{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CATHERINE   J REED","gend":1,"add":"1555 SHADY GROVE ROAD NW                                    ","city":"INDIAN VALLEY                 ","state":"VA","zip":"24105-3046","dob":"1972-02-11","age":"","mstatus":"","insh":3179907,"cliId":"","pno":5402508012,"cno":"","email":"","ename":"","eno":"","pphy":"TATE, GLEN E                                                ","ppno":2763982292,"pcpadd":"40 Wiley Dr                                                 ,                                                            ","pcpcity":"Ferrum                        ","pcpstate":"VA","pcpzip":240881100,"pcpcounty":"","pcpid":"","pcpname":"TRI AREA COMMUNITY HEALTH CENTER","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"1555 SHADY GROVE ROAD NW                                    ","add3":"","madd1":"1555 SHADY GROVE ROAD NW                                    ","madd2":"                                                            ","madd3":"","mcity":"INDIAN VALLEY                 ","mstate":"VA","mzip":"24105-3046","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E78.5","J06.9","Z79.899","J45.32","J35.1","R59.0","R47.02","J02.9","F31.81","F90.0","H18.613","H25.041","M47.816","M54.16","M96.1","R05","R50.9","R06.00","I45.81","R06.02","R94.31","R07.9","Z71.1","J45.909","Z87.01","Z87.891","Z30.9","Z01.818","H25.13","F41.1","F41.9","D64.9","Z87.09","Z79.84","H25.11","R68.89","T42.4X2A","Y92.9","T50.902A","F43.22","F33.2","H25.12","Z76.0","J45.20","Z79.891","R11.2","D72.829","E78.00","R41.0","R55","R51","F31.9","Z88.5","Z79.51","F17.210","E87.6","R73.9","I10","R03.0","G43.009","F17.200","R11.0","Z82.49","J44.1","R91.8","Z20.828","R00.0","R07.2","E78.2","E88.81","E55.9","I47.1","I49.1","I49.3","F43.0","G62.9","G89.29","R06.2","F32.9","Z20.822","R21","F43.10","J45.21","R07.81","R79.1","F41.8","F39","F40.01","M54.5","M54.41","Z96.82","M54.9","M25.78","G95.81","Z98.890","M47.896","R63.5","T85.199A","L02.214","M25.551","E11.40","F51.04","M51.36","M51.37","M48.061","M51.26","M51.9","B97.89","Z01.810","Z01.812","G81.94","Z98.1","I05.8","I63.9","M47.26","I63.532","I95.89","I63.81","E66.01","E11.9","M48.062","R47.1","R47.81","M47.27","J44.9","R41.82","R29.91","I69.354","I69.398","H53.461","I63.411","I63.432","I95.9","D75.839","R73.03","E87.8","E87.2","I69.393","H54.7","M54.50","R27.8","E83.51","D62","I48.0","F41.0","E03.9","D50.0","H53.8","M79.2","G47.00","M79.672","M62.838","R54","H54.61","M54.42","Z91.81","Z79.82","R20.0","W19.XXXA","R25.2","R26.9","Z96.1","G43.001","Z86.73","R63.0","R42","R51.9","Z95.818","G03.9","A87.9","J45.40","G44.59","R05.9","M43.6","H53.149","F11.90","I65.23","G97.1","Z09","R53.1","G81.90","Z48.89","Z95.9","E78.49","I69.359","Z72.0","F32.A","E86.0","M54.12","S40.012A","W01.0XXA","R07.89","R20.2","M25.512","M79.602","W18.30XA","Z04.3","E66.9","F90.2","G45.9","Z94.7","R29.818","F43.9","Z79.4","M47.22","M48.02","M50.321","M47.812","J10.89","R10.84","J10.1"],"date":["2021-11-01","2021-08-24","2022-08-21","2021-02-04","2020-01-15","2020-01-15","2020-01-22","2020-01-22","2021-04-27","2020-10-22","2020-03-11","2020-03-11","2021-10-06","2021-10-06","2021-10-06","2020-09-07","2020-04-06","2020-04-06","2021-10-28","2022-08-22","2022-08-21","2022-11-06","2020-04-06","2022-11-06","2020-05-15","2022-08-21","2022-05-03","2021-10-08","2020-05-13","2022-12-09","2022-08-21","2021-10-20","2020-05-15","2020-05-15","2020-06-11","2020-05-22","2020-05-23","2020-05-23","2020-05-23","2020-05-24","2020-05-26","2020-06-18","2020-07-01","2022-08-21","2020-07-01","2022-01-07","2022-07-25","2020-08-13","2022-09