{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TINA   M MULLINS","gend":1,"add":"200   NORTHPOINTE LANE                                      ","city":"DANVILLE                      ","state":"VA","zip":"24540-1450","dob":"1968-12-03","age":"","mstatus":"","insh":4366180,"cliId":"","pno":4347096298,"cno":"","email":"","ename":"","eno":"","pphy":"PRADHAN, PRADEEP K                                          ","ppno":4348573600,"pcpadd":"110 Exchange St Ste F                                       ,                                                            ","pcpcity":"Danville                      ","pcpstate":"VA","pcpzip":245413500,"pcpcounty":"","pcpid":"","pcpname":"PIEDMONT PRIMECARE CENTRAL MEDICAL GROUP","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"200   NORTHPOINTE LANE                                      ","add3":"","madd1":"200   NORTHPOINTE LANE                                      ","madd2":"APT 103                                                     ","madd3":"","mcity":"DANVILLE                      ","mstate":"VA","mzip":"24540-1450","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F31.81","M54.5","M62.838","L85.3","M54.9","F31.9","Z68.41","R53.82","G89.29","Z87.891","E03.9","E66.01","G47.33","N39.41","R35.0","R35.1","R39.15","F33.1","F41.9","K59.00","K21.9","K76.0","R68.89","M54.16","G43.709","N39.46","Z23","K59.09","R32","N39.0","E78.00","K58.9","Z86.19","Z91.030","R10.9","Z88.8","Z91.018","R73.03","M13.0","Z79.899","Z00.00","I44.7","M48.062","G93.3","F32.9","R63.4","Z99.89","R06.02","E66.9","I11.0","I50.21","I47.1","I31.3","I42.8","M10.9","I48.91","R06.00","R60.9","I50.9","J81.0","R00.0","I10","J96.21","I42.0","R94.31","I50.82","Z12.31","Z68.42","Z91.81","M48.061","M79.672","M79.671","B35.1","L60.3","L60.0","F43.0","F43.10","I07.1","I50.20","F31.0","Z01.818","G43.909","G47.30","Z98.890","Z01.419","N93.9","R01.1","R11.2","R74.8","R68.81","G47.10","R94.5","B18.2","D64.9","Z11.59","Z20.828","K30","F98.0","R26.2","Z98.1","M47.816","M25.552","K31.84","D53.9","H50.05","H25.13","J32.4","J31.0","M54.10","M19.90","Z71.9","Z71.3","N89.8","M47.26","K04.7","M51.9","E66.8","B19.20","M26.619","M26.602","R05.9","J30.9","Z20.822","Z78.9","M25.561","M26.69","M25.48","M25.70","M26.609","S02.5XXA","K08.89","R07.89","Z91.89","R26.89","L84","L03.031","S91.101A","M54.12","M17.11","M54.2","M62.81","F41.1","L57.0","M77.41","E11.69","R53.1","F32.A","M65.311","F31.70","K58.1","S09.90XA","S00.83XA","F31.32","L03.116","Z99.11","R06.09","R26.9","M96.1","R51.9","M51.36","M53.2X6","J02.9","M51.16"],"date":["2022-10-21","2020-01-05","2020-01-05","2020-01-08","2022-03-11","2022-06-07","2022-10-25","2022-10-05","2022-08-17","2022-10-11","2022-10-11","2022-10-25","2022-10-11","2022-08-19","2022-08-19","2022-08-19","2022-02-03","2022-11-17","2022-11-17","2021-01-12","2022-10-11","2022-10-11","2022-07-25","2022-09-28","2022-08-11","2022-11-18","2022-09-20","2022-06-07","2020-06-30","2020-02-05","2022-10-11","2022-04-15","2022-06-10","2020-02-05","2021-07-14","2020-02-05","2020-02-05","2022-03-11","2021-12-03","2022-05-13","2022-06-07","2022-09-27","2022-10-04","2022-06-07","2020-05-28","2021-07-14","2022-11-18","2021-06-21","2022-08-08","2022