{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ROBIN   L MARSHALL","gend":1,"add":"5164 WALKERS GRANT LANE","city":"VIRGINIA BEACH","state":"VA","zip":"23455-2560","dob":"1967-10-23","age":"","mstatus":"","insh":10035904,"cliId":"","pno":7578036873,"cno":7578036873,"email":"","ename":"","eno":"","pphy":"SARINO, NELSON C","ppno":7577381300,"pcpadd":"1147 Independence Blvd, ","pcpcity":"Virginia Beach","pcpstate":"VA","pcpzip":234555545,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"TIDEWATER","aligned":"","ano":"","add2":"BLDG 7","add3":"","madd1":"1903 Jefferson St","madd2":"BLDG 7","madd3":"","mcity":"Portsmouth","mstate":"VA","mzip":"23704-5427","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R68.89","F33.1","M17.31","F17.200","M25.562","M17.12","G89.29","A41.9","R91.8","R60.0","R07.81","R05","R06.02","S83.282A","S83.242A","R10.13","R11.2","K20.9","E66.9","Z68.26","Z90.49","F17.210","Z88.5","Z88.8","A41.51","T40.601A","Y92.019","J69.0","J96.02","J96.01","J15.5","R65.21","N17.0","G92","S32.511A","E87.1","E87.0","E87.4","E87.3","T40.3X1A","N17.9","E87.2","D72.819","D70.9","T50.902A","G89.4","T50.901A","J18.9","R50.9","D72.820","J06.9","T50.901D","M62.81","R26.9","R41.89","T40.3X1D","F10.20","I10","F32.9","K21.9","I26.93","R91.1","R07.9","K76.0","K44.9","J45.901","J98.4","T40.2X4A","F33.41","F41.1","S62.633A","I95.9","S22.41XA","R10.84","K59.00","K62.5","R10.9","R11.10","T40.2X1A","E03.9","G25.81","Z79.899","E86.0","Z72.0","F19.10","D64.9","T40.2X1D","G93.40","Z98.890","Y93.E6","Y92.009","F41.9","F90.9","E03.4","J45.909","K92.2","R00.0","L03.211","R21","R22.0","M79.662","M79.661","M79.89","R09.02","J44.9","M54.5","Z53.29","Z87.39","M47.812","M47.816","M47.814","D48.5","Z71.9","Z28.21","Z68.28","Z01.89","J96.00","T40.605A","E87.70","R74.0","R79.89","R10.11","M79.604","M79.605","Z01.818","K21.0","K92.0","D62","M12.9","M54.9","M54.2","E78.00","R10.10","M25.561","F32.2","R10.12","J90","Z46.82","Z45.2","J98.11","J18.1","I82.403","M17.0","I82.4Y2","Z68.27","E87.6","M17.11","Z96.9","Z01.810","Z01.812","S83.272D","M25.462","K82.9","J96.91","R78.81","S32.591A","R06.03","K92.1","R93.89","Z79.01","S62.632B","S61.313A","S62.638B","S69.90XA","W19.XXXA","R42","F11.20","Z86.711","S00.03XA","J20.9","F10.10","J44.0","I11.0","I50.9","E78.5","R41.82","X58.XXXD","F41.8","J96.90","J41.1","D50.9","K80.20","Z12.11","S69.92XA","F90.2","F39","M25.512","W01.0XXA","Y92.012","R51.9","J44.1","Z79.52","Z20.822","M54.16","M25.569","K64.9","Z23","Z01.419","M23.201","Z47.89","I49.3","R63.3","R09.01","W19.XXXD","I26.99","M47.26","M54.31","R29.898","R34","R60.9","E66.09","M54.32","Z68.31","I45.81","Z86.79","L98.492","M48.061","M48.02","M51.24","R10.811","R10.816","I08.1","Z80.3","Z81.8","Z82.49","S09.90XA","S99.912A","R63.4","R40.20","K62.89","J02.9","M47.22","M51.16","R06.89","D72.829","T40.605D","E83.42","K83.8","R78.89","R13.10","R07.1","W01.198A","R06.2","R06.9","M71.22","M21.061","L92.0","S83.207A","X58.XXXA","Y93.9","S83.232A","M65.9","M22.42","R51","I46.9","E11.65","R40.4","S81.801D","Z00.00","E78.2","R53.83","M17.32","W18