","69315015501","HYDROCHLOROT","69315015501 HYDROCHLOROT ","30","Select","Select",""],["","43598044874","NICOTINE","43598044874 NICOTINE ","28","Select","Select",""],["","65862020290","LOSARTAN","65862020290 LOSARTAN ","30","Select","Select",""],["","13668009190","PRAMIPEXOLE","13668009190 PRAMIPEXOLE ","28","Select","Select",""],["","60505082901","FLUTICASONE","60505082901 FLUTICASONE ","16","Select","Select",""],["","67618010760","SLOW-MAG","67618010760 SLOW-MAG ","56","Select","Select",""],["","43547027010","ROPINIROLE","43547027010 ROPINIROLE ","28","Select","Select",""],["","62756052169","SUMATRIPTAN","62756052169 SUMATRIPTAN ","9","Select","Select",""],["","45802086802","POLYETH","45802086802 POLYETH ","238","Select","Select",""],["","72060014230","CAPLYTA","72060014230 CAPLYTA ","30","Select","Select",""],["","70954005940","PREDNISONE","70954005940 PREDNISONE ","48","Select","Select",""],["","57237007710","ONDANSETRON","TAB 4MG ODT","12","Select","Select",""],["","65862050320","AMOX\/K","TAB 875-125","20","Select","Select",""],["","67877025010","QUETIAPINE","67877025010 QUETIAPINE ","28","Select","Select",""],["","00406012301","HYDROCO\/APAP","TAB 5-325MG","21","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","00555032302","HYDROXYZ","00555032302 HYDROXYZ ","20","Select","Select",""],["","00093005805","TRAMADOL","TAB 50MG","28","Select","Select",""],["","45963067611","METOPROLOL","TAB 50MG ER","28","Select","Select",""],["","49281072110","FLUBLOK","49281072110 FLUBLOK ","0.5","Select","Select",""],["","49035019402","EQ","DIS 21MG\/24H","28","Select","Select",""],["","68382005005","MELOXICAM","TAB 7.5MG","7","Select","Select",""],["","68382032010","POT  CHLORIDE","68382032010 POT  CHLORIDE","12","Select","Select",""],["","60258017101","MAG","TAB 400MG","3","Select","Select",""],["","00832532411","POT  CL MICRO","TAB 10MEQ ER","12","Select","Select",""],["","50111078751","AZITHROMYCIN","50111078751 AZITHROMYCIN ","6","Select","Select",""],["","00054817625","DEXAMETHASON","00054817625 DEXAMETHASON ","30","Select","Select",""],["","00781261305","AMOXICILLIN","CAP 500MG","30","Select","Select",""],["","42192060716","BROM\/PSE\/DM","SYP ","120","Select","Select",""],["","00054018913","BUPREN\/NALOX","SUB 8-2MG","28","Select","Select",""],["","60432060416","PROMETHAZINE","60432060416 PROMETHAZINE ","150","Select","Select",""],["","00093314705","CEPHALEXIN","00093314705 CEPHALEXIN ","21","Select","Select",""],["","00832059011","DIPHEN\/ATROP","TAB ","12","Select","Select",""],["","61314064511","NEO\/POLY\/HC","SUS 1% OTIC","10","Select","Select",""],["","43598043611","NITROGLYCERN","SUB 0.4MG","25","Select","Select",""],["","42806071401","BENZONATATE","42806071401 BENZONATATE ","30","Select","Select",""],["","00591219130","RAMELTEON","TAB 8MG","28","Select","Select",""],["","65757040303","ARISTADA","65757040303 ARISTADA ","3.2","Select","Select",""],["","69238110002","DOXYCYCL","69238110002 DOXYCYCL ","20","Select","Select",""],["","55111014512","FLUCONAZOLE","55111014512 FLUCONAZOLE ","2","Select","Select",""],["","00555003302","CHLORDIAZEP","CAP 10MG","42","Select","Select",""],["","00904530680","BANOPHEN","00904530680 BANOPHEN ","60","Select","Select",""],["","11523726803","MIRALAX","POW 3350 NF","30","Select","Select",""],["","00591090030","GLIPIZIDE","TAB 2.5MG","30","Select","Select",""],["","49884093547","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","64380080307","RANITIDINE","TAB 150MG","60","Select","Select",""],["","00378395077","ATORVASTATIN","TAB 10MG","30","Select","Select",""],["","50428027915","CVS","TAB 8.6MG","60","Select","Select",""],["","00527179001","FLUPHENAZINE","TAB 5MG","84","Select","Select",""],["","69097014812","LAMOTRIGINE","TAB 25MG","60","Select","Select",""],["","68645057290","GLIMEPIRIDE","TAB 2MG","30","Select","Select",""],["","00781709459","ERY\/BENZOYL","GEL 5-3%","46.6","Select","Select",""],["","53746051101","SPIRONOLACT","TAB 25MG","12","Select","Select",""],["","67457040913","HALOPER","INJ 100MG\/ML","1","Select","Select",""],["","00536466110","THEREMS-M","TAB ","30","Select","Select",""],["","65862096801","ESZOPICLONE","TAB 2MG","15","Select","Select",""],["","33332031901","AFLURIA","INJ 2019-20","0.5","Select","Select",""],["","00904671839","MUCUS","TAB 600MG ER","28","Select","Select",""],["","55111028130","LEVOFLOXACIN","TAB 750MG","7","Select","Select",""],["","59310057922","PROAIR","AER ","8.5","Select","Select",""],["","43547030403","ARIPIPRAZOLE","TAB 10MG","30","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","10","Select","Select",""],["","00173069500","ADVAIR","AER 100\/50","60","Select","Select",""],["","60432053716","NYSTATIN","SUS 100000","280","Select","Select",""],["","00406051201","OXYCOD\/APAP","TAB 5-325MG","10","Select","Select",""],["","00005197102","PREVNAR","INJ ","0.5","Select","Select",""],["","00093031401","KETOROLAC","TAB 10MG","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":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["1",""],"comment":["",""],"sub":{"indx":[["","",""],[""],[""],[""],[""]],"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":""}]}]}