{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"S A EELSREYLA","gend":1,"add":"FTER42121DAOR DRO","city":"COEBURN","state":"VA","zip":"24230-6022","dob":"1976-08-31","age":"","mstatus":"","insh":"8687088","cliId":"","pno":"1267223160","cno":"","email":"","ename":"","eno":"","pphy":"STANLEY, NATASHA","ppno":2765984448,"pcpadd":"1014 PARK AVE NW,","pcpcity":"Norton","pcpstate":"VA","pcpzip":"24273-1823","pcpcounty":"","pcpid":"","pcpname":"HOPKINS MEDICAL ASSOCIATION LLC","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"SOUTHWEST","aligned":"","ano":"","add2":"12124RETFORD ROAD","add3":"","madd1":"12124RETFORD ROAD","madd2":"APT 36","madd3":"","mcity":"COEBURN","mstate":"VA","mzip":"24230-6022","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["U07.1","F33.2","F41.9","K02.9","K04.7","R11.0","K08.89","E11.9","I10","Z87.891","Z79.82","Z79.899","M10.9","M25.572","M79.672","M79.89","E78.00","Z79.4","L53.9","R79.89","R53.83","E78.2","G25.81","Z23","E11.42","I49.3","R12","E78.1","R10.31","R10.2","B37.3","Z01.419","B37.2","Z71.89","Z12.72","Z90.710","R87.610","E11.65","L02.91","E04.2","E89.0","Z85.850","N83.201","Z90.721","L02.234","Z12.31","C73","E78.5","E11.40","F32.9","R00.2","L03.115","M79.671","R22.41","L08.9","M79.604","M79.605","R60.9","B34.9","R10.9","R19.7","Z86.16","Z79.84","R10.84","R11.2","N76.4","I73.9","L30.9","R25.2","R32","M25.511","S46.911A","X58.XXXA","F32.A","E87.6","R60.0","M25.471","G43.909","R45.851","Z20.822","Z13.39","Z86.59","Z68.29","F33.41","E10.9","L84","G47.33","E66.9","G89.29","Z68.31","M75.41","M19.011","M75.111","H55.00","R51.9","N83.9","N83.209","Z01.810","Z01.818","Z01.812","M75.01","S43.491A","S43.431A","G89.18","Z98.890","Z47.89","R09.02","K21.9","Z76.89","Z13.9","Z13.220","Z13.21"],"date":["2021-01-15","2023-04-04","2023-04-04","2021-02-01","2021-02-01","2021-10-30","2021-02-01","2023-05-02","2023-04-12","2022-11-25","2021-02-01","2022-11-25","2021-03-27","2021-03-27","2021-03-27","2022-04-09","2021-03-27","2023-04-12","2022-04-09","2021-04-20","2023-05-02","2021-04-23","2021-04-23","2022-02-24","2023-04-12","2021-04-23","2022-10-14","2021-04-23","2022-11-25","2021-07-01","2021-04-23","2021-05-28","2021-05-28","2021-05-28","2021-05-28","2021-06-24","2021-05-28","2023-04-12","2021-06-21","2023-04-27","2021-06-21","2021-06-21","2022-11-25","2021-06-24","2021-07-01","2021-08-03","2023-04-12","2023-04-12","2023-05-01","2021-08-13","2021-08-13","2021-08-26","2021-08-26","2021-08-26","2021-09-03","2021-09-10","2021-09-10","2022-04-09","2021-10-30","2022-11-25","2021-10-30","2022-11-25","2022-11-25","2021-10-30","2022-11-09","2021-11-04","2022-02-24","2022-01-02","2022-04-29","2022-02-24","2023-01-04","2022-03-24","2022-03-24","2022-10-14","2022-04-09","2022-04-09","2022-04-09","2022-04-09","2022-07-22","2022-04-18","2022-04-18","2022-04-19","2022-04-22","2022-08-23","2022-07-21","2022-07-21","2023-01-07","2022-07-22","2022-07-22","2022-07-22","2022-12-08","2022-12-08","2022-12-08","2022-11-09","2022-11-09","2022-11-25","2022-12-06","2022-12-05","2022-12-05","2022-12-05","2022-12-08","2022-12-08","2022-12-08","2022-12-08","2023-01-04","2022-12-19","2023-01-04","2023-05-01","2023-05-02","2023-05-02","2023-05-02","2023-05-02"],"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":[["","68382005105","MELOXICAM","TAB 15MG","30","Select","Select",""],["","65162010350","GABAPENTIN","CAP 