.39XA","Y92.002"],"date":["2021-02-28","2020-11-15","2021-02-17","2020-06-02","2021-02-17","2021-02-17","2021-02-17","2020-03-15","2020-05-06","2020-08-12","2020-02-11","2020-02-11","2021-04-22","2019-07-19","2019-07-19","2019-08-28","2019-08-28","2019-11-04","2019-08-28","2019-08-28","2019-10-03","2021-04-22","2020-08-12","2020-08-12","2020-02-01","2019-11-27","2019-11-24","2020-03-21","2020-03-21","2021-04-22","2019-11-24","2020-03-15","2019-11-24","2020-02-03","2019-11-30","2020-03-15","2020-03-15","2019-11-24","2019-11-24","2019-11-24","2020-03-15","2020-03-15","2019-11-25","2019-11-25","2019-11-25","2020-12-10","2019-12-08","2020-02-20","2019-12-13","2019-12-13","2019-12-08","2020-03-21","2019-12-13","2019-12-13","2019-12-13","2020-02-01","2020-02-01","2021-04-22","2020-02-03","2020-03-05","2020-03-31","2020-03-10","2020-08-12","2020-03-10","2020-03-10","2020-03-10","2020-03-17","2020-03-21","2020-03-21","2020-03-21","2020-06-02","2020-08-12","2021-04-22","2019-05-21","2020-06-03","2020-05-07","2020-03-06","2019-04-12","2019-05-06","2021-04-22","2021-04-22","2021-04-22","2019-05-06","2020-05-06","2019-05-06","2020-03-15","2019-05-08","2019-11-26","2020-05-06","2019-08-03","2020-02-11","2021-04-01","2019-08-16","2019-08-03","2020-02-03","2019-08-19","2020-03-07","2020-01-16","2020-01-16","2020-01-16","2020-05-06","2020-05-06","2020-08-12","2020-05-06","2020-05-06","2020-05-08","2020-05-06","2020-05-06","2019-01-29","2020-05-22","2019-01-29","2019-04-12","2019-04-12","2019-04-12","2019-10-30","2019-05-06","2019-11-25","2019-05-07","2019-05-20","2019-05-25","2020-12-10","2019-10-31","2019-06-25","2019-06-25","2019-07-09","2020-06-03","2019-08-16","2019-08-16","2019-08-16","2020-02-20","2020-02-20","2020-02-20","2019-10-03","2020-05-06","2020-05-22","2019-10-03","2019-11-28","2019-11-28","2019-11-28","2019-11-28","2020-03-15","2020-02-18","2019-02-25","2019-01-18","2019-06-24","2019-05-21","2019-04-02","2019-04-02","2019-07-05","2019-07-05","2019-07-05","2019-11-21","2019-11-04","2019-11-28","2019-11-30","2019-11-30","2020-02-20","2020-05-07","2020-05-07","2020-08-12","2020-06-02","2020-06-02","2020-06-02","2020-06-02","2020-06-02","2020-08-12","2021-01-01","2020-08-12","2020-02-11","2020-03-05","2020-02-20","2020-03-05","2020-03-05","2020-03-05","2020-03-15","2020-03-15","2020-03-15","2020-03-15","2020-03-19","2020-05-22","2020-05-22","2020-06-03","2020-06-03","2020-06-04","2021-04-01","2021-04-01","2021-03-10","2021-03-10","2021-03-10","2021-03-10","2021-04-22","2021-04-22","2021-04-22","2019-01-07","2019-02-25","2019-07-18","2019-09-25","2019-10-16","2019-10-29","2019-10-29","2019-12-11","2020-02-05","2020-02-05","2020-02-20","2020-03-09","2020-05-05","2020-05-05","2020-05-05","2020-05-05","2020-05-05","2020-05-05","2020-05-05","2020-05-05","2020-05-18","2020-05-18","2020-09-09","2019-01-07","2019-01-07","2019-01-07","2019-10-03","2019-10-03","2019-11-25","2020-02-03","2020-02-03","2020-02-03","2020-02-11","2020-02-18","2020-03-06","2020-03-15","2020-05-08","2020-05-08","2019-01-07","2019-01-07","2020-03-15","