{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"STEPHANIE   D COLES","gend":1,"add":"191   CHATELAINE AVENUE                                     ","city":"DANVILLE                      ","state":"VA","zip":"24541-3857","dob":"1990-03-18","age":"","mstatus":"","insh":5429377,"cliId":"","pno":4347109757,"cno":"","email":"","ename":"","eno":"","pphy":"FALGUI, VICENTE T                                           ","ppno":4347991565,"pcpadd":"990 Main St                                                 ,Ste 100                                                     ","pcpcity":"Danville                      ","pcpstate":"VA","pcpzip":245411801,"pcpcounty":"","pcpid":"","pcpname":"DRS T M ALABANZA AND VT FALGUI PARTNERS","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"","add3":"","madd1":"191   CHATELAINE AVENUE                                     ","madd2":"APT B                                                       ","madd3":"","mcity":"DANVILLE                      ","mstate":"VA","mzip":"24541-3857","pcpfaxno":"(434) 793-2631","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J11.1","H61.22","J10.1","R05","I10","E78.5","R53.82","G43.909","M54.9","E55.9","Z00.00","E66.01","R51","E53.8","N62","L30.4","N64.81","M25.519","Z98.890","R60.0","R53.81","R53.83","D72.829","M54.16","M54.32","M54.89","M54.2","M25.511","M25.512","M95.4","N64.89","Z11.59","M51.24","I51.7","R16.0","Z88.5","M54.5","M51.25","Z88.6","D64.9","I16.1","R07.2","R07.9","Z87.2","F17.200","M21.371","R73.9","Z79.899","Z51.81","M62.81","R26.81","R82.90","G40.909","Z13.89","H61.23","F17.210","D51.3","Z90.711","R26.9","E88.81","Z13.1","Z01.419","Z11.3","Z12.4","Z90.710","F32.9","E88.1","D53.1","E79.0","N39.0","Z20.822","J01.90","R09.81","R05.9","R06.02","Z13.6","Z71.89","E11.9","M79.605","R22.42","E78.00","N28.9","E87.6","F17.211","E66.9","M54.59","N89.8","R81","B37.2","N76.0","B37.3","R52","D48.5","E11.65","R60.1","B96.89","R60.9","Z53.20","R22.43","M13.0","M79.641","M79.642","R70.0","R25.2","R21","I89.0","I87.2","M79.89","L82.0","L82.1","R79.89","L02.512","L03.012","L08.9","L98.416","L02.31","E11.622","L98.412","Z79.4","Z68.43","Z83.3","L98.415","L97.112","R31.9","N28.89","R10.9","R31.0","Z09","E87.0","R74.8","R31.29","H40.1122","H40.1111","H52.13","M25.572","R94.5","R11.0","R06.01","S46.001A","G47.10","R06.83","R51.9","E11.8","D50.9"],"date":["2020-01-05","2020-01-05","2020-01-08","2020-01-08","2022-12-05","2022-09-29","2020-06-10","2022-11-29","2022-10-14","2022-12-05","2022-11-14","2022-12-05","2020-05-13","2022-05-04","2020-06-25","2020-06-25","2020-06-25","2020-06-19","2022-03-24","2022-08-22","2020-06-10","2022-04-21","2022-03-24","2022-08-22","2020-06-22","2020-08-21","2020-06-25","2022-12-05","2022-10-31","2020-06-25","2020-06-25","2022-01-20","2020-08-21","2020-08-12","2022-11-22","2022-08-18","2021-03-18","2020-08-12","2020-08-15","2022-02-23","2020-08-21","2020-08-21","2020-08-22","2020-10-07","2020-10-07","2020-10-19","2022-04-06","2022-11-18","2022-07-15","2022-02-23","2020-10-29","2022-07-15","2020-11-16","2022-02-23","2021-03-01","2021-03-18","2022-03-24","2022-03-24","2021-05-10","2021-11-05","2022-02-23","2021-10-08","2021-10-08","2021-10-08","2021-10-08","2021-11-05","2021-11-05","2021-11-05","2022-03-18","2022-09-29","2022-01-20","2022-01-20","2022-01-20","2022-02-04","2022-11-14","2022-10-27","2022-02-23","2022-11-14","2022-03-04","2022-03-04","2022-10-27","2022-10-27","2022-04-13","2022-03-24","2022-11-14","2022-03-24","2022-04-06","2022-04-06","2022-04-06","2022-04-06","2022-04-06","2022-05-20","2022-04-07","2022-06-09","2022-04-13","2022-04-13","2022-04-13","2022-04-13","2022-04-13","2022-04-21","2022-04-21","2022-04-21","2022-08-22","2022-11-18","2022-08-22","2022-05-17","2022-10-27","2022-04-29","2022-04-29","2022-04-29","2022-08-22","2022-05-18","2022-05-18","2022-05-18","2022-05-20","2022-08-18","2022-08-18","2022-08-18","2022-08-18","2022-11-22","2022-08-18","2022-06-08","2022-06-09","2022-07-15","2022-07-20","2022-10-14","2022-07-20","2022-08-18","2022-08-22","2022-08-22","2022-10-14","2022-10-03","2022-10-03","2022-10-03","2022-10-31","2022-11-22","2022-11-22","2022-11-14","2022-11-29","2022-12-05","2022-12-05","2022-12-05","2022-12-05","2022-12-05"],"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":[["","08290320550","BD  PEN NEEDL","MIS 32GX5\/32","100","Select","Select",""],["","00002143380","TRULICITY","INJ 0.75\/0.5","2","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","00378456105","POT  CHLORIDE","TAB 