{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MONICA L ROBINSON","gend":1,"add":"444 KELLEY STREET","city":"HARRISONBURG","state":"VA","zip":22802,"dob":"1969-08-27","age":"","mstatus":"","insh":3208511,"cliId":"","pno":5407462088,"cno":"","email":"","ename":"","eno":"","pphy":"UNKNOWN PROVIDER QNXT PCP","ppno":5407462088,"pcpadd":"UNKNOWN ST,","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":23219,"pcpcounty":"","pcpid":"","pcpname":"UNKNOWN PROVIDER QNXT PCP","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"WESTERN\/CHARLOTTESVILLE","aligned":"","ano":"","add2":"","add3":"","madd1":"4732 PLAYER DRIVE NE","madd2":"","madd3":"","mcity":"HARRISONBURG","mstate":"VA","mzip":"22802-4807","pcpfaxno":"(804) 828-5775","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11.9","I10","R56.9","E78.00","M54.2","R25.1","M54.5","Z79.4","G89.29","H10.413","H18.231","F45.42","F11.20","M54.16","M51.36","Z13.89","F32.9","G62.9","R52","M50.122","M46.96","M54.12","M47.26","G56.03","R06.02","R07.89","R51","I89.0","Z88.1","Z88.5","Z88.0","Z88.8","R07.9","R79.1","M79.7","M50.30","M54.17","M51.37","G58.9","M50.13","F41.9","G40.909","J45.909","Z79.899","Z79.1","I63.81","Z23","Z86.73","E66.9","Z68.32","M54.6","M79.671","M79.672","R25.2","M25.511","M79.10","M70.61","M70.62","Z79.891","Z20.828","J96.11","J98.6","G47.33","M25.50","J96.12","J98.4","R06.00","R09.02","R40.0","M79.18","M53.3","M47.896","M43.8X6","M48.061","M51.16","I63.9","Z71.89","K21.9","R40.4","G45.9","R47.01","Y92.9","R47.1","T42.8X5A","T40.2X5A","G89.4","G25.81","R53.1","R29.818","Z92.82","B34.9","I49.9","Z20.822","G47.10","J96.01","G93.41","F32.0","G70.9","J96.02","F41.8","E55.9","R40.1","R41.0","R42","R41.82","Z03.818","R27.0","E11.65","E66.01","G25.3","M54.59","M54.50","U07.1","R91.8","J12.82","G47.34","G92.9","R73.03","R73.9","R00.1","Z68.39","M47.812","J01.90","J40","M25.551","E11.8","M54.32","D50.8","M25.552","E78.5","N39.0","B96.89","R10.9","N30.00"],"date":["2021-10-02","2021-10-02","2021-10-02","2021-08-14","2022-03-10","2020-04-07","2021-09-29","2021-10-02","2022-03-10","2020-05-29","2020-05-12","2022-02-24","2021-07-15","2022-01-26","2020-10-21","2020-10-21","2021-08-14","2022-03-10","2022-03-10","2020-08-03","2020-08-03","2021-08-14","2020-08-03","2020-09-02","2021-10-26","2021-08-14","2020-08-21","2020-08-21","2020-09-22","2020-09-22","2021-10-27","2020-08-21","2021-08-14","2020-08-21","2021-10-14","2020-09-02","2020-09-17","2020-09-17","2020-09-17","2020-09-22","2021-08-14","2021-09-30","2021-10-27","2021-10-14","2020-09-22","2021-10-12","2020-10-19","2022-03-10","2021-10-14","2020-10-19","2022-03-10","2022-03-10","2022-03-10","2022-03-10","2021-01-25","2021-01-18","2022-03-10","2021-12-28","2022-02-24","2021-03-15","2021-10-14","2021-10-14","2021-10-27","2021-04-01","2021-10-14","2021-10-14","2021-10-26","2021-10-27","2021-06-07","2021-06-17","2022-03-10","2021-07-23","2021-07-23","2022-01-26","2021-07-23","2021-08-16","2021-08-14","2021-10-02","2021-08-14","2021-08-14","2021-08-15","2021-08-14","2021-08-14","2021-08-14","2021-08-14","2021-10-27","2021-09-30","2021-10-29","2021-10-29","2021-08-15","2021-09-02","2021-10-22","2021-09-30","2021-09-09","2022-02-04","2021-09-30","2021-10-02","2021-09-30","2021-10-11","2021-09-30","2021-10-02","2021-09-30","2021-09-30","2021-10-01","2021-10-11","2021-09-30","2021-10-01","2021-10-11","2021-10-11","2021-10-12","2021-10-14","2022-03-10","2021-10-30","2021-10-26","2021-10-30","2021-10-26","2021-10-30","2021-10-27","2021-10-27","2021-10-30","2021-10-27","2022-01-26","2019-03-19","2019-03-19","2019-05-24","2019-05-24","2019-05-24","2019-05-24","2019-05-24","2019-06-28","2019-07-21","2019-07-20","2019-07-21","2019-07-21"],"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":[["","42858010201","OXYCOD\/APAP","TAB 