{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KRISTY   M CRAWFORD","gend":1,"add":"163 INDIAN TRAIL ROAD","city":"PENN LAIRD","state":"VA","zip":"22846-2020","dob":"1988-06-10","age":"","mstatus":"","insh":4109727,"cliId":"","pno":5402693174,"cno":"","email":"","ename":"","eno":"","pphy":"PENCE, ROBERT P","ppno":5408792585,"pcpadd":"15 Killdeer Ln, ","pcpcity":"Dayton","pcpstate":"VA","pcpzip":228219745,"pcpcounty":"","pcpid":"","pcpname":"CARILION FAMILY MEDICINE DAYTON","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"","add3":"","madd1":"163 INDIAN TRAIL ROAD","madd2":"","madd3":"","mcity":"PENN LAIRD","mstate":"VA","mzip":"22846-2020","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F41.1","M65.9","M25.571","M65.871","W18.39XA","Y93.89","Y92.003","Z87.891","Z88.0","E03.9","G43.009","F32.9","F41.9","K52.9","R07.9","R53.81","R05","R53.83","R07.89","E05.00","S76.211A","S83.421A","S90.31XA","S79.911A","M25.551","S99.921A","M79.671","M25.561","S83.91XA","M79.604","Y93.01","W19.XXXA","Y92.008","S39.011A","M89.8X5","Z83.1","Z20.9","R06.82","R42","R60.9","R11.0","M41.86","M54.41","M51.16","M47.816","J30.9","Z01.419","R87.610","N39.0","R30.0","Z23","J01.90","N92.0","R45.86","F31.10","B19.9","Z20.828","N92.1","Z97.5","N93.9","J01.40","B18.2","K76.9","D18.03","F43.10","Z79.899","J34.2","Z30.46","J06.9","Z03.818","Z20.822","J02.9","K13.79","K21.00","Z86.19","K14.6","K21.9","N32.81","F10.11","K14.0","S80.852A","W45.8XXA","O26.851","Z3A.00","O26.01","O28.9","Z34.91","O46.90","Z3A.01","O26.859","O26.841","Z3A.08","Z34.80","B19.20","N80.9","Z34.81","O20.0","Z3A.15","Z34.82","Z3A.18","Z34.90","O26.892","R10.9","Z3A.21","O26.842","Z3A.25","N89.8","Z3A.26","O23.42","O99.89","R94.6","R51","O99.282","Z79.890","Z34.83","Z3A.28","O26.893","Z3A.30","Z03.71","O42.913","O26.843","Z3A.33","R35.0","O21.2","Z3A.34","Z3A.35","O03.9","M54.9","Z3A.36","R10.2","Z3A.38","O47.1","Z03.79","O41.90X0","Z3A.39","O98.42","O99.284","O76","O70.0","O99.344","Z37.0","O70.1","O62.9","O80","Z39.1","Z39.2","Z30.017","Z32.02","K04.7"],"date":["2021-04-12","2020-01-11","2020-01-12","2020-01-12","2020-01-12","2020-01-12","2020-01-12","2022-03-22","2022-03-22","2021-02-05","2021-02-05","2020-11-06","2020-11-06","2020-02-29","2020-03-05","2020-03-05","2021-03-22","2020-03-05","2020-03-05","2021-09-22","2020-07-27","2020-07-30","2020-07-27","2020-07-27","2020-07-27","2020-07-27","2020-07-27","2020-07-27","2020-07-27","2020-07-27","2020-07-27","2020-07-27","2020-07-27","2020-07-27","2020-07-27","2020-07-27","2020-07-27","2020-07-27","2020-07-27","2020-07-27","2020-07-27","2020-07-30","2020-07-30","2020-07-30","2020-07-30","2020-09-08","2020-09-16","2020-09-16","2021-08-16","2020-09-29","2021-10-20","2022-02-11","2020-10-23","2020-10-23","2020-11-06","2021-02-05","2020-12-04","2021-02-05","2021-02-05","2021-02-05","2021-03-22","2021-11-08","2021-04-26","2021-04-26","2022-01-04","2021-08-05","2021-07-26","2021-08-04","2021-08-16","2021-08-16","2022-01-11","2021-09-22","2021-09-22","2021-09-22","2021-09-22","2021-10-20","2021-10-20","2021-10-20","2021-11-08","2021-11-19","2022-03-22","2022-03-22","2019-01-11","2019-01-02","2019-01-02","2019-01-05","2019-01-07","2019-01-08","2019-01-11","2019-01-11","2019-01-29","2019-01-29","2019-05-