{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CHRISTINA   E BERRY","gend":1,"add":"373 TRAINING CENTER ROAD","city":"WOODLAWN","state":"VA","zip":"24381-3525","dob":"1980-03-01","age":"","mstatus":"","insh":10038749,"cliId":"","pno":2766853256,"cno":2766853256,"email":"","ename":"","eno":"","pphy":"BROWN, PAUL G","ppno":2767838123,"pcpadd":"1046 Terrace Dr, ","pcpcity":"Marion","pcpstate":"VA","pcpzip":243544138,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"SOUTHWEST","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"373 TRAINING CENTER ROAD","madd2":"                                                            ","madd3":"","mcity":"WOODLAWN","mstate":"VA","mzip":"24381-3525","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11.9","F43.10","F60.3","M25.50","F33.1","R41.83","F79","F81.2","F81.0","S83.92XA","M25.562","X58.XXXA","M19.90","Z88.8","Z88.5","Z79.4","Z79.899","F17.200","J44.1","R06.02","J40","Z87.891","I10","M17.12","E11.69","Z91.19","M25.561","G89.29","L02.211","L03.311","K76.0","R19.00","R10.9","F17.210","G43.109","L02.414","R50.9","R60.0","E11.40","E78.2","G47.30","Z51.81","I21.4","E11.42","Z82.49","E66.01","G43.909","Z79.82","Z90.710","Z68.25","Z79.2","R06.00","Z72.0","E11.65","I25.10","F31.9","Z68.43","R92.8","B37.3","R07.9","R88.8","E78.00","F33.2","E11.39","E11.3293","H35.043","I21.09","I21.19","R79.89","L30.9","L73.2","R07.89","U07.1","J02.0","X50.1XXA","N61.1","M79.3","L03.114","R53.1","M79.602","R21","Z88.0","Z20.828","L02.91","I21.A1","E66.9","I95.9","Z88.1","Z88.6","Z79.02","R94.31","M25.569","M25.511","M62.81","G47.33","N83.201","R16.1","R10.30","F32.9","A41.9","Y92.238","R00.0","D72.829","Z91.14","Z76.5","T36.8X5A","I21.3","Z99.89","Z74.3","R07.2","G62.9","B37.2","F41.0","Z99.3","F41.1","Z86.69","L73.8","L98.9","R05","N63.20","R92.2","N64.4","Z79.1","Z95.5","R03.0","Z20.818","F43.12","J45.21","Z23","R11.0","Z79.84","J06.9","N64.89","L02.426","L02.425","N61.0","M15.0","M48.061","N63.21","F41.9","M25.512","M54.12","I20.9"],"date":["2021-03-31","2020-01-02","2020-06-01","2019-02-08","2020-01-02","2020-01-02","2020-01-02","2020-01-02","2020-01-02","2019-03-12","2019-07-11","2019-03-12","2020-10-11","2021-01-22","2021-01-22","2021-03-08","2021-03-22","2021-03-08","2019-04-16","2021-03-31","2019-04-16","2019-04-16","2020-04-23","2019-06-21","2020-12-29","2019-07-11","2019-07-11","2019-07-11","2019-08-01","2019-07-30","2020-02-07","2019-07-30","2019-08-01","2021-04-20","2019-12-26","2020-01-24","2020-01-24","2020-01-24","2020-02-07","2020-02-07","2020-08-10","2020-02-07","2020-11-19","2020-02-24","2020-02-24","2021-04-20","2020-05-14","2020-02-24","2020-10-11","2020-02-24","2020-02-24","2020-08-10","2021-03-31","2020-11-20","2021-04-20","2020-08-10","2020-10-11","2020-09-18","2020-09-30","2020-10-11","2020-10-11","2021-04-20","2019-02-07","2021-03-08","2021-03-08","2019-08-30","2020-02-24","2020-02-24","2020-05-11","2020-10-09","2021-03-22","2020-10-11","2021-01-26","2021-01-22","2019-03-12","2020-01-05","2019-07-30","2020-01-24","2020-01-24","2020-01-24","2020-01-24","2021-01-22","2020-06-29","2020-10-05","2020-10-11","2020-10-11","2020-10-11","2020-10-11","2020-10-11","2020-10-11","2020-10-11","2019-03-08","2019-03-08","2019-03-08","2021-03-31","2019-08-01","2019-08-01","2019-08-01","2020-08-10","2019-07-29","2019-07-29","2019-07-29","2019-07-29","2019-07-29","2019-07-29","2019-07-29","2020-02-24","2020-02-24","2020-02-24","2020-02-25","2020-02-25","2020-07-29","2020-08-10","2020-08-10","2020-08-10","2020-11-19","2020-11-20","2019-03-17","2021-01-22","2019-08-21","2019-08-21","2020-01-05","2020-01-23","2020-10-28","2021-03-08","2021-05-10","2019-01-10","2019-03-14","2019-10-24","2020-02-03","2020-05-13","2020-06-29","2020-09-18","2020-11-02","2020-11-02","2019-03-18","2019-06-21","2019-06-21","2019-08-21","2020-04-23","2020-04-28","2020-04-28","2020-05-11"],"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":[["","00002850101","HUMULIN ","INJ U-500","20","Select","Select",""],["","49281042010","FLUZONE ","INJ 2020-21","0.5","Select","Select",""],["","13107003105","MIRTAZAPINE ","TAB 15MG","30","Select","Select",""],["","08290320122","BD  PEN NEEDL","MIS 32GX4MM","100","Select","Select",""],["","99073070805","FREESTYLE    MIS LITE","MIS LITE","1","Select","Select",""],["","00093220301","METOCLOPRAM ","TAB 10MG","120","Select","Select",""],["","62135098505","DOXYCYCL ","CAP 100MG","20","Select","Select",""],["","59762374302","CLINDAMYCIN ","GEL 0.01","60","Select","Select",""],["","08222093196","INSULIN ","MIS 1ML\/30G","20","Select","Select",""],["","47781045704","NITROGLYCERN ","SUB 0.4MG","25","Select","Select",""],["","99073013001","FREESTYLE    MIS LANCETS","MIS LANCETS","100","Select","Select",""],["","99073070827","FREESTYLE    TES LITE","TES LITE","100","Select","Select",""],["","00074055402","HUMIRA ","INJ 40\/0.4ML","4","Select","Select",""],["","50742017501","ISOSORB ","TAB 30MG ER","30","Select","Select",""],["","00603548321","PROPRANOLOL ","TAB 20MG","60","Select","Select",""],["","13668021730","ARIPIPRAZOLE ","TAB 5MG","30","Select","Select",""],["","00169280015","SAXENDA ","INJ 18MG\/3ML","15","Select","Select",""],["","00169255013","TRESIBA ","INJ 200UNIT","45","Select","Select",""],["","08290326730","BD ","MIS 31GX6MM","100","Select","Select",""],["","00193731221","CONTOUR ","TES NEXT","100","Select","Select",""],["","68462015713","ONDANSETRON ","TAB 4MG ODT","4","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","20","Select","Select",""],["","00406048401","APAP\/CODEINE ","TAB 300-30MG","20","Select","Select",""],["","65862019399","FLUOXETINE ","CAP 20MG","30","Select","Select",""],["","00193658621","MICROLET ","MIS LANCETS","100","Select","Select",""],["","00169413602","OZEMPIC ","INJ 2\/1.5ML","3","Select","Select",""],["","31722070010","LOSARTAN ","TAB 25MG","30","Select","Select",""],["","63868036320","ASPIRIN ","TAB 81MG EC","30","Select","Select",""],["","52817036000","METOPROL ","TAB 25MG","30","Select","Select",""],["","00406012305","HYDROCO\/APAP ","TAB 5-325MG","4","Select","Select",""],["","51672413001","LAMOTRIGINE ","TAB 25MG","42","Select","Select",""],["","00169633910","NOVOLOG ","INJ FLEXPEN","15","Select","Select",""],["","00591040501","LISINOPRIL ","TAB 2.5MG","30","Select","Select",""],["","00186077760","BRILINTA ","TAB 90MG","60","Select","Select",""],["","00603533932","PREDNISONE ","TAB 20MG","5","Select","Select",""],["","16729004617","ATORVASTATIN ","TAB 40MG","30","Select","Select",""],["","57237023305","SMZ-TMP ","TAB 800-160","40","Select","Select",""],["","66993001968","ALBUTEROL ","AER HFA","18","Select","Select",""],["","67405060301","FLUCONAZOLE ","TAB 150MG","3","Select","Select",""],["","29300012410","MELOXICAM ","TAB 7.5MG","30","Select","Select",""],["","69315030660","NYSTATIN ","POW 100000","60","Select","Select",""],["","00527133010","BACLOFEN ","TAB 10MG","30","Select","Select",""],["","51224002206","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","67877025145","TRIAMCINOLON ","CRE 0.001","15","Select","Select",""],["","68180012202","CEPHALEXIN ","CAP 500MG","40","Select","Select",""],["","65162052111","PROMETHAZINE ","25MG","15","Select","Select",""],["","65862056099","PANTOPRAZOLE ","40MG","90","Select","Select",""],["","00378022201","CHLORTHALID ","25MG","15","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","",""],["No","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":""}]}]}