{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KIMBERLY BONIN","gend":1,"add":"311 S HIGH STREET","city":"FRANKLIN","state":"VA","zip":"23851-1632","dob":"1981-01-23","age":"","mstatus":"","insh":6860732,"cliId":"","pno":7577408032,"cno":"","email":"","ename":"","eno":"","pphy":"HASHMI, AFREEDA","ppno":7575622158,"pcpadd":"106 Fairview Dr Ste A, ","pcpcity":"Franklin","pcpstate":"VA","pcpzip":238511235,"pcpcounty":"","pcpid":"","pcpname":"SOUTHAMPTON FAMILY PRACTICE","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"311 S HIGH STREET","madd2":"","madd3":"","mcity":"FRANKLIN","mstate":"VA","mzip":"23851-1632","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["L02.11","L72.9","F31.9","F17.210","Z91.030","Z91.040","Z91.09","M54.17","G89.29","M54.5","Z72.0","M25.551","M79.672","S90.32XA","S99.922A","X50.1XXA","Y93.41","Z79.899","K21.9","J45.909","X50.0XXA","M25.475","G56.01","M72.2","S93.412A","M65.872","J45.21","R06.02","R07.9","R51.9","J18.9","Z20.828","Z79.1","Z79.51","J45.901","D72.829","R00.0","R06.03","R05","R06.2","R07.89","F12.99","F31.0","S61.012A","W26.0XXA","R00.2","I83.813","F17.290","I25.10","M54.9","R53.83","R11.2","Z20.822","I87.2","O99.511","J45.31","J06.9","Z3A.00","U07.1","Z32.01","O09.521","Z3A.01","Z36.89","Z03.818","O09.511","N92.6","Z86.32","Z3A.11","O23.12","O23.592","N76.0","B96.89","Z3A.15","O26.892","O99.332","N30.00","B76.0","J44.9","Z3A.16","Z72.89","Z91.048","R10.2","Z36.3","O09.529","Z3A.19","B37.3","M62.08","O71.89","O26.893","R10.33","K59.00","O99.333","O99.613","Z3A.28","Z3A.27","O09.92","O09.93","O40.3XX1","R10.9","Z3A.30","K42.9","Z3A.31","O09.523","O40.9XX0","Z3A.33","M77.11","M67.432","M77.02","M77.01","S56.511A","X58.XXXA","F17.200","G43.909","R51","R68.89","Z00.01","R58","F41.9","M67.471","D72.820","N32.81","Z01.419","Z11.3","Z11.8","Z13.89","R61","N94.3","Z30.41","J02.9","F31.81","G47.00","M62.838","F32.9"],"date":["2020-05-10","2020-05-10","2021-11-10","2021-09-16","2022-03-01","2022-03-01","2020-05-10","2020-06-10","2020-06-10","2020-06-12","2020-06-10","2020-06-12","2021-01-26","2020-09-03","2020-09-03","2020-09-03","2020-09-03","2021-09-16","2021-09-16","2021-06-25","2020-09-03","2021-01-26","2020-11-10","2021-01-26","2020-12-15","2020-12-15","2021-09-16","2021-06-21","2021-06-25","2021-11-30","2021-06-21","2020-12-19","2021-09-13","2020-12-19","2020-12-19","2020-12-19","2021-06-21","2020-12-19","2021-09-16","2021-09-13","2021-07-27","2021-02-05","2021-09-13","2021-03-16","2021-03-16","2021-07-27","2021-06-23","2021-07-27","2021-05-27","2022-03-20","2021-06-25","2021-06-25","2021-11-30","2021-07-27","2021-09-13","2021-09-13","2021-09-13","2022-03-31","2021-09-13","2021-09-16","2021-10-11","2021-10-11","2021-10-11","2021-10-20","2021-11-10","2021-11-10","2021-11-10","2021-11-10","2021-11-30","2021-11-30","2022-03-02","2021-11-30","2021-11-30","2021-11-30","2021-11-30","2021-11-30","2021-11-30","2021-11-30","2021-11-30","2021-11-30","2022-03-01","2021-11-30","2022-01-03","2022-01-03","2022-01-03","2022-02-14","2022-03-01","2022-03-01","2022-03-20","2022-03-01","2022-03-01","2022-03-01","2022-03-01","2022-03-01","2022-03-02","2022-03-14","2022-04-07","2022-03-14","2022-03-25","2022-03-25","2022-03-25","2022-03-30","2022-03-30","2022-03-31","2022-04-07","2019-01-31","2019-01-08","2019-01-11","2019-01-11","2019-01-31","2019-01-31","2019-07-23","2019-07-23","2019-12-25","2019-07-23","2019-06-10","2019-06-10","2019-07-23","2019-06-10","2019-07-23","2019-07-23","2019-08-29","2019-08-29","2019-08-29","2019-08-29","2019-08-29","2019-08-29","2019-08-29","2019-10-04","2019-11-08","2019-11-08","2019-12-25","2019-12-25"],"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":[["","68180087613","NORETHINDRON","TAB 0.35MG","28","Select","Select",""],["","65862052730","VENLAFAXINE","CAP 37.5 ER","30","Select","Select",""],["","68645052254","SERTRALINE","TAB 50MG","30","Select","Select",""],["","29300011516","TOPIRAMATE","TAB 25MG","30","Select","Select",""],["","31722071390","PANTOPRAZOLE","TAB 40MG","90","Select","Select",""],["","10702000709","CYCLOBENZAPR","TAB 10MG","30","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","69543038810","KETOROLAC","TAB 10MG","15","Select","Select",""],["","65162083366","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","65162047810","NITROFURANTN","CAP 100MG","14.00","Select","Select",""],["","50111033402","METRONIDAZOL","TAB 500MG","20","Select","Select",""],["","13668021830","ARIPIPRAZOLE","TAB 10MG","30","Select","Select",""],["","00093005405","BUSPIRONE","TAB 10MG","90","Select","Select",""],["","29300011101","LAMOTRIGINE","TAB 25MG","180","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","68462015713","ONDANSETRON","TAB 4MG ODT","14","Select","Select",""],["","68382005105","MELOXICAM","TAB 15MG","30","Select","Select",""],["","50111078751","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","42806054701","VITAMIN","CAP 1.25MG","4","Select","Select",""],["","31722099601","HYDROCO\/APAP","TAB 5-325MG","6.00","Select","Select",""],["","42806031250","DOXYCYCL","TAB 100MG","14","Select","Select",""],["","51672130200","TERCONAZOLE","CRE 0.008","20.00","Select","Select",""],["","67877021905","CEPHALEXIN","CAP 500MG","14","Select","Select",""],["","43598075205","BUPROPION","TAB 150MG SR","60","Select","Select",""],["","42858010201","OXYCOD\/APAP","TAB 5-325MG","15","Select","Select",""],["","68645056259","IBUPROFEN","TAB 600MG","18","Select","Select",""],["","55111014512","FLUCONAZOLE","TAB 150MG","1","Select","Select",""],["","00000000000",""," ","360","Select","Select",""],["","42192060716","BROM\/PSE\/DM","SYP ","120","Select","Select",""],["","00185061501","HYDROXYZ","CAP 50MG","30","Select","Select",""],["","00054001829","PREDNISONE","TAB 20MG","10","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","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":""}]}]}