{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LISA G SMITH","gend":1,"add":"2126 BELVIN PLACE","city":"HAYES","state":"VA","zip":230729999,"dob":"1969-01-03","age":"","mstatus":"","insh":11005975,"cliId":"7UF6Q22JG40","pno":7577596143,"cno":8044132448,"email":"","ename":"","eno":"","pphy":"BARRON, NATALIE A","ppno":7579685700,"pcpadd":"2855 Denbigh Blvd Ste A","pcpcity":"Grafton","pcpstate":"VA","pcpzip":236926501,"pcpcounty":"","pcpid":"P9058943","pcpname":"PATRIOT PRIMARY CARE","plan":"VPHP - VIRGINIA PREMIER","program":"Medicare","lob":"DSNP","region":"TIDEWATER","aligned":"N","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["L89.159","I63.00","Z93.0","J96.11","R39.81","R15.9","G83.5","J96.10","Z43.0","L22","R53.2","M62.81","J95.00","I50.9","J96.22","G82.50","J95.09","N39.0","R06.02","J96.21","J40","K21.9","G89.4","Z74.01","Z86.73","Z87.891","Z93.1","I45.81","R79.1","I10","R27.9","Z03.89","J96.00","Z43.1","I69.365","L89.153","Z48.00","I69.315","J44.9","J41.1","J18.9","R33.9","N31.9","R82.90","R09.02","K94.23","K59.00","Z12.11","I95.2","E46","Z82.49","Z83.3","Z86.14","Z88.1","Z88.2","Z88.6","I63.9","F41.9","E66.9","Z92.29","G89.29","K59.03","T40.2X5A","R06.9","R11.2","R05","R07.9","Z79.899","R50.9","J43.9","J95.03","R13.13","E55.9","H61.23","Z98.890","F05","M51.36","Z87.440","Z99.81","T85.598A","I69.391","J45.909","Z91.81","R30.0","Z23","N30.00","A41.59","X58.XXXA","B02.9","E87.2","Z66","E87.1","M79.89","S40.812A","R13.10","K59.09","A41.9","B96.4","B99.9","L53.9","I69.354"],"date":["2020-04-29","2021-05-29","2021-05-30","2021-05-29","2021-06-11","2021-06-11","2021-06-11","2020-12-26","2021-05-26","2021-06-11","2021-05-29","2021-05-29","2021-05-29","2019-01-27","2019-01-27","2021-03-29","2020-12-19","2020-12-28","2019-06-25","2019-01-27","2019-01-27","2021-05-05","2019-01-27","2019-01-27","2020-09-23","2020-12-19","2021-02-09","2019-01-27","2019-01-27","2020-12-26","2020-12-29","2019-01-27","2019-01-30","2021-05-26","2021-05-26","2021-05-26","2019-02-03","2019-02-03","2021-02-12","2021-03-29","2020-05-29","2019-03-08","2019-03-08","2019-03-27","2020-12-18","2021-05-05","2021-05-05","2020-04-27","2019-04-30","2019-05-08","2019-05-08","2019-05-08","2020-12-19","2019-05-08","2019-05-08","2019-05-08","2021-06-29","2020-12-26","2020-08-19","2020-08-19","2020-09-22","2020-12-22","2020-12-22","2019-06-25","2019-06-25","2019-06-25","2019-06-25","2020-09-22","2020-12-26","2020-08-16","2020-08-16","2020-12-19","2019-10-16","2019-09-16","2020-09-21","2020-09-23","2019-10-16","2019-10-16","2020-12-19","2019-11-01","2020-12-19","2020-12-19","2020-12-19","2019-12-10","2019-12-18","2019-12-18","2020-12-26","2020-12-26","2020-12-28","2020-12-26","2020-12-26","2020-12-26","2020-12-26","2020-12-26","2021-05-05","2020-12-26","2020-12-28","2020-12-27","2020-12-27","2020-12-27","2021-06-29"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}},{"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":[["","121057716","LACTULOSE","SOL 10GM\/15","","Select","Select",""],["","52817032010","BACLOFEN","TAB 10MG","","Select","Select",""],["","69315011610","FUROSEMIDE","TAB 20MG","","Select","Select",""],["","61442010301","DICLOFENAC","TAB 75MG DR","","Select","Select",""],["","67877011601","METHADONE","TAB 