{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LEQUITA   I RANKIN","gend":1,"add":"6271   PLANK ROAD                                           ","city":"KENBRIDGE                     ","state":"VA","zip":"23944-4114","dob":"1988-03-03","age":"","mstatus":"","insh":4715078,"cliId":"","pno":4342385913,"cno":"","email":"","ename":"","eno":"","pphy":"HOLLAND, JOHN A                                             ","ppno":4346962165,"pcpadd":"1508 K V Rd                                                 ,                                                            ","pcpcity":"Victoria                      ","pcpstate":"VA","pcpzip":239742624,"pcpcounty":"","pcpid":"","pcpname":"LUNENBURG MEDICAL CENTER","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"CENTRAL","aligned":"","ano":"","add2":"6271   PLANK ROAD                                           ","add3":"","madd1":"6271   PLANK ROAD                                           ","madd2":"APT 402                                                     ","madd3":"","mcity":"KENBRIDGE                     ","mstate":"VA","mzip":"23944-4114","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F31.81","O24.419","Z3A.00","O99.89","M54.5","Z3A.27","O99.512","Z87.891","Z88.5","Z88.0","Z91.040","N76.0","O99.810","O99.212","Z3A.28","O32.1XX0","O09.893","O09.13","Z68.44","E66.01","O99.213","O36.0939","O99.343","O99.513","Z3A.31","O24.415","Z39.1","Z34.82","Z34.83","O09.293","Z3A.33","O10.013","Z3A.36","F31.9","O24.313","O11.4","Z37.0","O10.92","O24.429","O99.284","O99.214","E78.00","O99.52","J45.909","O36.0930","F41.8","O26.893","Z3A.30","Z3A.37","O43.90","Z39.2","R10.30","S30.1XXA","T81.31XA","Z74.3","N85.8","R17","Z30.013","Z32.02","Z30.09","O24.439","L03.112","E66.8","Z30.42","G89.29","M17.0","M79.7","M51.36","M47.816","Z20.828","R50.9","R05","R06.02","Z53.21","L03.113","L20.84","F11.20","Z30.41","H91.8X9","H90.3","H91.93","Z79.899","K12.2","R68.84","M17.9","U07.1","Z20.822","Z11.59","J01.90","Z77.120","S20.20XA","T78.49XD","Z79.891","J02.9","R51.9","R05.9","R11.2","R19.7","M25.561","M25.562","N39.0","F41.9","F32.9"],"date":["2022-11-29","2020-02-07","2020-04-16","2020-02-07","2020-11-05","2020-02-18","2020-02-07","2020-02-07","2020-02-07","2020-02-07","2020-02-07","2020-02-13","2020-02-18","2020-02-18","2020-02-18","2020-04-16","2020-04-15","2020-04-15","2022-10-26","2021-05-04","2020-04-15","2020-03-20","2020-04-15","2020-04-15","2020-03-06","2020-04-10","2020-03-09","2020-03-09","2020-03-09","2020-04-10","2020-03-20","2020-03-20","2020-04-15","2020-04-16","2020-04-10","2020-04-16","2020-04-16","2020-04-16","2020-04-16","2020-04-16","2020-04-16","2020-04-16","2020-04-16","2021-10-20","2020-04-16","2020-04-16","2020-04-16","2020-04-16","2020-04-16","2020-04-16","2020-06-02","2020-04-22","2020-04-22","2020-04-22","2020-04-22","2020-04-23","2020-04-28","2020-06-02","2020-06-02","2020-06-02","2020-06-16","2020-09-16","2021-07-20","2021-02-17","2022-10-25","2022-10-25","2022-10-25","2022-10-25","2022-10-25","2020-12-16","2020-12-16","2021-07-30","2020-12-16","2021-02-17","2021-04-01","2021-05-04","2022-01-20","2021-05-04","2021-05-04","2021-05-13","2021-05-13","2021-05-17","2021-07-20","2021-07-20","2021-07-29","2022-11-04","2022-10-26","2021-07-30","2021-09-08","2021-09-16","2021-09-16","2021-10-20","2022-10-25","2022-10-26","2022-08-31","2022-08-31","2022-04-01","2022-11-04","2022-10-25","2022-10-25","2022-08-24","2022-09-30","2022-09-30"],"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":[["","42858010450","OXYCOD\/APAP","TAB 