5-325MG","120","Select","Select",""],["","33342032915","TRIAMCINOLON","CRE 0.001","75","Select","Select",""],["","66993066430","DULOXETINE","CAP 60MG","30","Select","Select",""],["","63304045001","MORPHINE","TAB 15MG ER","60","Select","Select",""],["","43598029590","PREGABALIN","CAP 150MG","60","Select","Select",""],["","00378020810","FUROSEMIDE","TAB 20MG","30","Select","Select",""],["","60505025203","TIZANIDINE","TAB 4MG","120","Select","Select",""],["","69097015907","MELOXICAM","TAB 15MG","30","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","90","Select","Select",""],["","13668013601","ESCITALOPRAM","TAB 10MG","30","Select","Select",""],["","00832105410","BACLOFEN","TAB 10MG","180","Select","Select",""],["","69452015120","VITAMIN","CAP 50000UNT","4","Select","Select",""],["","68180098103","LISINOPRIL","TAB 20MG","30","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","55111078401","FEXOFENADINE","TAB 180MG","30","Select","Select",""],["","65862085901","FAMOTIDINE","TAB 20MG","60","Select","Select",""],["","69097094312","GABAPENTIN","CAP 300MG","90","Select","Select",""],["","69097014260","ALBUTEROL","AER HFA","6.7","Select","Select",""],["","43547027010","ROPINIROLE","TAB 1MG","150","Select","Select",""],["","59385002160","BELBUCA","MIS 75MCG","60.00","Select","Select",""],["","00228202950","ALPRAZOLAM","TAB 0.5MG","2","Select","Select",""],["","70377002911","ATORVASTATIN","TAB 40MG","30","Select","Select",""],["","00574232545","TRETINOIN","GEL 0.00025","45","Select","Select",""],["","24510011660","NUCYNTA","TAB 100MG","60","Select","Select",""],["","63304069301","CLINDAMYCIN","CAP 300MG","30","Select","Select",""],["","49483060350","IBUPROFEN","TAB 600MG","28","Select","Select",""],["","19515081852","FLULAVAL","INJ 2021-22","0.5","Select","Select",""],["","00187517045","RETIN-A","GEL 0.00025","45","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","51991081901","PROPRANOLOL","CAP 120MG ER","30","Select","Select",""],["","00169643810","LEVEMIR","INJ FLEXTOUC","15","Select","Select",""],["","70710122600","AMITRIPTYLIN","TAB 25MG","60","Select","Select",""],["","51672403601","ETODOLAC","TAB 500MG","60","Select","Select",""],["","67877057305","BENZONATATE","CAP 100MG","30","Select","Select",""],["","65862056090","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","70710113908","FLUCONAZOLE","TAB 150MG","1","Select","Select",""],["","00310651201","BYETTA","INJ 5MCG","1.2","Select","Select",""],["","65862024608","LEVETIRACETA","TAB 500MG","60","Select","Select",""],["","68180071160","CEFDINIR","CAP 300MG","20","Select","Select",""],["","53746051101","SPIRONOLACT","TAB 25MG","30","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","10","Select","Select",""],["","00054001825","PREDNISONE","TAB 20MG","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":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"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":""}]}]}