10MG","","Select","Select",""],["","13107001401","GLYCOPYRROL","TAB 1MG","","Select","Select",""],["","832046515","NYAMYC","POW 100000","","Select","Select",""],["","487020101","IPRATROPIUM\/","SOL ALBUTER","","Select","Select",""],["","68180040203","CEFPROZIL","SUS 250\/5ML","","Select","Select",""],["","69315090601","LORAZEPAM","TAB 2MG","","Select","Select",""],["","68462039530","OMEPRAZOLE","CAP 10MG","","Select","Select",""],["","52817033010","CYCLOBENZAPR","TAB 5MG","","Select","Select",""],["","121072104","FLUOXETINE","SOL 20MG\/5ML","","Select","Select",""],["","713067831","NYSTATIN","CRE 100000","","Select","Select",""],["","45802006435","TRIAMCINOLON","CRE 0.001","","Select","Select",""],["","310197030","MOVANTIK","TAB 25MG","","Select","Select",""],["","65862007701","CIPROFLOXACN","TAB 500MG","","Select","Select",""],["","66685100200","AMOX\/K CLAV","TAB 500-125","","Select","Select",""],["","62332011231","METOPROL TAR","TAB 25MG","","Select","Select",""],["","116200116","CHLORHEX GLU","SOL 0.0012","","Select","Select",""],["","70515061001","PRILOSEC","POW 10MG","","Select","Select",""],["","27808008202","MORPHINE SUL","SOL 100\/5ML","","Select","Select",""],["","69547035302","NARCAN","SPR ","","Select","Select",""],["","13811071910","NITROFURANTN","CAP 100MG","","Select","Select",""],["","76204060005","IPRATROPIUM\/ ","SOL ALBUTER","90","Select","Select",""],["","121057716","LACTULOSE ","SOL 10GM\/15","473","Select","Select",""],["","13107001401","GLYCOPYRROL ","TAB 1MG","90","Select","Select",""],["","52817033010","CYCLOBENZAPR ","TAB 5MG","180","Select","Select",""],["","69315090601","LORAZEPAM ","TAB 2MG","120","Select","Select",""],["","61442010301","DICLOFENAC ","TAB 75MG DR","60","Select","Select",""],["","67877011601","METHADONE ","TAB 10MG","120","Select","Select",""],["","69315011610","FUROSEMIDE ","TAB 20MG","90","Select","Select",""],["","52817032010","BACLOFEN ","TAB 10MG","90","Select","Select",""],["","68462039530","OMEPRAZOLE ","CAP 10MG","90","Select","Select",""],["","45802006435","TRIAMCINOLON ","CRE 0.001","30","Select","Select",""],["","68180040203","CEFPROZIL ","SUS 250\/5ML","200","Select","Select",""],["","121072104","FLUOXETINE ","SOL 20MG\/5ML","120","Select","Select",""],["","832046515","NYAMYC ","POW 100000","15","Select","Select",""],["","310197030","MOVANTIK ","TAB 25MG","30","Select","Select",""],["","62332011231","METOPROL ","TAB 25MG","30","Select","Select",""],["","116200116","CHLORHEX ","SOL 0.0012","473","Select","Select",""],["","713067831","NYSTATIN ","CRE 100000","60","Select","Select",""],["","70515061001","PRILOSEC ","POW 10MG","180","Select","Select",""],["","66685100200","AMOX\/K ","TAB 500-125","10","Select","Select",""],["","65862007701","CIPROFLOXACN ","TAB 500MG","17","Select","Select",""],["","27808008202","MORPHINE ","SOL 100\/5ML","1,200.00","Select","Select",""],["","13811071910","NITROFURANTN ","CAP 100MG","14","Select","Select",""],["","33342002208","LEVOFLOXACIN ","TAB 500MG","7","Select","Select",""],["","69547035302","NARCAN ","","2","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","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","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":""}]}]}