-23","2022-09-19","2020-09-07","2022-08-21","2022-01-07","2022-08-21","2021-05-06","2020-08-25","2021-04-27","2022-11-06","2020-08-25","2020-08-29","2022-07-25","2022-11-06","2020-08-29","2020-09-06","2021-01-07","2021-01-20","2022-07-25","2020-11-09","2022-09-19","2022-09-19","2022-09-19","2020-10-07","2020-10-07","2020-10-07","2020-11-06","2021-06-18","2021-12-31","2022-07-06","2021-12-31","2022-07-06","2021-01-06","2021-10-20","2021-01-20","2021-01-20","2021-02-04","2021-02-04","2022-12-09","2021-09-08","2021-08-21","2021-04-18","2022-08-21","2021-11-06","2021-04-26","2021-04-26","2021-10-19","2021-04-26","2021-04-27","2021-04-30","2021-05-06","2021-05-19","2021-10-20","2021-09-08","2022-05-31","2021-08-13","2022-05-31","2021-08-13","2021-10-13","2021-08-24","2021-09-30","2021-09-30","2021-10-14","2022-01-27","2021-10-13","2022-11-03","2021-10-13","2021-11-04","2021-10-13","2021-10-13","2021-10-20","2022-09-19","2021-10-20","2021-10-13","2021-10-13","2021-10-13","2021-10-28","2021-10-13","2021-10-14","2022-05-31","2021-12-31","2022-02-08","2021-10-16","2022-09-23","2021-10-16","2021-10-28","2022-08-21","2021-10-28","2021-10-25","2021-10-30","2021-10-30","2021-12-31","2021-11-01","2021-10-20","2021-10-20","2021-10-20","2022-11-02","2021-10-30","2021-10-28","2021-11-01","2022-08-18","2022-08-21","2021-11-01","2021-11-01","2021-11-04","2021-12-31","2021-11-06","2021-11-06","2022-01-07","2021-11-06","2021-11-06","2021-12-06","2021-12-06","2021-12-13","2022-01-06","2022-11-06","2022-01-06","2022-11-06","2022-01-25","2022-10-04","2022-01-07","2022-01-18","2022-01-09","2022-01-07","2022-11-06","2022-01-08","2022-01-07","2022-01-09","2022-01-10","2022-01-12","2022-01-18","2022-08-22","2022-01-18","2022-01-27","2022-04-14","2022-04-14","2022-08-18","2022-04-14","2022-05-31","2022-11-06","2022-07-25","2022-07-25","2022-07-25","2022-08-22","2022-07-25","2022-07-25","2022-07-25","2022-07-25","2022-07-25","2022-08-11","2022-08-18","2022-09-23","2022-08-21","2022-08-21","2022-11-23","2022-09-19","2022-09-23","2022-09-23","2022-09-23","2022-09-23","2022-11-06","2022-11-06","2022-11-06"],"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":[["","50428005345","B-12","TAB 500MCG","30","Select","Select",""],["","14539067401","HYDROXYZ","CAP 25MG","60","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","49483048112","ASPIRIN","TAB 81MG EC","30","Select","Select",""],["","","SYMBICORT","AER 160-4.5","10.2","Select","Select",""],["","27241009809","DULOXETINE","CAP 30MG","30","Select","Select",""],["","65862057490","MONTELUKAST","TAB 10MG","90","Select","Select",""],["","70436001102","BUPROPN","TAB 300MG XL","90","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","Select","Select",""],["","59762453802","MEDROXYPR","INJ 150MG\/ML","1","Select","Select",""],["","13107008405","LORAZEPAM","TAB 1MG","20","Select","Select",""],["","65862096701","ESZOPICLONE","TAB 1MG","30","Select","Select",""],["","65862022801","LAMOTRIGINE","TAB 100MG","30","Select","Select",""],["","68180061207","QUETIAPINE","TAB 50MG ER","60","Select","Select",""],["","00093083205","CLONAZEPAM","TAB 0.5MG","60","Select","Select",""],["","00169406012","VICTOZA","INJ 18MG\/3ML","6","Select","Select",""],["","31722054501","LITHIUM","CAP 300MG","60","Select","Select",""],["","69238115409","EZETIMIBE","TAB 10MG","30","Select","Select",""],["","47335053981","NIACIN","TAB 500MG","60","Select","Select",""],["","65862035790","CLOPIDOGREL","TAB 75MG","21","Select","Select",""],["","43547030303","ARIPIPRAZOLE","TAB 5MG","30","Select","Select",""],["","00228212750","CLONIDINE","TAB 