{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"R NAIVIVSEHGUH ","gend":1,"add":"EKUD1424TEERTS ","city":"ALEXANDRIA","state":"VA","zip":"22304-2490","dob":"1962-01-04","age":"","mstatus":"","insh":"42019626","cliId":"","pno":"7830770110","cno":"","email":"","ename":"","eno":"","pphy":"CORNETT, MONIQUE S.","ppno":4342225730,"pcpadd":"3900 PLANK RD","pcpcity":"Fredericksburg","pcpstate":"VA","pcpzip":"22407-6839","pcpcounty":"","pcpid":"","pcpname":"MELODYS CONSULTING LLC","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"NORTHERN & WINCHESTER","aligned":"","ano":"","add2":"4241DUKE STREET","add3":"","madd1":"4241DUKE STREET","madd2":"APT A1","madd3":"","mcity":"ALEXANDRIA","mstate":"VA","mzip":"22304-2490","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z01.818","Z11.59","K29.50","R10.13","K57.92","K31.89","K64.4","K57.32","J45.909","H40.9","R73.03","K21.9","I10","Z86.73","G47.30","R10.32","Z87.19","D12.5","B96.81","K57.30","E66.01","Z71.3","G47.33","Z68.38","F25.0","J44.9","G89.29","G44.59","F31.60","G40.909","Z91.09","L20.9","K44.9","Z20.822","G43.909","Z79.83","Z79.899","Z90.89","Z88.8","Z74.3","R51.9","Z79.82","Z23","R11.2","Z98.84","R13.10","F32.9","M54.5","M51.17","M47.27","M51.36","Z91.030","M62.81","M62.838","T14.8XXA","N83.00","K92.1","N85.00","R93.3","M51.26","M54.50","S09.90XA","W10.9XXA","W22.09XA","Y93.01","Y92.008","M16.12","M48.061","M47.817","Z87.891","Z79.51","M54.6","M25.552","W10.8XXA","S39.92XA","S29.9XXA","S79.912A","R05.9","Z72.0","J01.90","Z12.31","Z97.5","G47.63","G47.54","K57.90","N83.201","D35.00","R10.31","D25.9","N13.2","D35.02","R10.9","N20.0","R30.0","L50.0","L50.9","T36.1X5A","R21","T50.905A","E55.9","K91.2","Z13.220","Z11.1","S39.012A","M54.9","X50.1XXA","Z01.419","Z12.39","Z12.11","Z30.432","Z80.3","Z87.42","Z12.4","D69.6","E65","N64.81","F17.210","H10.33","H57.9","H10.9","H00.026","H02.842","L23.89","H01.00A","H01.00B","L98.9","J45.901","R06.02","R06.2","T78.49XS","G47.8","F41.1","Z68.25","Z71.82","E78.5","F41.9","F31.9","F43.10","Z87.898","K83.8","Z11.9","J98.11","K91.840","R57.1","K66.1","R57.8","D62","E66.3","Z68.28","R42","R55","R58","R53.1","J44.1","D50.0","R39.15","R05.1","H54.3","F41.8","J40","J20.9","F33.8","R56.9","Z68.27","U07.1","R50.9","N85.02","N83.291","N84.1","N83.8"],"date":["2022-11-08","2021-01-07","2021-03-02","2021-01-11","2021-01-15","2021-01-11","2021-01-11","2021-01-11","2021-02-27","2022-12-31","2022-04-22","2022-12-31","2022-12-31","2022-11-10","2022-11-10","2021-01-11","2021-01-11","2021-01-11","2021-03-02","2023-02-02","2021-03-02","2022-09-14","2022-11-09","2021-03-02","2022-11-30","2023-02-02","2021-04-20","2021-04-20","2022-04-22","2021-08-24","2021-04-20","2021-08-24","2021-02-27","2022-12-29","2022-12-31","2021-02-27","2022-11-09","2021-02-27","2022-11-09","2022-11-10","2021-06-15","2021-03-30","2022-11-21","2021-04-14","2022-11-09","2021-06-15","2021-06-15","2021-09-16","2021-07-02","2021-07-02","2021-08-24","2023-02-02","2021-09-16","2021-08-18","2021-08-24","2021-08-24","2021-08-24","2021-08-24","2021-08-24","2021-10-09","2021-10-09","2021-10-09","2022-04-23","2021-10-09","2021-10-09","2021-10-09","2021-10-09","2021-10-09","2021-10-09","2022-12-22","2021-10-09","2021-10-09","2021-10-09","2022-04-23","2022-04-23","2021-10-09","2021-10-09","2022-12-29","2022-04-22","2021-10-26","2023-02-09","2022-03-21","2022-08-24","2022-08-24","2022-04-09","2023-02-21","2022-04-09","2022-12-22","2023-03-27","2022-04-09","2022-04-09","2022-04-20","2022-05-04","2022-04-21","2022-04-21","2022-04-21","2022-04-21","2022-04-21","2022-04-21","2023-02-02","2022-04-22","2022-04-22","2022-04-22","2022-04-23","2022-04-23","2022-04-23","2022-04-26","2022-04-26","2022-04-