{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"AMY   L ADKINS","gend":1,"add":"89 CEDAR LANE","city":"WOODSTOCK                     ","state":"VA","zip":"22664-2192","dob":"1985-02-19","age":"","mstatus":"","insh":4615921,"cliId":"","pno":5404810473,"cno":"","email":"","ename":"","eno":"","pphy":"UNKNOWN PROVIDER QNXT PCP","ppno":"","pcpadd":"UNKNOWN STREET,","pcpcity":"RICHMOND                      ","pcpstate":"VA","pcpzip":232190000,"pcpcounty":"","pcpid":"","pcpname":"UNKNOWN PROVIDER QNXT PCP","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"NORTHERN\/ WINCHESTER","aligned":"","ano":"","add2":"89 CEDAR LANE","add3":"","madd1":"89 CEDAR LANE","madd2":"APT 5","madd3":"","mcity":"WOODSTOCK                     ","mstate":"VA","mzip":"22664-2192","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E66.01","Z68.42","F99","F41.1","F33.1","Z30.42","M54.16","M24.159","M25.559","M51.36","M54.5","M25.561","M25.361","R06.83","E66.09","F45.42","M79.7","M54.6","M54.17","Z13.89","M17.11","M22.41","G47.33","G47.10","E66.9","M51.37","G58.9","E88.81","F11.20","G89.29","G43.909","M46.96","M51.26","M51.16","S34.21XS","M48.061","M25.552","F41.9","M24.152","M76.02","R25.2","J01.10","Z01.810","Z01.818","Z98.84","K21.9","S73.192A","X58.XXXA","M94.252","K76.0","F32.9","Z98.51","Z87.891","Z82.49","Z88.1","K91.2","K82.9","R10.12","N12","R11.0","R10.9","K80.10","R10.13","F33.9","Z79.891","K80.50","K82.8","N83.201","R10.31","R11.2","R05","Z79.899","N83.202","Z90.49","Z90.79","Z83.49","Z81.8","Z82.0","Z83.79","S90.01XA","M25.571","V00.131A","S99.911A","M79.89","M16.12","S73.192D","E61.8","E55.9","D52.0","D50.8","Z71.3","Z13.1","Z13.29","E53.8","M25.852","M19.071","M77.9","M25.461","S76.111A","R60.0","M47.896","M16.0","M47.816","M16.31","M25.859","R94.5","R17","M99.04","M54.32","M48.062","M48.07","M51.27","M47.817","M72.2","S93.421A","G89.18","M76.72","M76.71","G25.81","R06.02","R60.9","M76.61","Z47.89","I87.2","K63.89","K64.9","N39.0","R10.84","M77.31","K64.4","K64.1","M47.9","Z86.39","Z87.01","Q24.8","I47.1","R00.2","X50.1XXA","R07.89","R42","M65.871","E21.1","R10.10","M47.26","M53.3","M54.50","M79.671","Z48.89","K22.89","K44.9","R79.9","I31.8","R14.0","M46.1","I07.1","H04.123","H52.13","H25.813","H35.412","M70.62","M70.72","I83.892","I10","M15.9"],"date":["2021-09-21","2021-09-21","2020-08-28","2020-11-17","2020-08-28","2020-04-28","2021-12-29","2020-05-21","2020-05-21","2021-12-29","2021-09-30","2021-05-20","2020-03-10","2020-05-07","2020-03-16","2021-12-17","2020-05-21","2020-05-21","2020-05-21","2020-05-21","2021-09-02","2020-04-28","2021-12-31","2020-05-07","2021-03-22","2021-05-17","2020-05-14","2021-04-22","2020-05-21","2021-12-29","2021-12-29","2021-12-29","2020-11-12","2021-10-06","2021-12-29","2021-10-06","2021-12-29","2021-09-02","2021-12-29","2021-12-29","2021-12-29","2020-07-28","2020-08-31","2021-12-09","2021-11-12","2021-12-31","2021-05-03","2020-09-01","2021-05-03","2021-06-09","2020-09-14","2020-09-14","2021-12-31","2021-12-31","2021-12-31","2021-09-21","2020-10-29","2020-10-29","2020-10-29","2020-10-29","2021-08-25","2020-11-17","2021-11-03","2020-11-17","2021-12-31","2020-11-17","2020-11-17","2021-01-07","2021-01-07","2020-12-07","2020-12-11","2021-12-31","2020-12-11","2021-12-31","2021-12-31","2021-12-31","2021-01-07","2021-01-07","2021-01-07","2021-04-22","2021-12-30","2021-02-26","2021-02-26","2021-12-09","