0.1MG","90","Select","Select",""],["","50742024990","DILTIAZEM","CAP 180MG ER","30","Select","Select",""],["","50428030716","CVS","TAB 81MG EC","30","Select","Select",""],["","08290320119","BD  PEN NEEDL","MIS 31GX5MM","30","Select","Select",""],["","72060014240","CAPLYTA","CAP 42MG","30","Select","Select",""],["","10702001801","OXYCODONE","TAB 5MG","20","Select","Select",""],["","51672128901","NYSTATIN","CRE 100000","15","Select","Select",""],["","00378064205","PREDNISONE","TAB 20MG","8","Select","Select",""],["","59746011506","PROCHLORPER","TAB 10MG","10","Select","Select",""],["","60505392801","GUANFACINE","TAB 2MG ER","30","Select","Select",""],["","70377003012","ATORVASTATIN","TAB 80MG","90","Select","Select",""],["","43386035801","HYDROCO\/APAP","TAB 10-325MG","10","Select","Select",""],["","69238207707","PROPRANOLOL","TAB 10MG","90","Select","Select",""],["","50428025183","BP","MIS WRIST","1","Select","Select",""],["","60505016501","FLUVOXAMINE","TAB 50MG","30","Select","Select",""],["","00172392770","DIAZEPAM","TAB 10MG","2","Select","Select",""],["","68462010530","ONDANSETRON","TAB 4MG","30","Select","Select",""],["","00093342210","CYCLOBENZAPR","TAB 10MG","60","Select","Select",""],["","65162019050","NAPROXEN","TAB 500MG","14","Select","Select",""],["","59267100002","PFIZER","INJ COVID-19","0.3","Select","Select",""],["","00173088710","TRELEGY","AER ELLIPTA","60","Select","Select",""],["","50111064801","FLUOXETINE","CAP 20MG","30","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","48","Select","Select",""],["","69452015120","VITAMIN","CAP 50000UNT","12","Select","Select",""],["","64380076111","OMEGA-3-ACID","CAP 1GM","360","Select","Select",""],["","16571020106","DICLOFENAC","TAB 75MG DR","60","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","20","Select","Select",""],["","69097094312","GABAPENTIN","CAP 300MG","60","Select","Select",""],["","49884012201","LABETALOL","TAB 100MG","180","Select","Select",""],["","00603020922","MAG","TAB 400MG","180","Select","Select",""],["","68180038909","FENOFIBRATE","TAB 145MG","30","Select","Select",""],["","65862070560","ZIPRASIDONE","CAP 80MG","30","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","68180051801","LISINOP\/HCTZ","TAB 10-12.5","90","Select","Select",""],["","70377000812","ROSUVASTATIN","TAB 20MG","90","Select","Select",""],["","65862050320","AMOX\/K","TAB 875-125","14","Select","Select",""],["","23155022801","ACYCLOVIR","TAB 800MG","35","Select","Select",""],["","51991029301","OXCARBAZEPIN","TAB 300MG","30","Select","Select",""],["","46581083006","SALONPAS","PAD 0.04","30","Select","Select",""],["","69315012710","FOLIC","TAB 1000MCG","30","Select","Select",""],["","","ZOLPIDEM","TAB 5MG","15","Select","Select",""],["","59651000305","OMEPRAZOLE","CAP 40MG","30","Select","Select",""],["","65862085901","FAMOTIDINE","TAB 20MG","30","Select","Select",""],["","53489011905","DOXYCYCL","CAP 100MG","10","Select","Select",""],["","10702010201","METHYLPHENID","TAB 20MG","60","Select","Select",""],["","00603188016","LIDOCAINE","PAD 0.05","30","Select","Select",""],["","00006483703","PNEUMOVAX","INJ 25\/0.5","0.5","Select","Select",""],["","69315030805","CIPROFLOXACN","SOL 0.3% OP","5","Select","Select",""],["","60505100301","KETOROLAC","SOL 0.005","5","Select","Select",""],["","61314063705","PREDNISOLONE","SUS 1% OP","5","Select","Select",""],["","50111043301","TRAZODONE","TAB 50MG","60","Select","Select",""],["","00591410101","PERPHENAZINE","TAB 2MG","60","Select","Select",""],["","60505283303","ATOMOXETINE","CAP 40MG","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":""}]}]}