10-325MG","120","Select","Select",""],["","43598029790","PREGABALIN","CAP 225MG","60","Select","Select",""],["","45802057178","FEXOFENADINE","TAB 180MG","30","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","68001040008","FLUOXETINE","CAP 20MG","30","Select","Select",""],["","51672130406","TERCONAZOLE","CRE 0.004","45","Select","Select",""],["","00093317431","ALBUTEROL","FAT E","8.5","Select","Select",""],["","69097052444","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","51672400501","CARBAMAZEPIN","TAB 200MG","60","Select","Select",""],["","00078051005","TEGRETOL-XR","TAB 100MG","30","Select","Select",""],["","68462013801","OXCARBAZEPIN","TAB 300MG","60","Select","Select",""],["","00185061501","HYDROXYZ","CAP 50MG","90","Select","Select",""],["","00378018201","PROPRANOLOL","TAB 10MG","60","Select","Select",""],["","68001030800","BUPROPION","TAB 75MG","30","Select","Select",""],["","68001010603","DIVALPROEX","TAB 500MG ER","30","Select","Select",""],["","16729013716","CLONAZEPAM","TAB 1MG","30","Select","Select",""],["","00069108530","PAXLOVID","TAB 300-100","30","Select","Select",""],["","00781717612","NALOXONE","SPR ","2","Select","Select",""],["","42806071401","BENZONATATE","CAP 100MG","15","Select","Select",""],["","59746017506","PREDNISONE","TAB 20MG","13","Select","Select",""],["","72578000105","DOXYCYCL","TAB 100MG","20","Select","Select",""],["","68001036206","CEFDINIR","CAP 300MG","20","Select","Select",""],["","29300024601","BUSPIRONE","TAB 15MG","60","Select","Select",""],["","42571025101","CLINDAMYCIN","CAP 150MG","60","Select","Select",""],["","00116200116","CHLORHEX","SOL 0.0012","473","Select","Select",""],["","70700011985","ESTARYLLA","TAB 0.25-35","28","Select","Select",""],["","68001016200","PROMETHAZINE","TAB 25MG","60","Select","Select",""],["","69238120202","BUPRENORPHIN","DIS 5MCG\/HR","4","Select","Select",""],["","67877025145","TRIAMCINOLON","CRE 0.001","15","Select","Select",""],["","68462018022","MUPIROCIN","OIN 0.02","22","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","14","Select","Select",""],["","24208063562","NEO\/POLY\/HC","SUS 1% OTIC","10","Select","Select",""],["","59267100001","PFIZER","INJ COVID-19","0.3","Select","Select",""],["","57896045101","GERI-KOT","TAB 8.6MG","30","Select","Select",""],["","59385002260","BELBUCA","MIS 150MCG","60","Select","Select",""],["","00193731150","CONTOUR","TES NEXT","150","Select","Select",""],["","43598016630","OLANZAPINE","TAB 10MG","30","Select","Select",""],["","61874017008","VRAYLAR","CAP 1.5-3MG","7","Select","Select",""],["","24385059029","MICONAZOLE","CRE 0.02","45","Select","Select",""],["","50228010510","METFORMIN","TAB 500MG","60","Select","Select",""],["","62332009930","ARIPIPRAZOLE","TAB 10MG","30","Select","Select",""],["","00193658621","MICROLET","MIS LANCETS","100","Select","Select",""],["","69618004602","ASPIRIN","TAB 81MG EC","30","Select","Select",""],["","45802065087","LORATADINE","TAB 10MG","30","Select","Select",""],["","64380080706","IBUPROFEN","TAB 800MG","30","Select","Select",""],["","00406012310","HYDROCO\/APAP","TAB 5-325MG","20","Select","Select",""],["","29300011101","LAMOTRIGINE","TAB 25MG","46","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":""}]}]}