{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DAWN   M LEIBLE","gend":1,"add":"10718 BENT TREE DRIVE                                       ","city":"FREDERICKSBURG                ","state":"VA","zip":"22407-1625","dob":"1980-08-24","age":"","mstatus":"","insh":6283678,"cliId":"","pno":5403886238,"cno":"","email":"","ename":"","eno":"","pphy":"BREEN, JACQUELINE M","ppno":5403700295,"pcpadd":"5825 Plank Rd Ste 105                                       ,                                                            ","pcpcity":"Fredericksburg                ","pcpstate":"VA","pcpzip":224075207,"pcpcounty":"","pcpid":"","pcpname":"MARY WASHINGTON MEDICAL GROUP PEDIATRICS","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"CENTRAL","aligned":"","ano":"","add2":"10718 BENT TREE DRIVE                                       ","add3":"","madd1":"10718 BENT TREE DRIVE                                       ","madd2":"                                                            ","madd3":"","mcity":"FREDERICKSBURG                ","mstate":"VA","mzip":"22407-1625","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["B86","R21","T78.40XA","F98.8","B37.2","L24.5","F22","F41.9","R53.83","R51","G47.00","L51.1","R68.83","R61","R09.81","R07.0","F90.9","R19.00","B00.1","L28.0","L30.9","F11.20","F10.20","H10.9","L29.9","D18.00","L66.3","L85.3","L56.2","F33.1","F41.1","F33.9","F90.2","H57.89","Q61.3","Z98.890","H10.523","H10.023","B37.81","R09.82","R05","K12.0","J02.9","K12.1","D22.5","D23.72","L70.0","R11.10","R11.2","B37.0","L01.01","R60.9","N13.0","N13.9","N12","D72.829","N13.6","I87.8","M41.9","N83.209","Z98.51","Z87.442","Z20.822","N20.0","N39.0","N20.2","N13.30","N20.1","N10","N13.2","S05.02XA","H10.33","X58.XXXA","Y92.89","Y93.89","H57.13","Z23","B02.8","H10.012","H16.142","S05.01XA","B88.0","Z87.2","H10.013","H16.143","S05.02XD","H04.123","H16.9","H40.053","H01.02B","H01.02A","S05.00XA","R53.1","L97.119","R10.9","N30.01","R30.0","B37.3","R31.9","J01.10","H10.31","J30.1"],"date":["2020-02-03","2021-08-02","2020-04-01","2020-01-18","2020-01-16","2020-01-18","2021-05-10","2021-05-10","2020-01-18","2020-01-19","2020-01-18","2020-01-18","2020-01-18","2020-01-18","2020-01-18","2020-01-18","2021-02-03","2020-01-19","2020-01-19","2020-01-19","2021-07-06","2020-02-25","2020-02-25","2021-01-21","2021-08-02","2020-03-18","2020-08-10","2020-03-18","2020-04-01","2020-04-02","2022-01-25","2022-01-25","2022-01-25","2020-07-04","2021-03-09","2020-06-29","2020-07-03","2020-07-04","2020-07-04","2020-07-04","2020-07-04","2021-07-06","2020-07-18","2021-07-06","2020-08-10","2020-08-10","2020-08-10","2020-10-23","2020-10-23","2022-01-18","2021-06-29","2021-01-06","2021-02-03","2021-02-04","2021-02-03","2021-02-04","2021-02-03","2021-02-03","2021-02-03","2021-02-03","2021-02-03","2021-02-03","2021-02-03","2021-02-03","2021-02-04","2021-02-03","2021-02-03","2021-02-04","2021-02-04","2021-02-04","2021-07-29","2021-03-09","2021-07-29","2021-04-20","2021-04-20","2021-04-20","2021-03-09","2021-04-03","2021-04-03","2021-04-28","2021-07-29","2021-04-20","2021-04-20","2021-09-05","2021-05-03","2021-04-28","2021-06-02","2021-06-02","2021-06-02","2021-05-21","2021-05-21","2021-07-29","2021-07-29","2021-08-02","2022-01-18","2022-01-18","2022-01-18","2022-01-18","2019-03-20","2019-10-05","2019-10-05","2019-10-05"],"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":{"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":[["","75826011410","PHENAZOPYRID","TAB 100MG","15","Select","Select",""],["","66689000802","NYSTATIN","SUS 