2021-09-02","2021-09-01","2021-09-21","2021-03-22","2021-03-22","2021-03-22","2021-03-22","2021-04-22","2021-04-22","2021-04-22","2021-06-25","2021-05-11","2021-06-24","2021-05-11","2021-05-11","2021-08-23","2021-05-17","2021-10-06","2021-10-06","2021-05-19","2021-05-24","2021-09-21","2021-06-09","2021-06-14","2021-06-14","2021-06-18","2021-06-18","2021-06-18","2021-06-18","2021-12-27","2021-06-24","2021-07-05","2021-09-15","2021-12-27","2021-12-29","2021-09-07","2021-09-03","2021-08-23","2021-12-27","2021-12-31","2021-08-25","2021-08-25","2021-08-25","2021-08-25","2021-10-04","2021-09-01","2021-09-02","2021-09-02","2021-09-02","2021-12-31","2021-09-03","2021-12-30","2021-09-07","2021-09-07","2021-09-07","2021-09-07","2021-09-15","2021-09-21","2021-11-12","2021-10-06","2021-11-23","2021-12-29","2021-12-30","2021-10-27","2021-11-03","2021-11-03","2021-12-09","2021-11-11","2021-11-12","2021-11-23","2021-11-30","2021-12-16","2021-12-16","2021-12-16","2021-12-16","2021-12-27","2021-12-27","2021-12-31","2021-12-31","2021-12-31"],"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":[["","52817033200","CYCLOBENZAPR","TAB 10MG","81","Select","Select",""],["","52817032010","BACLOFEN","TAB 10MG","120","Select","Select",""],["","00406052301","OXYCOD\/APAP","TAB 10-325MG","120","Select","Select",""],["","00406912576","FENTANYL","DIS 25MCG\/HR","10","Select","Select",""],["","00093762698","PREGABALIN","CAP 150MG","60","Select","Select",""],["","00781717612","NALOXONE","SPR 4MG","2","Select","Select",""],["","00378034505","DIAZEPAM","TAB 5MG","2","Select","Select",""],["","69557011130","ZTLIDO","PAD 0.018","30","Select","Select",""],["","69452015120","VITAMIN","CAP 50000UNT","8","Select","Select",""],["","68462015713","ONDANSETRON","TAB 4MG ODT","60","Select","Select",""],["","11534016503","FOLIC","TAB 1MG","90","Select","Select",""],["","00904679480","ASPIRIN","CHW 81MG","28","Select","Select",""],["","69315090405","LORAZEPAM","TAB 0.5MG","30","Select","Select",""],["","27241009903","DULOXETINE","CAP 60MG","30","Select","Select",""],["","65862001105","SERTRALINE","TAB 25MG","36","Select","Select",""],["","51862001601","NORTRIPTYLIN","CAP 25MG","90","Select","Select",""],["","00591333119","BUPROPN","TAB 150MG XL","60","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","20","Select","Select",""],["","42806016005","HYDROXYZ","TAB 25MG","180","Select","Select",""],["","00363017512","PAIN","TAB 500MG","90","Select","Select",""],["","62037099905","POT  CL MICRO","TAB 20MEQ ER","60","Select","Select",""],["","60505006501","OMEPRAZOLE","CAP 20MG","30","Select","Select",""],["","31722053301","METHOCARBAM","TAB 500MG","240","Select","Select",""],["","60505079204","ENOXAPARIN","INJ 40\/0.4ML","5.6","Select","Select",""],["","00406012505","HYDROCO\/APAP","TAB 10-325MG","120","Select","Select",""],["","47781041060","HYDROCODONE","CAP 15MG ER","60","Select","Select",""],["","24510011010","XTAMPZA","CAP 9MG","60","Select","Select",""],["","29300012510","MELOXICAM","TAB 15MG","30","Select","Select",""],["","00406055201","OXYCODONE","TAB 5MG","6","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","65862050320","AMOX\/K","TAB 875-125","20","Select","Select",""],["","68382013805","TOPIRAMATE","TAB 25MG","240","Select","Select",""],["","65224031560","ZOHYDRO","CAP 15MG","60","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":""}]}]}