2019-05-06","2019-05-08","2019-05-21","2019-05-21","2019-05-21","2019-12-05","2020-02-11","2020-02-11","2020-02-20","2021-04-22","2019-01-30","2019-02-25","2019-04-12","2019-07-09","2019-07-17","2019-07-17","2019-07-19","2019-07-17","2019-07-17","2020-01-15","2020-03-15","2020-03-15","2020-03-15","2020-08-13","2021-01-25","2021-01-25","2021-01-25","2021-02-24","2021-03-10","2021-03-10"],"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":[]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","00904576960","ARTHRTS ","TAB 650MG","30","Select","Select",""],["","00487950125","ALBUTEROL ","NEB 0.00083","75","Select","Select",""],["","60505257908","ATORVASTATIN ","TAB 20MG","30","Select","Select",""],["","65862018601","CLINDAMYCIN ","CAP 300MG","28","Select","Select",""],["","00378003210","METOPROL ","TAB 50MG","180","Select","Select",""],["","00093078710","ATENOLOL ","TAB 25MG","30","Select","Select",""],["","45963055650","GABAPENTIN ","CAP 300MG","180","Select","Select",""],["","68382011305","RISPERIDONE ","TAB 0.5MG","90","Select","Select",""],["","00536408610","SENEXON-S ","TAB 8.6-50MG","30","Select","Select",""],["","69097015912","MELOXICAM ","TAB 15MG","30","Select","Select",""],["","65862050320","AMOX\/K ","TAB 875-125","10","Select","Select",""],["","00406051201","OXYCOD\/APAP ","TAB 5-325MG","42","Select","Select",""],["","69315011710","FUROSEMIDE ","TAB 40MG","30","Select","Select",""],["","50111043403","TRAZODONE ","TAB 100MG","90","Select","Select",""],["","55566410001","EUFLEXXA ","INJ 10MG\/ML","6","Select","Select",""],["","00085113204","PROVENTIL ","AER HFA","6.7","Select","Select",""],["","58914017014","CARAFATE ","SUS 1GM\/10ML","200","Select","Select",""],["","00173068220","VENTOLIN ","AER ","18","Select","Select",""],["","00536114941","ASPIRIN ","TAB 81MG EC","28","Select","Select",""],["","68462010340","FLUCONAZOLE ","TAB 150MG","1","Select","Select",""],["","00591024005","LORAZEPAM ","TAB 0.5MG","10","Select","Select",""],["","00781207410","TRIAMT\/HCTZ ","CAP 37.5-25","30","Select","Select",""],["","31722095401","METHYLPHENID ","TAB 36MG ER","60","Select","Select",""],["","59746017206","PREDNISONE ","TAB 5MG","21","Select","Select",""],["","50111078810","AZITHROMYCIN ","TAB 500MG","4","Select","Select",""],["","00054418425","DEXAMETHASON ","TAB 4MG","6","Select","Select",""],["","70677003101","SM ","DIS 14MG\/24H","7","Select","Select",""],["","43386031214","GAVILAX ","POW ","510","Select","Select",""],["","57896040110","DOCUSATE ","CAP 100MG","30","Select","Select",""],["","50458058451","XARELTO ","TAB 15\/20MG","51","Select","Select",""],["","00185067405","HYDROXYZ ","CAP 25MG","180","Select","Select",""],["","50458058601","CONCERTA ","TAB 36MG","60","Select","Select",""],["","00536120215","LIDOCAINE ","PAD 0.04","3","Select","Select",""],["","49884072703","DOXYCYC ","CAP 100MG","4","Select","Select",""],["","68462039710","OMEPRAZOLE ","CAP 40MG","30","Select","Select",""],["","43547040011","CYCLOBENZAPR ","TAB 10MG","90","Select","Select",""],["","00121077516","GG\/CODEINE ","SOL 