400MG","90","Select","Select",""],["","59148004013","REXULTI","TAB 4MG","30","Select","Select",""],["","68382013905","TOPIRAMATE","TAB 50MG","60","Select","Select",""],["","50111045002","TRAZODONE","TAB 150MG","30","Select","Select",""],["","68001041408","DULOXETINE","CAP 30MG","30","Select","Select",""],["","68462039610","OMEPRAZOLE","CAP 20MG","60","Select","Select",""],["","08290320109","BD PEN NEEDL","MIS 31GX8MM","100","Select","Select",""],["","65862042005","SMZ\/TMP DS","TAB 800-160","14","Select","Select",""],["","00002882427","HUMULIN R","INJ U-500","18","Select","Select",""],["","00024587102","TOUJEO MAX","INJ 300IU\/ML","6","Select","Select",""],["","63868036336","ASPIRIN LOW","TAB 81MG EC","30","Select","Select",""],["","67877032105","IBUPROFEN","TAB 800MG","60","Select","Select",""],["","00185067405","HYDROXYZ PAM","CAP 25MG","90","Select","Select",""],["","55111061901","ESZOPICLONE","TAB 2MG","30","Select","Select",""],["","00193658621","MICROLET","MIS LANCETS","100","Select","Select",""],["","00193731221","CONTOUR","TES NEXT","100","Select","Select",""],["","00574200830","NYSTOP","POW 100000","30","Select","Select",""],["","69097045805","FENOFIBRATE","TAB 145MG","30","Select","Select",""],["","57664047758","METOPROL TAR","TAB 50MG","60","Select","Select",""],["","16729000216","GLIMEPIRIDE","TAB 2MG","60","Select","Select",""],["","65862046999","LOSARTAN\/HCT","TAB 100-12.5","30","Select","Select",""],["","42571025101","CLINDAMYCIN","CAP 150MG","60","Select","Select",""],["","68001024617","ONDANSETRON","TAB 4MG ODT","20","Select","Select",""],["","65162062711","TRAMADOL HCL","TAB 50MG","6","Select","Select",""],["","00002822259","INSULIN LISP","INJ 100\/ML","30","Select","Select",""],["","00169406012","VICTOZA","INJ 18MG\/3ML","6","Select","Select",""],["","00781261305","AMOXICILLIN","CAP 500MG","20","Select","Select",""],["","68001025320","FLUCONAZOLE","TAB 150MG","1","Select","Select",""],["","50383066730","LIDO\/PRILOCN","CRE 2.5-2.5%","30","Select","Select",""],["","80777027310","MODERNA VAC","INJ COVID-19","0.25","Select","Select",""],["","51224002218","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","68382070718","DOXYCYC MONO","CAP 100MG","20","Select","Select",""],["","33342032915","TRIAMCINOLON","CRE 0.001","30","Select","Select",""],["","62175027137","OXYBUTYNIN","TAB 10MG ER","30","Select","Select",""],["","60505477303","VILAZODONE","TAB 20MG","30","Select","Select",""],["","00002143380","TRULICITY","INJ 0.75\/0.5","2","Select","Select",""],["","45802052555","AMMONIUM LAC","LOT 0.12","454","Select","Select",""],["","56151173301","INSULIN SYRG","MIS 1ML\/31G","100","Select","Select",""],["","00310628030","XIGDUO XR","TAB 10-1000","30","Select","Select",""],["","57896063412","MAG OXIDE","TAB 400MG","30","Select","Select",""],["","00456112030","VIIBRYD","TAB 20MG","30","Select","Select",""],["","68462019005","NAPROXEN","TAB 500MG","14","Select","Select",""],["","52817033200","CYCLOBENZAPR","TAB 10MG","15","Select","Select",""],["","00781717612","NALOXONE","SPR 4MG","2","Select","Select",""],["","00406012410","HYDROCO\/APAP","TAB 7.5-325","16","Select","Select",""],["","00054429731","FUROSEMIDE","TAB 20MG","14","Select","Select",""],["","62037099901","POT CL MICRO","TAB 20MEQ ER","10","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":""}]}]}