-06-10","2020-07-01","2022-09-27","2020-07-01","2020-07-01","2020-06-30","2020-06-30","2022-02-14","2021-11-17","2022-10-11","2020-06-30","2020-07-01","2022-08-29","2020-07-01","2022-10-11","2020-07-01","2022-09-27","2022-09-16","2020-08-20","2021-04-22","2022-10-04","2020-09-23","2021-11-29","2022-10-13","2022-10-13","2022-03-03","2020-09-27","2020-12-23","2020-10-19","2020-10-19","2020-10-20","2020-10-21","2021-02-08","2022-09-12","2022-10-04","2022-11-08","2022-11-08","2020-11-05","2021-07-14","2022-10-05","2021-02-26","2021-01-21","2022-01-31","2022-10-11","2022-06-10","2021-02-03","2021-02-03","2021-02-26","2021-11-03","2021-07-02","2021-06-25","2022-12-02","2021-04-22","2022-05-13","2021-04-27","2021-05-20","2021-05-20","2021-06-03","2021-09-09","2022-10-11","2021-06-16","2022-11-08","2022-11-21","2021-06-17","2022-11-15","2022-01-31","2021-08-18","2022-09-27","2022-09-27","2021-09-29","2021-12-17","2022-01-26","2021-10-15","2021-10-15","2022-11-08","2022-04-21","2021-12-13","2021-12-13","2021-12-13","2021-12-13","2021-12-14","2021-12-14","2022-01-26","2022-09-27","2022-09-27","2022-10-13","2022-03-28","2022-03-28","2022-06-07","2022-04-21","2022-05-16","2022-05-16","2022-07-01","2022-10-13","2022-09-08","2022-10-13","2022-09-21","2022-06-10","2022-08-18","2022-06-28","2022-06-28","2022-07-06","2022-07-06","2022-12-05","2022-07-18","2022-07-25","2022-07-25","2022-08-11","2022-08-17","2022-09-21","2022-10-04","2022-10-04","2022-10-27","2022-11-15"],"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":[["","65862018730","ONDANSETRON","TAB 4MG","30","Select","Select",""],["","67877032105","IBUPROFEN","TAB 800MG","21","Select","Select",""],["","51672400401","NORTRIPTYLIN","CAP 75MG","42","Select","Select",""],["","65162090209","ARIPIPRAZOLE","TAB 30MG","21","Select","Select",""],["","70436005802","BUPROPION","TAB 100MG SR","28","Select","Select",""],["","31722054501","LITHIUM","CAP 300MG","42","Select","Select",""],["","57664051083","MIRTAZAPINE","TAB 7.5MG","21","Select","Select",""],["","55111029209","SUMATRIPTAN","TAB 50MG","9","Select","Select",""],["","00904693126","PEG","POW ","56","Select","Select",""],["","68462010910","TOPIRAMATE","TAB 100MG","90","Select","Select",""],["","62756014202","METFORMIN","TAB 500MG ER","28","Select","Select",""],["","00904536560","ACID","CHW ","30","Select","Select",""],["","57664050389","TIZANIDINE","TAB 4MG","60","Select","Select",""],["","00555087302","MEDROXYPR","TAB 5MG","30","Select","Select",""],["","00904759060","FEROSUL","TAB 325MG","28","Select","Select",""],["","00536718001","ACIDOPHILUS\/","TAB CIT PECT","90","Select","Select",""],["","","VALSARTAN","TAB 80MG","30","Select","Select",""],["","","SPIRONOLACT","TAB 25MG","30","Select","Select",""],["","","BISOPROL","TAB 5MG","60","Select","Select",""],["","55111012305","ATORVASTATIN","TAB 40MG","30","Select","Select",""],["","60258017101","MAG","TAB 400MG","60","Select","Select",""],["","00536120610","CALCIUM","TAB 648MG","60","Select","Select",""],["","16714004112","ALLOPURINOL","TAB 100MG","30","Select","Select",""],["","00904264172","CERTAVITE\/","TAB ANTIOXID","30","Select","Select",""],["","45802065078","LORATADINE","TAB 