10MEQ ER","15","Select","Select",""],["","70010049105","METFORMIN","ER ORAL TAB","30","Select","Select",""],["","59762033302","LATANOPROST","SOL 0.00005","2.5","Select","Select",""],["","00781569031","EZETIMIBE","TAB 10MG","90","Select","Select",""],["","55111012205","ATORVASTATIN","TAB 20MG","30","Select","Select",""],["","29300012810","HYDROCHLOROT","TAB 25MG","30","Select","Select",""],["","00193731221","CONTOUR","TES NEXT","100","Select","Select",""],["","00193658621","MICROLET","MIS LANCETS","100","Select","Select",""],["","00054429731","FUROSEMIDE","TAB 20MG","15","Select","Select",""],["","00002822259","INSULIN","INJ 100\/ML","6","Select","Select",""],["","68462043890","OLMESA","TAB 40MG","30","Select","Select",""],["","31722052201","HYDRALAZINE","TAB 100MG","60","Select","Select",""],["","00088221905","LANTUS","INJ 100\/ML","15","Select","Select",""],["","11917017096","VITAMIN","CAP 2000UNIT","30","Select","Select",""],["","68462016505","CARVEDILOL","TAB 25MG","60","Select","Select",""],["","43547033810","BENAZEPRIL","TAB 40MG","90","Select","Select",""],["","65862017760","CEFDINIR","CAP 300MG","14","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","64380071206","BENZONATATE","CAP 100MG","30","Select","Select",""],["","65862001105","SERTRALINE","TAB 25MG","30","Select","Select",""],["","68180047301","AMLOD\/BENAZP","CAP 10-40MG","30","Select","Select",""],["","00093031401","KETOROLAC","TAB 10MG","10","Select","Select",""],["","55111012701","CIPROFLOXACN","TAB 500MG","14","Select","Select",""],["","68462010805","TOPIRAMATE","TAB 25MG","45","Select","Select",""],["","45963067611","METOPROL","TAB 50MG ER","30","Select","Select",""],["","51672208001","TERBINAFINE","CRE 0.01","15","Select","Select",""],["","00185012201","NITROFURANTN","CAP 100MG","10","Select","Select",""],["","00378427577","VALACYCLOVIR","TAB 500MG","6","Select","Select",""],["","57237000511","FLUCONAZOLE","TAB 150MG","2","Select","Select",""],["","50111033402","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","00093314705","CEPHALEXIN","CAP 500MG","21","Select","Select",""],["","00574200830","NYSTOP","POW 100000","60","Select","Select",""],["","00378108601","COLCHICINE","TAB 0.6MG","14","Select","Select",""],["","57664053788","TRAMADL\/APAP","TAB 37.5-325","21","Select","Select",""],["","00781618556","TRAVOPROST","DRO 0.00004","5","Select","Select",""],["","62037071001","POT  CL MICRO","TAB 10MEQ CR","30","Select","Select",""],["","16729013401","ALLOPURINOL","TAB 100MG","30","Select","Select",""],["","68462010530","ONDANSETRON","TAB 4MG","60","Select","Select",""],["","00093101042","MUPIROCIN","OIN 0.02","22","Select","Select",""],["","08271036100","LANCETS","MIS THIN","100","Select","Select",""],["","11917014486","BP","MIS WRIST","1","Select","Select",""],["","","IBUPROFEN","TAB 800MG","40","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","14","Select","Select",""],["","65162062711","TRAMADOL","TAB 50MG","14","Select","Select",""],["","68462019005","NAPROXEN","TAB 500MG","30","Select","Select",""],["","00406012305","HYDROCO\/APAP","TAB 5-325MG","30","Select","Select",""],["","00116200116","CHLORHEX","SOL 0.0012","473","Select","Select",""],["","70010075401","METHOCARBAM","TAB 500MG","60","Select","Select",""],["","","ACETAMIN","TAB 500MG","120","Select","Select",""],["","45963067611","METOPROLOL","TAB 50MG ER","30","Select","Select",""],["","00781808926","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","45802065087","LORATADINE","TAB 10MG","30","Select","Select",""],["","00591544210","PREDNISONE","TAB 10MG","10","Select","Select",""],["","65162010250","GABAPENTIN","CAP 300MG","81","Select","Select",""],["","65862001705","AMOXICILLIN","CAP 500MG","21","Select","Select",""],["","00143962125","CYANOCOBALAM","INJ 1000MCG","2","Select","Select",""],["","31604002674","D3","TAB 2000UNIT","30","Select","Select",""],["","52817033200","CYCLOBENZAPR","TAB 10MG","20","Select","Select",""],["","00527133001","BACLOFEN","TAB 10MG","30","Select","Select",""],["","00406048410","APAP\/CODEINE","TAB 300-30MG","16","Select","Select",""],["","62332041510","OSELTAMIVIR","CAP 75MG","10","Select","Select",""],["","68180072003","AMLODIPINE","TAB 5MG","90","Select","Select",""],["","55111017915","TIZANIDINE","TAB 2MG","15","Select","Select",""],["","16571020150","DICLOFENAC","TAB 75MG DR","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":{"indx":[["","",""],[""],[""],[""],[""]],"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":""}]}]}