{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CHRISTINA   M TRETICK","gend":1,"add":"3113 TURNER ROAD","city":"CHESTERFIELD","state":"VA","zip":"23832-8454","dob":"1984-10-28","age":"","mstatus":"","insh":6599335,"cliId":"","pno":8043071630,"cno":8046658341,"email":"","ename":"","eno":"","pphy":"PENDYAL, KAUSALYA","ppno":8045600490,"pcpadd":"500 Hioaks Rd, Ste B","pcpcity":"Richmond","pcpstate":"VA","pcpzip":232254061,"pcpcounty":"","pcpid":"","pcpname":"PRIMARY HEALTH GROUP INC","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"3113 Turner Rd","madd2":"","madd3":"","mcity":"Chesterfield","mstate":"VA","mzip":"23832-8454","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F11.20","G89.4","Z33.1","K50.90","O24.912","K56.609","Z3A.16","O99.612","K50.012","M06.9","Z85.3","Z87.891","Z90.13","Z96.641","Z98.890","Z79.2","R10.9","R10.84","R94.5","O26.892","Z3A.17","K59.00","F17.210","O09.522","K56.50","O99.322","O99.332","O99.352","Z86.32","F17.200","G89.29","K50.919","M05.79","J34.89","C50.412","Z11.3","Z12.4","R87.810","O09.212","Z3A.20","Z3A.21","Z3A.22","J30.9","J34.3","O99.89","Z3A.23","Z3A.24","F41.9","I49.9","R05","R06.02","Z3A.26","O99.512","O26.891","R19.7","Z3A.01","E11.9","Z79.4","Z3A.27","R06.2","N89.8","B37.3","L53.9","A60.9","O09.523","O99.323","Z3A.28","O42.913","O42.919","O41.1230","Z37.0","O99.324","O99.354","F32.9","Z3A.30","O99.334","R07.9","J98.11","Z3A.31","O42.113","O80","I20.0","R93.3","O90.89","R07.89","Z86.14","N81.10","F43.20","P28.4","P78.2","P04.14","P07.34","P00.89","R01.1","D64.9","K21.9","C50.912","N65.0","Z15.01","F90.2","F39","D22.9","F31.9","L60.1","M79.645","R10.30","R11.2","N20.0","S63.642A","L30.9","Z87.828","L40.9","L21.9","K56.600","R18.8","Z68.1","D84.821","K52.9","I95.9","K66.0","R63.6","J45.909","F41.8","K63.89","R10.12","R11.0","M19.90","Z87.11","Z79.899","M79.609","N63.21","Z85.79","Z98.82","Z92.21","Z92.25","K50.912","Z20.822","K56.690","K56.699","Z98.0","K08.89","R68.84","F13.20","C50.919","E87.1","D72.829","Z79.891","Z88.8","F11.10","K50.812","Z86.2","Z86.39","Z23","Z39.1","Z34.82","Z34.83","N39.0","Z96.649","Z90.49","Z91.19","K50.019","Z01.812","N65.1","R00.0","T85.44XA","Z83.2","G47.00","Z53.20","K59.03","T40.4X5A","Z17.1","R42","R68.83","K50.80","Z51.81","R11.10","R10.33","O21.0","O99.611","O21.9","O99.331","Z3A.08","Z3A.11","K72.00","O99.281","E87.6","O99.341","Z80.3"],"date":["2022-03-25","2022-03-24","2020-04-28","2022-03-02","2020-03-31","2021-11-18","2020-01-09","2020-03-31","2022-01-28","2021-11-18","2022-01-27","2020-01-09","2022-01-27","2022-01-27","2020-01-09","2020-01-09","2022-01-27","2020-01-19","2020-01-21","2020-03-25","2020-01-21","2022-03-02","2021-02-23","2020-02-11","2020-01-17","2020-03-11","2020-03-31","2020-01-17","2020-01-17","2022-01-29","2022-01-27","2021-06-06","2020-09-10","2020-01-21","2020-02-05","2020-02-06","2020-02-06","2020-02-06","2020-04-01","2020-02-14","2020-02-20","2020-02-27","2020-02-28","2020-02-28","2020-04-26","2020-03-05","2020-03-11","2022-03-24","2020-04-26","2020-03-25","2020-03-25","2020-03-25","2020-03-25","2020-03-31","2020-03-31","2020-03-31","2020-03-31","2020-03-31","2020-03-31","2020-03-31","2020-11-09","2020-04-01","2020-04-01","2020-11-09","2020-04-10","2020-04-30","2020-04-10","2020-04-30","2020-05-03","2020-05-03","2020-05-03","2020-04-26","2020-04-26","2021-02-20","2020-04-26","2020-04-26","2020-05-05","2020-05-05","2020-05-03","2020-05-03","2020-05-03","2020-05-05","2022-01-28","2020-05-05","2020-05-05","2020-05-21","2020-05-26","2020-05-29","2020-06-21","2020-06-21","2020-06-23","2020-06-23","2020-06-22","2020-06-21","2021-11-20","2021-02-20","2021-01-08","2020-08-12","2022-01-27","2022-03-24","2022-03-24","2020-09-10","2020-09-10","2020-09-10","2020-09-10","2020-09-23","2022-01-28","2020-09-23","2020-09-29","2020-12-09","2020-12-09","2020-12-28","2020-12-28","2022-01-27","2021-02-20","2021-02-20","2021-02-20","2021-02-20","2021-02-20","2021-02-20","2021-02-20","2021-02-20","2021-02-23","2022-01-27","2021-06-06","2021-06-06","2021-06-06","2021-06-06","2022-03-02","2021-06-07","2021-07-21","2021-07-21","2021-07-21","