100-10\/5","120","Select","Select",""],["","00143980350","DOXYCYCL ","CAP 100MG","20","Select","Select",""],["","00904759180","FERROUS ","TAB 325MG","30","Select","Select",""],["","65862052899","VENLAFAXINE ","CAP 75MG ER","90","Select","Select",""],["","00781261305","AMOXICILLIN ","CAP 500MG","30","Select","Select",""],["","00172392670","DIAZEPAM ","TAB 5MG","120","Select","Select",""],["","57237007710","ONDANSETRON ","TAB 4MG ODT","10","Select","Select",""],["","59676058015","JANSSEN ","INJ COVID-19","0.5","Select","Select",""],["","69238183707","LEVOTHYROXIN ","TAB 137MCG","30","Select","Select",""],["","67877021905","CEPHALEXIN ","CAP 500MG","30","Select","Select",""],["","00228212750","CLONIDINE ","TAB 0.1MG","21","Select","Select",""],["","67877012440","SILVER ","CRE 0.01","50","Select","Select",""],["","62332042671","BENZONATATE ","CAP 100MG","20","Select","Select",""],["","00832532515","POT  CL MICRO","TAB 20MEQ ER","30","Select","Select",""],["","53746051110","SPIRONOLACT ","TAB 25MG","30","Select","Select",""],["","00186091612","PULMICORT ","INH 180MCG","1","Select","Select",""],["","00172572970","FAMOTIDINE ","TAB 40MG","30","Select","Select",""],["","68462026290","ROSUVASTATIN ","TAB 10MG","30","Select","Select",""],["","64380073706","VITAMIN ","CAP 50000UNT","12","Select","Select",""],["","00536589688","NICOTINE ","DIS 21MG\/24H","28","Select","Select",""],["","65162083366","DICLOFENAC ","GEL 0.01","100","Select","Select",""],["","00406012305","HYDROCO\/APAP ","TAB 5-325MG","28","Select","Select",""],["","45802006405","TRIAMCINOLON ","CRE 0.001","30","Select","Select",""],["","00591079401","DICYCLOMINE ","CAP 10MG","90","Select","Select",""],["","00904198280","MAPAP ","TAB 325MG","20","Select","Select",""],["","00536106210","STOOL ","CAP 100MG","30","Select","Select",""],["","00093031401","KETOROLAC ","TAB 10MG","10","Select","Select",""],["","00573288320","PREPARATION ","SUP H","24","Select","Select",""],["","68382019716","PRAMIPEXOLE ","TAB 0.25MG","30","Select","Select",""],["","00904674880","BISACODYL ","TAB 5MG EC","2","Select","Select",""],["","00603333932","DIPHENHYDRAM ","CAP 25MG","30","Select","Select",""],["","00904676320","ROBAFEN ","LIQ 200\/10ML","118","Select","Select",""],["","43547026850","ROPINIROLE ","TAB 0.25MG","30","Select","Select",""],["","41167075142","CAPZASIN-HP ","CRE 0.001","1","Select","Select",""],["","00904645760","DOK ","CAP 100MG","30","Select","Select",""],["","00904759180","FEROSUL ","TAB 325MG","30","Select","Select",""],["","45802037635","AUG ","CRE 0.0005","60","Select","Select",""],["","45802086802","POLYETH ","POW 3350 NF","238","Select","Select",""],["","69547035302","NARCAN ","SPR ","2","Select","Select",""],["","45802018816","HEMORRHOIDAL ","OIN ","57","Select","Select",""],["","43292050022","ACIDOPHILUS ","CAP ","30","Select","Select",""],["","68462030205","INDOMETHACIN ","50MG","30","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":[[["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","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":""}]}]}