100000","200","Select","Select",""],["","69315030805","CIPROFLOXACN","SOL 0.3% OP","5","Select","Select",""],["","57237001401","TAMSULOSIN","CAP 0.4MG","7","Select","Select",""],["","68382003616","VENLAFAXINE","CAP 150MG ER","30","Select","Select",""],["","50111056001","TRAZODONE","TAB 50MG","60","Select","Select",""],["","65862048901","QUETIAPINE","TAB 25MG","30.00","Select","Select",""],["","60505056000","OFLOXACIN","DRO 0.3% OP","5","Select","Select",""],["","45802011222","MUPIROCIN","OIN 0.02","22","Select","Select",""],["","24208091055","ERYTHROMYCIN","OIN 5MG\/GM","3.5","Select","Select",""],["","59417010710","VYVANSE","CAP 70MG","30","Select","Select",""],["","00093768432","OLOPATADINE","SOL 0.002","2.5","Select","Select",""],["","00603533831","PREDNISONE","PAK 10MG","48","Select","Select",""],["","24208067004","SOD","SOL 10% OP","15","Select","Select",""],["","31722070530","VALACYCLOVIR","TAB 1GM","21","Select","Select",""],["","24208083060","NEO\/POLY\/DEX","SUS 0.1% OP","5","Select","Select",""],["","53489011802","DOXYCYCL","CAP 50MG","30","Select","Select",""],["","60758011905","PREDNISOLONE","SUS 1% OP","5","Select","Select",""],["","59651017301","DOXEPIN","CAP 10MG","90","Select","Select",""],["","65862039010","ONDANSETRON","TAB 4MG ODT","20","Select","Select",""],["","60505100301","KETOROLAC","SOL 0.005","5","Select","Select",""],["","00093005805","TRAMADOL","TAB 50MG","12","Select","Select",""],["","47781030301","NITROFURANTN","CAP 100MG","6","Select","Select",""],["","42858010201","OXYCOD\/APAP","TAB 5-325MG","20","Select","Select",""],["","50111091601","TORSEMIDE","TAB 10MG","30","Select","Select",""],["","65862084003","MOXIFLOXACIN","SOL HCL 0.5%","3","Select","Select",""],["","42799080601","IVERMECTIN","TAB 3MG","10","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","30","Select","Select",""],["","45802026937","PERMETHRIN","CRE 0.05","60","Select","Select",""],["","00116200116","CHLORHEX","SOL 0.0012","473","Select","Select",""],["","61314063305","GENTAMICIN","SOL 0.3% OP","5","Select","Select",""],["","50458058701","CONCERTA","TAB 54MG","30","Select","Select",""],["","10702001150","HYDROXYZ","TAB 25MG","60","Select","Select",""],["","63736012002","NIX","LIQ 0.01","59","Select","Select",""],["","52565004215","NYSTAT\/TRIAM","OIN ","15","Select","Select",""],["","69097085902","TERBINAFINE","TAB 250MG","14","Select","Select",""],["","51672125903","CLOBETASOL","OIN 0.0005","60","Select","Select",""],["","00472033730","HYDROCORT","CRE 0.025","30","Select","Select",""],["","49884051303","MINOCYCLINE","TAB 100MG","60","Select","Select",""],["","45802091987","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","68180065208","DOXYCYC","CAP 100MG","20","Select","Select",""],["","50383077504","LIDOCAINE","SOL 2% VISC","100","Select","Select",""],["","00054414622","CLOTRIMAZOLE","TRO 10MG","70","Select","Select",""],["","51672416403","METRONIDAZOL","GEL 0.01","60","Select","Select",""],["","65162052110","PROMETHAZINE","TAB 25MG","20","Select","Select",""],["","68462079817","TRIAMCINOLON","OIN 0.005","15","Select","Select",""],["","16729013700","CLONAZEPAM","TAB 1MG","60","Select","Select",""],["","13668001005","CITALOPRAM","TAB 20MG","30","Select","Select",""],["","16571020106","DICLOFENAC","TAB 75MG DR","20","Select","Select",""],["","50111078710","AZITHROMYCIN","TAB 250MG","5","Select","Select",""],["","16714048202","LORATADINE","TAB 10MG","30","Select","Select",""],["","65862053820","LEVOFLOXACIN","TAB 750MG","5","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":""}]}]}