{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DESERAE D PROFITT","gend":1,"add":"209 OSAGE AVE NE  ","city":"NORTON","state":"VA","zip":"24273-9998","dob":"1994-11-18","age":"","mstatus":"","insh":11002977,"cliId":"3WF8UE1TG50","pno":2763250240,"cno":2763250240,"email":"","ename":"","eno":"","pphy":"NICHOLS, TIFFANI MARIA  ","ppno":2766798890,"pcpadd":"716 Spring Ave SE Ste 204","pcpcity":"Wise  ","pcpstate":"VA","pcpzip":242935702,"pcpcounty":"","pcpid":"P9058558","pcpname":"COMMUNITY PHYSICIANS WISE","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"SOUTHWEST","aligned":"Y","ano":"","add2":"","add3":"","madd1":"209 OSAGE AVE NE  ","madd2":"","madd3":"","mcity":"NORTON","mstate":"VA","mzip":"24273-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["Z00.00","Z87.01","R13.10","K59.00","E87.8","Z43.1","G80.9","J18.9","R39.81","R15.9","G82.50","Z99.3","H16.123","B02.9","G40.909","K21.9","J30.9","Z79.899","E87.6","G40.B19","G47.33","G80.0","H54.3","H73.92","H93.91","J30.2","K08.409","K11.7","N94.4","R09.89","R32","R47.1","R63.0","Z74.01","Z93.1","G40.309","Z23","D72.1","F88","F79","H61.23","F72","H60.63","G00.9","K59.09","R06.00","R56.9","E53.8","Z93.4","R06.89","G06.2","L72.3","M60.08"],"date":["2020-06-29","2020-06-29","2021-08-19","2020-06-29","2020-06-29","2020-08-03","2021-08-19","2020-08-03","2019-12-22","2021-09-20","2021-09-20","2021-09-20","2021-05-13","2019-07-23","2021-08-19","2021-02-05","2021-02-05","2020-07-31","2018-08-21","2018-08-21","2018-08-21","2018-08-21","2018-08-21","2018-08-21","2018-08-21","2018-08-21","2018-08-21","2018-08-21","2018-08-21","2018-08-21","2019-12-22","2018-08-21","2018-08-21","2018-08-21","2018-08-21","2018-08-22","2021-10-21","2019-10-10","2019-10-10","2021-08-08","2019-12-10","2021-11-10","2019-12-10","2020-04-02","2018-06-15","2021-08-19","2021-08-08","2021-08-19","2021-08-19","2021-08-19","2021-10-21","2021-10-21","2021-11-10"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",null,"","","","","","","","","","",null]}},{"a":[]}]},{"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":{"indx":["","",""],"comment":["","",""],"sub":[]}},{"a":{"indx":["","",""],"comment":["","",""],"sub":[]}}]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","13517010716","PHENOBARB","ELX 20MG\/5ML","","Select","Select",""],["","23155060601","GLYCOPYRROL","TAB 1MG","","Select","Select",""],["","54318863","DIAZEPAM","SOL 5MG\/5ML","","Select","Select",""],["","409713809","SODIUM CHLOR","SOL 0.9% IRR","","Select","Select",""],["","31722072610","MONTELUKAST","TAB 10MG","","Select","Select",""],["","70710128501","BACLOFEN","TAB 10MG","","Select","Select",""],["","603154258","POT CHLORIDE","SOL 0.1","","Select","Select",""],["","24208029505","TOBRA\/DEXAME","SUS 0.3-0.1%","","Select","Select",""],["","69097031987","BUDESONIDE","SUS 0.5MG\/2","","Select","Select",""],["","54838055080","RANITIDINE","SYP 75MG\/5ML","","Select","Select",""],["","68180015001","FAMOTIDINE","SUS 40MG\/5ML","","Select","Select",""],["","57237004330","VALACYCLOVIR","TAB 1GM","","Select","Select",""],["","33332032001","AFLURIA QUAD","INJ 2020-21","","Select","Select",""],["","409713909","STERIL WATER","SOL IRRIG","","Select","Select",""],["","43386016801","POT  CHLORIDE","SOL 0.1","473","Select","Select",""],["","70710128501","BACLOFEN ","TAB 10MG","180","Select","Select",""],["","24208029505","TOBRA\/DEXAME ","SUS 0.3-0.1%","5","Select","Select",""],["","13517010716","PHENOBARB ","ELX 20MG\/5ML","1,400.00","Select","Select",""],["","23155060601","GLYCOPYRROL ","TAB 1MG","180","Select","Select",""],["","31722072610","MONTELUKAST ","TAB 10MG","30","Select","Select",""],["","54318863","DIAZEPAM ","SOL 5MG\/5ML","300","Select","Select",""],["","69097031987","BUDESONIDE ","SUS 0.5MG\/2","60","Select","Select",""],["","338004804","SODIUM ","SOL 0.9% IRR","12,000.00","Select","Select",""],["","121072716","RANITIDINE ","SYP 75MG\/5ML","473","Select","Select",""],["","33332032001","AFLURIA ","INJ 2020-21","0.5","Select","Select",""],["","68180015001","FAMOTIDINE ","SUS 40MG\/5ML","150","Select","Select",""],["","57237004330","VALACYCLOVIR ","TAB 1GM","30","Select","Select",""],["","409713909","STERIL ","SOL IRRIG","36,000.00","Select","Select",""],["","00338004804","SODIUM","0.9% IRR","12,000.00","Select","Select",""],["","33332032001","AFLURIA","2020-21","0.5","Select","Select",""],["","00409713909","STERIL","IRRIG","36,000.00","Select","Select",""],["","60432006500","AMOX\/K ","SUS 250\/5ML","400","Select","Select",""],["","00143928501","AMOXICILLIN ","TAB 875MG","14","Select","Select",""]]}},{"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":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[[["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""]]]},{"t":"Mini-Cog","q":[{"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":""}]}]}