{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"AMANDA   J WHITE","gend":1,"add":"11031 PAMELA CT","city":"KING GEORGE","state":"VA","zip":"22485-3848","dob":"2003-06-26","age":"","mstatus":"","insh":"4232387","cliId":"","pno":"5408407846","cno":"","email":"","ename":"","eno":"","pphy":"DEDWYLDER, ROSIER D","ppno":"5406449505          ","pcpadd":"5254 Potomac Dr, Ste C","pcpcity":"King George","pcpstate":"VA","pcpzip":"224855832","pcpcounty":"","pcpid":"","pcpname":"MARY WASHINGTON MEDICAL GROUP","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"11031 PAMELA CT","madd2":"","madd3":"","mcity":"KING GEORGE","mstate":"VA","mzip":"22485-3848","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M54.9","K21.9","M41.129","F90.9","G47.33","R10.9","R51","F54","G89.29","R13.10","G43.719","G52.3","G43.919","Z79.899","M25.511","K59.00","M54.5","M41.9","M54.81","H90.11","Z96.22","H90.71","G43.909","R42","I95.1","R07.89","R07.9","Z87.09","R06.02","R10.31","R10.2","R11.0","J45.909","R22.1","R55","R07.2","F41.9","F43.9","N39.0","R10.13","M62.81","H92.01","K63.89","K22.8","R12","K63.9","Z79.51","R10.84","Z01.10","G43.019","S80.11XA","S80.12XA","R58","K52.839","K30","G47.00","M21.761","M21.751","M25.371","M25.372","Z01.82","R23.3","R04.0","R51.9","M47.26","M71.38","M51.17","H93.291","G43.009","F90.2","G93.0","J34.89","H69.81","K21.00","R91.8","Z46.59","R20.2","M26.601","G96.191","H47.093","R20.1","J01.00","J32.9","R09.81","R09.82","J34.3","R31.9","R11.2","Z86.69","R10.11","R10.12","R10.32","E61.1","N92.6","M54.59","M25.561","M79.604","M54.6","Z11.59","J95.830","L76.22","G43.709","M41.86","M54.31","M94.0","R07.1","R94.31","J98.11","M41.84","F90.0"],"date":["2020-01-13","2021-07-21","2020-02-06","2021-06-16","2021-06-16","2021-11-27","2020-09-10","2020-06-22","2022-02-08","2020-02-26","2022-02-03","2020-03-17","2021-09-08","2022-04-06","2020-03-27","2021-07-21","2020-11-05","2021-09-08","2020-09-28","2021-05-25","2020-04-28","2020-04-28","2022-03-11","2021-11-27","2022-03-17","2022-03-14","2022-03-17","2020-05-12","2020-05-12","2021-12-21","2020-06-02","2020-06-24","2021-06-16","2020-07-07","2020-06-11","2020-06-11","2021-06-16","2020-06-22","2021-11-27","2020-06-24","2021-09-08","2020-07-01","2020-07-01","2020-07-01","2020-07-01","2020-07-01","2021-06-16","2020-07-01","2020-07-01","2021-09-27","2020-07-22","2020-07-22","2020-10-23","2021-07-21","2020-07-23","2020-07-29","2022-01-13","2020-08-25","2020-08-25","2020-08-25","2020-10-13","2020-10-23","2022-02-02","2022-02-02","2020-11-24","2020-11-24","2020-11-24","2020-12-04","2021-02-04","2021-04-16","2021-04-13","2021-08-24","2021-08-24","2021-06-16","2022-03-14","2021-06-16","2022-01-13","2021-08-24","2021-09-08","2021-09-08","2021-09-08","2021-10-10","2021-10-10","2021-10-10","2021-10-10","2022-02-01","2021-11-27","2022-01-28","2021-11-27","2021-11-27","2021-11-27","2021-11-27","2021-12-21","2021-12-21","2022-01-13","2022-01-13","2022-01-13","2022-02-08","2022-01-28","2022-02-02","2022-02-02","2022-04-06","2022-02-08","2022-03-03","2022-03-11","2022-03-11","2022-03-14","2022-03-14","2022-03-14","2022-04-08"],"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":[["","00002237711","EMGALITY","INJ 120MG\/ML","1.00","Select","Select",""],["","69367022001","SOD","TAB 1GM","120.00","Select","Select",""],["","50742061701","METOPROL","TAB 100MG ER","30.00","Select","Select",""],["","50111043301","TRAZODONE","TAB 