{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"S J   YTTEBNAMREDWART","gend":1,"add":"CELTTAB 911EVIRD KEER","city":"STANLEY","state":"VA","zip":"22851-2612","dob":"1974-03-14","age":"","mstatus":"","insh":"60012272","cliId":"","pno":"4204595944","cno":"","email":"","ename":"","eno":"","pphy":"TIMMONS, JOHN","ppno":5406529100,"pcpadd":"505 Williams Ave, ","pcpcity":"Shenandoah","pcpstate":"VA","pcpzip":228491263,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"NORTHERN\/ WINCHESTER","aligned":"","ano":"","add2":"","add3":"","madd1":"119 BATTLECREEK DRIVE","madd2":"","madd3":"","mcity":"STANLEY","mstate":"VA","mzip":"22851-2612","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N32.9","N39.490","N31.9","R51","G25.9","F41.1","Z51.81","Z79.01","Z95.2","R56.9","G93.89","I71.01","I71.03","I77.79","I71.2","I77.72","E83.19","M54.81","R06.83","G40.909","R53.83","I50.9","G25.0","G25.3","G40.89","N39.0","R41.82","E11.9","I10","B20","R35.0","R39.15","N39.41","M54.16","Z98.890","I73.9","T82.330A","E78.2","F17.210","Z86.73","R73.09","Z00.00","G47.33","Z88.0","Z88.8","Z91.018","Z91.048","J44.9","E66.9","B37.2","R21","R09.02","G47.34","L08.82","I65.23","Z95.9","Z95.828","I77.71","I65.21","K59.09","M54.5","G25.81","Z72.0","R10.84","G89.29","G50.0","D35.02","I72.4","K76.0","H00.012","J34.2","R29.898","H40.013","H52.4","R39.9","R30.0","E88.01","R26.2","R53.1","M79.606","M47.26","M51.16","M48.061","M51.26","M51.36","M79.2","M51.17","Z79.899","Z79.84","Z79.82","Z79.51","G47.30","I71.02","G95.11","M51.34","M51.24","M48.04","M53.84","I11.0","R25.1","R25.9","M62.81","M47.896","M54.2","F44.5","F41.8","Z68.32","Z99.81","S91.201A","L60.0","X58.XXXA","M54.9","J69.0","D62","D69.6","D64.9","E78.00","L93.0","Z01.810","Z01.818","I51.7","I20.9","R41.0","J81.1","Z46.82","J18.1","R50.9","I65.22","R09.89","J96.90","J98.4","R06.02","J96.01","J90","R06.89","S61.401A","S61.402A","Z48.812","M15.0","F32.9","F41.9","K21.9","L60.2","F43.10","R10.2","M79.18","M25.512","M54.6","Y83.8","Y92.239","J95.821","E87.2","K56.7","J94.2","I95.81","E78.5","F33.41","Z74.3","E11.42","Z68.30","R32","Y83.2","Z86.19","Z90.710","Z83.3","T82.898A","I70.201","R74.8","G89.18","J98.11","I71.1","G96.0","E86.1","Z45.2","J95.89","R91.8","E87.6","R13.10","S22.42XA","K59.8","R93.3","R11.2","R26.9","R53.81","K59.00","K59.9","T82.330D","S31.104D","E11.40","I95.1","R10.32","R10.9","M79.605","M79.604","R42","Z21","I71.6","M25.552","R29.6","S70.02XA","W18.30XA","J94.8","S22.32XA","K22.2","R07.2","H91.8X1","E28.2","J43.1","R00.2","S93.402A","W18.49XA","M25.572","M16.12","Z23","R68.89","M79.661","M79.662","R07.89","R82.998","R31.0","R31.9","N30.01"],"date":["2022-03-31","2022-03-31","2022-03-31","2020-06-11","2020-01-06","2020-01-06","2020-12-03","2020-12-03","2020-12-03","2020-11-25","2020-12-23","2020-06-03","2020-06-17","2020-02-03","2020-05-12","2020-02-03","2020-12-23","2021-01-28","2020-05-15","2020-12-23","2020-05-15","2020-05-15","2020-04-02","2020-04-02","2020-04-02","2020-04-03","2020-11-25","2020-08-19","2020-05-15","2020-08-13","2020-04-24","2020-04-24","2020-04-24","2020-10-27","2020-10-05","