10","2019-08-31","2019-01-29","2019-01-29","2019-03-19","2019-03-19","2019-09-06","2019-04-08","2019-09-17","2019-05-31","2019-07-28","2019-04-29","2019-04-29","2019-05-28","2019-05-31","2019-06-05","2019-06-05","2019-07-28","2019-06-05","2019-06-05","2019-06-05","2019-06-05","2019-09-06","2019-06-18","2019-08-09","2019-07-03","2019-06-29","2019-06-29","2019-08-02","2019-07-19","2019-07-28","2019-07-28","2019-07-28","2019-08-02","2019-08-09","2019-08-09","2019-08-12","2019-08-09","2019-08-26","2019-08-23","2019-08-23","2019-08-29","2019-08-31","2019-08-31","2019-08-31","2019-08-31","2019-08-31","2019-08-31","2019-08-31","2019-08-31","2019-08-31","2019-08-31","2019-09-06","2019-10-08","2019-10-24","2019-10-24","2019-11-08"],"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":[["","59267100001","PFIZER","INJ COVID-19","0.3","Select","Select",""],["","00115169449","EPINEPHRINE","INJ 0.3MG","2","Select","Select",""],["","69238153106","LARISSIA","TAB ","28","Select","Select",""],["","00093406701","PRAZOSIN","CAP 1MG","30","Select","Select",""],["","61874011530","VRAYLAR","CAP 1.5MG","30","Select","Select",""],["","50111043301","TRAZODONE","TAB 50MG","90","Select","Select",""],["","47781065710","LEVOTHYROXIN","TAB 125MCG","30","Select","Select",""],["","00093005405","BUSPIRONE","TAB 10MG","120","Select","Select",""],["","65862085901","FAMOTIDINE","TAB 20MG","60","Select","Select",""],["","42806031250","DOXYCYCL","TAB 100MG","14","Select","Select",""],["","00603533815","PREDNISONE","PAK 10MG","21","Select","Select",""],["","13668019030","TOLTERODINE","CAP 4MG ER","30","Select","Select",""],["","63402030630","LATUDA","TAB 60MG","30","Select","Select",""],["","37000045502","PRILOSEC","TAB 20MG","28","Select","Select",""],["","65862022801","LAMOTRIGINE","TAB 100MG","75","Select","Select",""],["","00074262528","MAVYRET","TAB 100-40MG","84","Select","Select",""],["","67877021660","CEFUROXIME","TAB 500MG","20.00","Select","Select",""],["","16714008310","HYDROXYZ","TAB 50MG","120","Select","Select",""],["","00591024005","LORAZEPAM","TAB 0.5MG","40","Select","Select",""],["","00093314701","CEPHALEXIN","CAP 500MG","30","Select","Select",""],["","00172541211","FLUCONAZOLE","TAB 150MG","2","Select","Select",""],["","45802065078","LORATADINE","TAB 10MG","30","Select","Select",""],["","65862001205","SERTRALINE","TAB 50MG","30","Select","Select",""],["","00555904958","CRYSELLE-28","TAB 28 TABS","28","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","14","Select","Select",""],["","00591293201","CLINDAMYCIN","CAP 300MG","21","Select","Select",""],["","51672126705","TRIAMCINOLON","PST DEN 0.1%","5","Select","Select",""],["","57237007710","ONDANSETRON","TAB 4MG ODT","10","Select","Select",""],["","49884028901","MEGESTROL","TAB 20MG","28","Select","Select",""],["","50111078751","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","68462019005","NAPROXEN","TAB 500MG","20","Select","Select",""],["","00185012201","NITROFURANTN","CAP 100MG","14","Select","Select",""],["","00378728753","LEVONOR\/ETHI","TAB 0.1-0.02","28","Select","Select",""],["","00116200116","CHLORHEX","SOL 0.0012","473","Select","Select",""],["","00052433001","NEXPLANON","IMP 68MG","1","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":""}]}]}