10MG","30","Select","Select",""],["","00378803077","LANSOPRAZOLE","CAP 30MG DR","30","Select","Select",""],["","68180096601","LEVOTHYROXIN","TAB 50MCG","30","Select","Select",""],["","65162044210","MECLIZINE","TAB 25MG","90","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","Select","Select",""],["","72618300002","NURTEC","TAB 75MG ODT","16","Select","Select",""],["","73336007530","GEMTESA","TAB 75MG","28","Select","Select",""],["","27241015504","OXYBUTYNIN","TAB 5MG ER","28","Select","Select",""],["","69315011610","FUROSEMIDE","TAB 20MG","30","Select","Select",""],["","00002143611","EMGALITY","INJ 120MG\/ML","1","Select","Select",""],["","68180012201","CEPHALEXIN","CAP 500MG","21","Select","Select",""],["","","NITROGLYCERN","SUB 0.4MG","25","Select","Select",""],["","00781808926","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","65162052110","PROMETHAZINE","TAB 25MG","30","Select","Select",""],["","69097052444","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","45802008801","ALBUTEROL","AER HFA","8.5","Select","Select",""],["","00143980350","DOXYCYCL","CAP 100MG","20","Select","Select",""],["","51672131200","MUPIROCIN","OIN 0.02","22","Select","Select",""],["","67877012425","SILVER","CRE 0.01","25","Select","Select",""],["","00456120330","LINZESS","CAP 72MCG","30","Select","Select",""],["","00781506120","AMOXICILLIN","TAB 875MG","20","Select","Select",""],["","00536100901","FERROUS","TAB 325MG","28","Select","Select",""],["","55111028050","LEVOFLOXACIN","TAB 500MG","4","Select","Select",""],["","00093227534","AMOX\/K","TAB 875-125","20","Select","Select",""],["","17478071130","LIDOCAINE","GEL 2% JELLY","30","Select","Select",""],["","42806071401","BENZONATATE","CAP 100MG","60","Select","Select",""],["","59746032530","VALACYCLOVIR","TAB 1GM","14","Select","Select",""],["","80777027399","MODERNA","INJ COVID-19","0.25","Select","Select",""],["","00143992801","CIPROFLOXACN","TAB 500MG","14","Select","Select",""],["","00185067401","HYDROXYZ","CAP 25MG","30","Select","Select",""],["","00135008969","CITRUCEL","POW ORANGE","480","Select","Select",""],["","","DIGOXIN","TAB 0.125MG","60","Select","Select",""],["","59310057922","PROAIR","AER ","8.5","Select","Select",""],["","00536105227","PEG3350","POW ","510","Select","Select",""],["","00135009826","GAVISCON","CHW EX-STR","30","Select","Select",""],["","65162010250","GABAPENTIN","CAP 300MG","90","Select","Select",""],["","00536404610","MULTI-VITAMN","TAB ","30","Select","Select",""],["","45802086802","POLYETH","POW 3350 NF","476","Select","Select",""],["","00085113204","PROVENTIL","AER HFA","6.7","Select","Select",""],["","57896050110","ONE-DAILY","TAB MULT-VIT","30","Select","Select",""],["","40985022928","ACIDOPHILUS","CAP PROBIOTI","90","Select","Select",""],["","00591544305","PREDNISONE","TAB 20MG","10","Select","Select",""],["","51672530200","CICLOPIROX","SOL 0.08","6.6","Select","Select",""],["","45802006436","TRIAMCINOLON","CRE 0.001","80","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","20","Select","Select",""],["","00904672559","SENNA","TAB 8.6MG","14","Select","Select",""],["","00904645760","DOK","CAP 100MG","14","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":""}]}]}