2020-06-30","2020-06-05","2020-05-12","2020-11-10","2020-05-15","2020-05-14","2020-05-14","2020-08-01","2020-11-10","2020-11-10","2020-11-10","2020-11-10","2020-08-19","2020-05-15","2020-05-25","2020-05-25","2020-08-01","2020-05-27","2020-05-30","2020-06-03","2020-06-03","2020-06-03","2020-06-05","2020-06-03","2020-06-17","2020-10-27","2020-11-10","2020-06-30","2020-06-17","2020-06-17","2020-09-23","2020-06-17","2020-06-17","2020-06-17","2020-06-22","2020-08-01","2020-06-30","2020-09-15","2020-07-31","2020-08-18","2020-08-18","2020-08-19","2020-10-27","2020-10-27","2020-10-27","2020-10-05","2020-11-10","2020-10-05","2020-10-07","2020-10-07","2020-10-23","2020-11-10","2020-11-10","2020-11-10","2020-11-10","2020-11-10","2020-11-10","2019-06-20","2019-01-10","2019-01-10","2019-01-10","2019-01-10","2019-01-10","2019-06-19","2019-01-23","2019-01-23","2019-02-04","2019-02-04","2019-02-04","2019-12-03","2019-12-03","2019-02-28","2019-02-28","2019-03-14","2019-03-14","2019-03-14","2019-03-23","2019-04-06","2019-06-22","2019-04-07","2019-04-25","2019-04-01","2019-04-01","2019-06-19","2019-04-02","2019-12-09","2019-04-02","2019-04-02","2019-04-02","2019-06-28","2019-04-02","2019-04-02","2019-04-03","2019-06-20","2019-04-05","2019-04-05","2019-09-01","2019-04-07","2019-07-01","2019-06-28","2019-05-11","2019-05-11","2019-06-19","2019-05-03","2019-05-03","2019-06-24","2019-04-26","2019-04-25","2019-09-16","2019-05-02","2019-05-13","2019-06-18","2019-06-18","2019-06-19","2019-06-19","2019-06-21","2019-06-19","2019-06-29","2019-06-24","2019-06-22","2019-06-19","2019-09-16","2019-06-19","2019-06-19","2019-06-19","2019-06-19","2019-06-19","2019-06-19","2019-06-19","2019-06-19","2019-06-19","2019-06-20","2019-06-22","2019-06-24","2019-09-01","2019-06-21","2019-06-21","2019-06-21","2019-06-24","2019-06-22","2019-07-01","2019-06-24","2019-06-24","2019-06-24","2019-06-27","2019-06-27","2019-06-27","2019-06-28","2019-08-06","2019-06-28","2019-06-30","2019-08-06","2019-08-06","2019-08-06","2019-07-11","2019-07-11","2019-07-11","2019-12-09","2019-12-09","2019-07-11","2019-07-11","2019-07-29","2019-10-24","2019-07-25","2019-07-25","2019-07-25","2019-09-01","2019-09-01","2019-09-01","2019-09-01","2019-09-16","2019-09-16","2019-09-16","2019-09-16","2019-10-24","2019-10-24","2019-10-24","2019-10-24","2019-11-12","2019-11-20","2019-11-22","2019-11-22","2019-11-22","2019-12-05","2019-12-26","2019-12-26","2019-12-27"],"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":[["","49483060650","GABAPENTIN","CAP 300MG","90","Select","Select",""],["","57237012201","WARFARIN","TAB 3MG","5","Select","Select",""],["","00093716456","TOLTERODINE","CAP 4MG ER","30","Select","Select",""],["","00186037020","SYMBICORT","AER 160-4.5","10.2","Select","Select",""],["","45802088830","OMEPRAZOLE","TAB 20MG","30","Select","Select",""],["","68645055554","LISINOPRIL","TAB 40MG","30","Select","Select",""],["","43547040111","FUROSEMIDE","TAB 20MG","30","Select","Select",""],["","16714089902","FEXOFENADINE","TAB 180MG","30","Select","Select",""],["","16729043316","EZETIMIBE","TAB 