{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CRYSTAL SUTHERLY","gend":1,"add":"211 VINE STREET","city":"HARRISONBURG","state":"VA","zip":"22802-6043","dob":"1982-12-25","age":"","mstatus":"","insh":4410242,"cliId":"","pno":5407462089,"cno":"","email":"","ename":"","eno":"","pphy":"MARIA A HERNANDEZ MD LLC","ppno":5404426144,"pcpadd":"129 University Blvd Ste E, ","pcpcity":"Harrisonburg","pcpstate":"VA","pcpzip":228013751,"pcpcounty":"","pcpid":"","pcpname":"MARIA A HERNANDEZ MD","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"APT 302","add3":"","madd1":"211 VINE STREET","madd2":"APT 302","madd3":"","mcity":"HARRISONBURG","mstate":"VA","mzip":"22802-6043","pcpfaxno":"                    ","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K59.00","R10.30","K62.5","K62.89","K92.1","D12.4","K62.1","K63.5","G43.909","F32.9","D64.9","G40.909","Z79.899","Z79.890","Z88.8","Z91.018","F17.210","F33.41","M54.2","E66.09","Z71.3","F51.05","M54.16","Z68.32","F99","M47.812","B34.9","R05","R09.81","R11.0","J02.9","E66.9","Z86.69","Z88.6","Z90.89","Z91.048","R06.02","J20.9","F17.200","M25.572","M79.89","M76.62","M79.672","G89.29","Z91.09","M76.60","E78.5","M19.072","G56.02","R20.2","M54.12","M19.031","M25.511","M19.012","M25.512","M19.011","S43.432A","M75.42","M75.41","E78.2","R23.2","E03.9","G25.81","Z68.30","S43.432D","M75.112","X58.XXXD","Z98.890","Z20.828","F33.1","R06.2","R43.2","J06.9","F11.20","R30.0","E03.8","E55.9","E66.3","K21.9","N39.41","R05.9","M25.551","M54.41","M54.42","M54.5","S39.012A","M51.36","R51","T43.215A","T50.905A","R25.3","R45.4","R68.89","G44.89","K04.7","G89.4","F33.2","M47.816","Q76.49","Z00.00","Z13.220","Z13.1","Z13.29","H66.002","J01.90","Z11.3","K59.01","B96.89","M16.11","M70.61","E66.01","Z68.35","Z76.89","Z68.34","Z68.33","Z23","H66.001"],"date":["2020-01-15","2020-01-15","2020-01-08","2020-01-15","2020-01-15","2020-01-15","2020-01-15","2020-01-15","2020-01-15","2020-05-27","2020-01-15","2020-01-15","2020-01-15","2020-01-15","2020-04-19","2020-05-16","2020-05-16","2021-12-14","2020-05-27","2020-11-11","2020-02-26","2020-11-11","2021-12-14","2020-02-26","2020-11-11","2020-02-26","2020-04-19","2021-03-01","2021-03-01","2020-04-19","2020-04-19","2020-04-19","2020-04-19","2020-05-16","2020-04-19","2020-04-19","2021-03-01","2021-03-01","2020-05-27","2020-06-02","2020-05-16","2020-05-16","2020-05-16","2020-05-16","2020-05-16","2020-06-02","2020-06-24","2020-06-02","2020-06-24","2020-07-01","2021-12-14","2020-07-16","2020-07-16","2020-07-16","2020-07-16","2020-07-16","2020-07-16","2020-11-11","2021-01-14","2022-02-11","2020-11-11","2020-11-11","2021-12-14","2020-11-11","2021-01-14","2021-01-14","2020-11-11","2021-01-14","2021-01-17","2021-08-25","2021-03-01","2021-03-01","2021-07-21","2022-02-20","2021-12-14","2022-02-11","2021-12-14","2021-12-14","2021-12-14","2021-12-14","2021-12-14","2019-06-24","2019-03-15","2019-03-15","2019-03-15","2019-04-08","2019-05-08","2019-04-30","2019-04-30","2019-04-30","2019-04-30","2019-04-30","2019-05-06","2019-06-03","2019-05-06","2019-05-06","2019-06-28","2019-05-08","2019-05-08","2019-06-04","2019-06-04","2019-06-04","2019-06-04","2019-06-03","2019-06-03","2019-06-04","2019-06-03","2019-06-03","2019-06-24","2019-06-24","2019-06-25","2019-06-25","2019-06-25","2019-08-13","2019-11-20","2019-10-22","2019-10-22"],"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":[["","00363023806","STOOL","CAP 100MG","60","Select","Select",""],["","00527328043","LEVOTHYROXIN","TAB 25MCG","30","Select","Select",""],["","57237000830","MIRTAZAPINE","TAB 15MG","30","Select","Select",""],["","00781286810","OMEPRAZOLE","CAP 20MG","30","Select","Select",""],["","68462025601","ROPINIROLE","TAB 2MG","30","Select","Select",""],["","50228011505","FLUOXETINE","CAP 40MG","30","Select","Select",""],["","13668000801","ZOLPIDEM","TAB 10MG","30","Select","Select",""],["","11917012697","VITAMIN","CAP 2000UNIT","60","Select","Select",""],["","00093762498","PREGABALIN","CAP 75MG","60","Select","Select",""],["","16714023501","PENICILLN","TAB 500MG","20","Select","Select",""],["","00406055201","OXYCODONE","TAB 5MG","12","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","74312017621","D3","CAP 50MCG","60","Select","Select",""],["","00904699880","DOCUSATE","CAP 100MG","120","Select","Select",""],["","00143928501","AMOXICILLIN","TAB 875MG","14","Select","Select",""],["","50111033402","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","00135046105","ALLI","CAP 60MG","60","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","60432026415","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","51224002218","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","63824017565","DELSYM","SUS 30MG\/5ML","148","Select","Select",""],["","00406051205","OXYCOD\/APAP","TAB 5-325MG","40","Select","Select",""],["","16729031701","OXYBUTYNIN","TAB 5MG ER","30","Select","Select",""],["","49281042050","FLUZONE","INJ 2020-21","0.5","Select","Select",""],["","51224001050","BENZONATATE","CAP 100MG","30","Select","Select",""],["","63824000832","MUCINEX","TAB 600MG ER","20","Select","Select",""],["","00054001925","PREDNISONE","TAB 50MG","5","Select","Select",""],["","68382091634","METHYLPRED","TAB 4MG","21","Select","Select",""],["","59267100001","PFIZER","INJ COVID-19","0.3","Select","Select",""],["","57237000511","FLUCONAZOLE","TAB 150MG","1","Select","Select",""],["","66685100100","AMOX\/K","TAB 875-125","20","Select","Select",""],["","43386009019","GAVILYTE-G","SOL ","4,000.00","Select","Select",""],["","57237001930","DULOXETINE","CAP 60MG","30","Select","Select",""],["","00071101468","LYRICA","CAP 75MG","60","Select","Select",""],["","68180071160","CEFDINIR","CAP 300MG","20","Select","Select",""],["","00591352530","LIDOCAINE","PAD 0.05","30","Select","Select",""],["","10702000750","CYCLOBENZAPR","TAB 10MG","12","Select","Select",""],["","00832105415","BACLOFEN","TAB 10MG","120","Select","Select",""],["","68462015713","ONDANSETRON","TAB 4MG ODT","20","Select","Select",""],["","00904645780","DOK","CAP 100MG","120","Select","Select",""],["","16729021716","SERTRALINE","TAB 100MG","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":""}]}]}