50MG","60.00","Select","Select",""],["","68462069497","FROVATRIPTAN","TAB 2.5MG","12.00","Select","Select",""],["","57237001830","DULOXETINE","CAP 30MG","60.00","Select","Select",""],["","31722071390","PANTOPRAZOLE","TAB 40MG","60.00","Select","Select",""],["","55111016330","OLANZAPINE","TAB 2.5MG","5.00","Select","Select",""],["","50742019001","CYPROHEPTAD","TAB 4MG","20.00","Select","Select",""],["","68645056259","IBUPROFEN","TAB 600MG","30.00","Select","Select",""],["","00781261305","AMOXICILLIN","CAP 500MG","21.00","Select","Select",""],["","00023649810","UBRELVY","TAB 50MG","8.00","Select","Select",""],["","31722094101","HYDROCO\/APAP","TAB 5-325MG","12.00","Select","Select",""],["","00116200116","CHLORHEX","SOL 0.0012","473.00","Select","Select",""],["","27241004221","ALMOTRIPTAN","TAB 12.5MG","12.00","Select","Select",""],["","50228018105","GABAPENTIN","CAP 400MG","30.00","Select","Select",""],["","57237007710","ONDANSETRON","TAB 4MG ODT","15.00","Select","Select",""],["","50428009256","GENTLE","TAB 5MG EC","25.00","Select","Select",""],["","00527058601","DICYCLOMINE","CAP 10MG","15.00","Select","Select",""],["","65862050320","AMOX\/K","TAB 875-125","20.00","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21.00","Select","Select",""],["","47781017601","AMPHET\/DEXTR","TAB 10MG","60.00","Select","Select",""],["","00135057401","GAVISCON","SUS CHERRY","355.00","Select","Select",""],["","16714083001","MESALAMINE","TAB 1.2GM","224.00","Select","Select",""],["","69097084507","CYCLOBENZAPR","TAB 5MG","20.00","Select","Select",""],["","00172572970","FAMOTIDINE","TAB 40MG","30.00","Select","Select",""],["","59726019003","BISACODYL","5 MG","20.00","Select","Select",""],["","00378524685","ALMOTRIP","TAB 12.5MG","10.00","Select","Select",""],["","23155005901","VERAPAMIL","TAB 40MG","60.00","Select","Select",""],["","45802086802","POLYETH","POW 3350 NF","238.00","Select","Select",""],["","65162047810","NITROFURANTN","CAP 100MG","14.00","Select","Select",""],["","17478071710","KETOTIF","DRO 0.025%OP","5.00","Select","Select",""],["","00173071920","FLOVENT","AER 110MCG","12.00","Select","Select",""],["","55111015930","OMEPRAZOLE","CAP 40MG","60.00","Select","Select",""],["","65162083366","DICLOFENAC","GEL 0.01","100.00","Select","Select",""],["","00054001925","PREDNISONE","TAB 50MG","5.00","Select","Select",""],["","59779030603","CVS","POW ","510.00","Select","Select",""],["","68382004001","PROMETHAZINE","TAB 12.5MG","5.00","Select","Select",""],["","00054418425","DEXAMETHASON","TAB 4MG","10.00","Select","Select",""],["","65162019011","NAPROXEN","TAB 500MG","20.00","Select","Select",""],["","65162068210","PHENAZOPYRID","TAB 200MG","6.00","Select","Select",""],["","29300022019","MONTELUKAST","TAB 10MG","90.00","Select","Select",""],["","00781635587","MOMETASONE","SPR 50MCG","17.00","Select","Select",""],["","69367020301","BUT\/APAP\/CAF","TAB ","20.00","Select","Select",""],["","65862078430","ESOMEPRA","CAP 40MG DR","60.00","Select","Select",""],["","59746011506","PROCHLORPER","TAB 10MG","3.00","Select","Select",""],["","49035030603","EQ","POW ","510.00","Select","Select",""],["","70010075401","METHOCARBAM","TAB 500MG","30.00","Select","Select",""],["","00536132701","ACETAMINOPHE","TAB 325MG","30.00","Select","Select",""],["","70710122701","AMITRIPTYLIN","TAB 50MG","30.00","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":""}]}]}