26","2022-04-26","2023-02-21","2023-03-27","2022-04-26","2022-05-09","2022-11-09","2022-11-09","2022-11-08","2022-06-01","2022-05-20","2022-06-01","2022-06-10","2022-06-03","2022-06-24","2022-06-06","2022-06-06","2022-06-06","2022-06-11","2022-06-11","2022-06-11","2022-06-24","2022-08-24","2022-12-31","2022-09-14","2022-09-14","2022-11-09","2022-11-09","2022-11-10","2023-01-20","2022-11-09","2022-11-10","2022-11-10","2022-11-10","2022-11-10","2022-11-11","2022-11-10","2022-11-12","2022-11-11","2023-02-02","2022-11-10","2022-11-10","2022-11-10","2022-11-12","2022-11-10","2022-11-11","2023-02-02","2023-02-02","2023-02-02","2023-02-02","2023-02-02","2022-12-28","2022-12-29","2022-12-31","2022-12-31","2022-12-31","2023-02-02","2023-02-02","2023-02-21","2023-03-27","2023-03-27","2023-03-27"],"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":[]},{"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":[["","62175061743","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","55111029136","SUMATRIPTAN","TAB 25MG","18","Select","Select",""],["","00173069600","ADVAIR DISKU","AER 250\/50","180","Select","Select",""],["","00115169449","EPINEPHRINE","INJ 0.3MG","2","Select","Select",""],["","27241009903","DULOXETINE","CAP 60MG","30","Select","Select",""],["","45802065078","LORATADINE","TAB 10MG","90","Select","Select",""],["","13668001005","CITALOPRAM","TAB 20MG","30","Select","Select",""],["","75834002001","VITAMIN D3","CAP 50000UNT","12","Select","Select",""],["","16729018201","HYDROCHLOROT","TAB 12.5MG","90","Select","Select",""],["","68180016011","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","55111015810","OMEPRAZOLE","CAP 20MG","28","Select","Select",""],["","50111033301","METRONIDAZOL","TAB 250MG","56","Select","Select",""],["","23155076701","TETRACYCLINE","CAP 500MG","56","Select","Select",""],["","50428642686","CVS BISMUTH","CHW 262MG","112","Select","Select",""],["","00093342210","CYCLOBENZAPR","TAB 10MG","10","Select","Select",""],["","69097052444","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","70710113908","FLUCONAZOLE","TAB 150MG","1","Select","Select",""],["","42806016005","HYDROXYZ HCL","TAB 25MG","45","Select","Select",""],["","16571040250","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","28","Select","Select",""],["","65862022701","LAMOTRIGINE","TAB 25MG","60","Select","Select",""],["","47781030301","NITROFURANTN","CAP 100MG","14","Select","Select",""],["","00378064205","PREDNISONE","TAB 20MG","12","Select","Select",""],["","69452015120","VITAMIN D","CAP 50000UNT","4","Select","Select",""],["","64380071207","BENZONATATE","CAP 100MG","90","Select","Select",""],["","00378827052","ALBUTEROL","NEB 0.00083","75","Select","Select",""],["","65862085901","FAMOTIDINE","TAB 20MG","10","Select","Select",""],["","69097012403","TOPIRAMATE","TAB 100MG","60","Select","Select",""],["","69842026925","CVS OLOPATAD","SOL 0.002","2.5","Select","Select",""],["","69315030805","CIPROFLOXACN","SOL 0.3% OP","5","Select","Select",""],["","24208072002","DEXAMETH PHO","SOL 0.1% OP","5","Select","Select",""],["","61314063136","NEO\/POLY\/DEX","OIN 0.1% OP","3.5","Select","Select",""],["","45802000403","HYDROCORT","CRE 0.025","56","Select","Select",""],["","42858010201","OXYCOD\/APAP","TAB 5-325MG","20","Select","Select",""],["","57237001401","TAMSULOSIN","CAP 0.4MG","7","Select","Select",""],["","16714001610","ENOXAPARIN","INJ 40\/0.4ML","4","Select","Select",""],["","49483060350","IBUPROFEN","TAB 600MG","40","Select","Select",""],["","00574060801","FERROUS SULF","TAB 324MG EC","30","Select","Select",""],["","68180042201","MOXIFLOXACIN","SOL HCL 0.5%","6","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":""}]}]}