2021-07-21","2022-01-28","2022-01-29","2022-01-27","2021-09-05","2021-09-05","2021-09-05","2021-10-08","2021-10-10","2022-03-18","2021-11-18","2021-11-18","2022-01-27","2022-01-27","2021-11-18","2022-01-29","2022-03-02","2022-03-02","2022-03-02","2022-03-02","2019-02-04","2019-02-04","2019-02-04","2019-02-10","2019-02-10","2019-12-05","2019-11-07","2019-02-10","2019-03-11","2019-03-19","2019-03-19","2019-03-19","2019-03-28","2019-04-09","2019-04-09","2019-04-09","2019-04-09","2019-04-09","2019-07-01","2019-07-01","2019-07-11","2019-07-11","2019-08-31","2019-11-07","2019-11-07","2019-12-05","2019-11-07","2019-11-07","2019-11-07","2019-12-05","2019-12-05","2019-12-05","2019-12-05","2019-12-05","2019-12-05"],"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":{"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":[["","00074055402","HUMIRA","INJ 40\/0.4ML","2","Select","Select",""],["","00781261305","AMOXICILLIN","CAP 500MG","30","Select","Select",""],["","00406048410","APAP\/CODEINE","TAB 300-30MG","16","Select","Select",""],["","00603533831","PREDNISONE","PAK 10MG","48","Select","Select",""],["","50428026496","CVS","TAB 8.6MG","30","Select","Select",""],["","67877032105","IBUPROFEN","TAB 800MG","30","Select","Select",""],["","12496120803","SUBOXONE","MIS 8-2MG","5","Select","Select",""],["","69097083412","SERTRALINE","TAB 50MG","30","Select","Select",""],["","00093083205","CLONAZEPAM","TAB 0.5MG","14","Select","Select",""],["","71225010501","HYDROXYPROG","INJ 250MG\/ML","4","Select","Select",""],["","10370010250","BUPROPN","TAB 300MG XL","30","Select","Select",""],["","60505283303","ATOMOXETINE","CAP 40MG","30","Select","Select",""],["","68180095601","CLOBETASOL","CRE 0.0005","15","Select","Select",""],["","00093031401","KETOROLAC","TAB 10MG","12","Select","Select",""],["","00591354360","BUPROPION","TAB 150MG SR","30","Select","Select",""],["","66993087761","CALCIPOTRIEN","CRE 0.00005","120","Select","Select",""],["","52565004230","NYSTAT\/TRIAM","OIN ","60","Select","Select",""],["","60432056161","TRIAMCINOLON","LOT 0.001","60","Select","Select",""],["","42858010201","OXYCOD\/APAP","TAB 5-325MG","5","Select","Select",""],["","66689000816","NYSTATIN","SUS 100000","600","Select","Select",""],["","16714008210","HYDROXYZ","TAB 25MG","90","Select","Select",""],["","45802046564","KETOCONAZOLE","SHA 0.02","120","Select","Select",""],["","50102091101","ELLA","TAB 30MG","1","Select","Select",""],["","65862092585","INCASSIA","TAB 0.35MG","28","Select","Select",""],["","69452015120","VITAMIN","CAP 50000UNT","4","Select","Select",""],["","00093101042","MUPIROCIN","OIN 0.02","22","Select","Select",""],["","51991018142","FERROCITE","TAB 324MG","30","Select","Select",""],["","65862039010","ONDANSETRON","TAB 4MG ODT","20","Select","Select",""],["","00832105410","BACLOFEN","TAB 10MG","90","Select","Select",""],["","31722070430","VALACYCLOVIR","TAB 500MG","6","Select","Select",""],["","65862022701","LAMOTRIGINE","TAB 25MG","45","Select","Select",""],["","65862050320","AMOX\/K","TAB 875-125","20","Select","Select",""],["","00574060801","FERROUS","TAB 324MG EC","30.00","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","12","Select","Select",""],["","00115165903","PROPRANOLOL","TAB 10MG","30","Select","Select",""],["","81131013836","INSULIN","MIS 0.5\/31G","30","Select","Select",""],["","47781035703","BUPREN\/NALOX","MIS 8-2MG","30","Select","Select",""],["","68382004001","PROMETHAZINE","TAB 12.5MG","90","Select","Select",""],["","99073070827","FREESTYLE    TES LITE","TES LITE","100","Select","Select",""],["","00527058601","DICYCLOMINE","CAP 10MG","30","Select","Select",""],["","50383079516","LACTULOSE","SOL 10GM\/15","180","Select","Select",""],["","68180012101","CEPHALEXIN","CAP 250MG","28","Select","Select",""],["","00002831501","HUMULIN","INJ U-100","10","Select","Select",""],["","99073013001","FREESTYLE    MIS LANCETS","MIS LANCETS","100","Select","Select",""],["","42858050203","BUPRENORPHIN","SUB 8MG","30","Select","Select",""],["","69097081312","GABAPENTIN","CAP 100MG","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":""}]}]}