10MG","30","Select","Select",""],["","27241009990","DULOXETINE","CAP 60MG","30","Select","Select",""],["","65162075550","DIVALPROEX","TAB 250MG ER","90","Select","Select",""],["","00093005405","BUSPIRONE","TAB 10MG","30","Select","Select",""],["","61958250101","BIKTARVY","TAB ","30","Select","Select",""],["","68645048154","ATORVASTATIN","TAB 20MG","30","Select","Select",""],["","00904675180","ASPIRIN","TAB 81MG EC","30","Select","Select",""],["","23155010210","METFORMIN","TAB 500MG","60","Select","Select",""],["","68645019059","METOPROL","TAB 50MG","30","Select","Select",""],["","43547027010","ROPINIROLE","TAB 1MG","60","Select","Select",""],["","65162047810","NITROFURANTN","CAP 100MG","14","Select","Select",""],["","50111043301","TRAZODONE","TAB 50MG","60","Select","Select",""],["","68462012801","ZONISAMIDE","CAP 25MG","120","Select","Select",""],["","49281042050","FLUZONE","INJ 2020-21","0.5","Select","Select",""],["","00006483703","PNEUMOVAX","INJ 25\/0.5","0.5","Select","Select",""],["","55111018015","TIZANIDINE","TAB 4MG","90","Select","Select",""],["","00193731221","CONTOUR","TES NEXT","100","Select","Select",""],["","61314063136","NEO\/POLY\/DEX","OIN 0.1% OP","3.5","Select","Select",""],["","00574200802","NYSTOP","POW 100000","60","Select","Select",""],["","37000045504","PRILOSEC","TAB 20MG","30","Select","Select",""],["","72205002130","SOLIFENACIN","TAB 10MG","30","Select","Select",""],["","69097081815","TOPIRAMATE","TAB 100MG","15","Select","Select",""],["","08470104801","UNISTIK","MIS COMFORT","75","Select","Select",""],["","10702000709","CYCLOBENZAPR","TAB 10MG","60","Select","Select",""],["","51293081101","PHENAZOPYRID","TAB 200MG","6","Select","Select",""],["","68180071160","CEFDINIR","CAP 300MG","14","Select","Select",""],["","68462018022","MUPIROCIN","OIN 0.02","22","Select","Select",""],["","00469260130","MYRBETRIQ","TAB 25MG","30","Select","Select",""],["","00832105415","BACLOFEN","TAB 10MG","90","Select","Select",""],["","61958200201","DESCOVY","TAB 200\/25","30","Select","Select",""],["","00054001825","PREDNISONE","TAB 20MG","5","Select","Select",""],["","49035057139","ALLERGY","TAB 180MG","30","Select","Select",""],["","00904645780","DOK","CAP 100MG","8","Select","Select",""],["","65862001905","CEPHALEXIN","CAP 500MG","14","Select","Select",""],["","51248015101","VESICARE","TAB 10MG","30","Select","Select",""],["","42858000101","OXYCODONE","TAB 5MG","20","Select","Select",""],["","57896048914","POLYETH","POW 3350 NF","238","Select","Select",""],["","49702022813","TIVICAY","TAB 50MG","60","Select","Select",""],["","00093005805","TRAMADOL","TAB 50MG","90","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","20","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","63304069301","CLINDAMYCIN","CAP 300MG","21","Select","Select",""],["","00904671980","ACETAMINOPHEN","TA B 325","36","Select","Select",""],["","00536338601","NICOTINE","GUM 2MGFRUIT","100","Select","Select",""],["","00591352530","LIDOCAINE","PAD 0.05","30","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":[]}},{"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":""}]}]}