{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"REBECCA   S BURRELL","gend":1,"add":"20299 MT PONY ROAD","city":"CULPEPER","state":"VA","zip":"22701-7559","dob":"1958-01-22","age":"","mstatus":"","insh":10042242,"cliId":"","pno":5408290231,"cno":5408290231,"email":"","ename":"","eno":"","pphy":"DEVINCENTIS, CHRISTINA","ppno":5408256263,"pcpadd":"1043 Oaklawn Dr Ste A, ","pcpcity":"Culpeper","pcpstate":"VA","pcpzip":227013339,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"NORTHERN\/ WINCHESTER","aligned":"","ano":5402226515,"add2":"                                                            ","add3":"","madd1":"20299 MT PONY ROAD","madd2":"                                                            ","madd3":"","mcity":"CULPEPER","mstate":"VA","mzip":"22701-7559","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J44.9","J01.90","J02.9","R53.81","E11.9","F32.9","F51.01","R53.83","E55.9","I50.9","I82.90","Z72.0","Z79.01","Z71.9","N20.0","Z85.3","R68.89","J44.1","R06.09","R07.89","I11.0","F31.9","F17.210","Z79.899","Z79.51","Z90.49","Z90.711","Z90.12","D64.9","K29.70","D50.9","C44.311","J32.9","E66.9","R05","J18.9","E61.1","Z20.828","Z23","F31.70","J18.1","M17.0","E87.6","R10.31","R60.0","Z99.81","K92.1","K31.89","R10.30","K29.50","I65.23","K21.0","I10","I87.2","F17.200","Z86.711","Z86.010","Z87.11","C50.112","Z17.0","Z51.81","M25.569","F41.8","R51","Z68.41","R45.0","I51.7","R09.89","B34.9","R06.2","L03.90","R79.89","E53.8","J40","H10.9","R09.82","M54.16","M47.819","L02.91","M54.9","L82.1","L91.8","J20.9","C44.91","F33.9","F41.1","B02.9","I83.90","B37.0","K21.9","L40.3","W19.XXXA","M25.473","K08.89","R11.0","R19.7","K58.9","M13.80","E78.5","R19.5","K31.9","R60.9","J81.0","M19.90","G47.00","Z00.01","Z12.11","M54.5","Z68.42","Z08","M25.562","M25.561","E66.01","M47.816","I83.893","H92.09","G89.29","N39.0","Z12.39","J91.8","K04.7","G43.909","M54.2","G47.33","D33.2","M48.061","M51.26","J45.909","F41.9","R63.0","K92.2","R10.9","R39.15","Z48.815","K59.00","I26.90","H65.93","I26.99","S33.5XXA","M17.10","Z68.29","R73.09","R45.7","D48.9","I89.0","M79.10","T14.8XXA"],"date":["2021-03-30","2020-01-11","2019-04-01","2019-08-01","2021-03-24","2019-11-25","2020-12-07","2019-04-03","2019-04-06","2021-03-24","2020-12-28","2020-05-27","2020-12-28","2019-05-31","2019-06-17","2019-08-14","2019-06-17","2019-07-31","2019-07-31","2020-02-26","2020-02-26","2020-02-26","2019-08-14","2019-11-13","2020-02-26","2020-02-26","2019-07-31","2019-07-31","2020-12-03","2019-10-23","2021-04-12","2020-02-06","2021-03-24","2021-02-23","2020-09-22","2020-05-15","2020-05-15","2021-02-23","2020-09-22","2019-02-14","2019-02-27","2021-05-17","2019-06-17","2019-06-17","2021-02-23","2020-02-26","2019-10-21","2019-10-21","2019-10-21","2019-10-21","2019-10-21","2019-10-21","2020-11-23","2020-12-22","2019-10-21","2020-02-26","2019-10-21","2019-10-21","2020-12-28","2020-12-28","2020-12-28","2020-07-10","2020-01-14","2020-01-14","2020-01-14","2020-02-06","2020-02-26","2020-02-26","2020-02-26","2020-11-23","2021-02-23","2021-02-23","2021-02-23","2021-03-24","2021-03-24","2019-02-27","2020-04-23","2020-04-23","2019-06-10","2019-07-12","2019-07-31","2019-07-31","2019-08-17","2019-08-17","2020-12-07","2020-12-07","2019-11-25","2020-04-23","2020-07-10","2020-07-10","2020-07-10","2020-12-03","2020-12-03","2020-04-07","2019-06-17","2019-06-17","2019-06-17","2019-06-17","2020-02-26","2019-11-13","2019-11-13","2020-02-26","2020-02-26","2020-02-26","2020-02-26","2020-08-24","2020-08-24","2020-12-06","2021-02-23","2019-01-10","2019-04-25","2019-04-25","2019-04-25","2019-06-24","2019-07-12","2020-04-07","2020-05-06","2020-05-27","2020-09-22","2019-01-17","2019-09-27","2019-05-21","2019-05-16","2019-05-21","2019-05-21","2019-06-24","2019-06-24","2020-04-27","2019-08-14","2019-09-26","2019-10-11","2020-09-22","2019-10-11","2019-11-13","2020-04-27","2020-12-28","2019-02-13","2019-01-10","2019-03-21","2019-05-06","2019-05-06","2019-05-06","2019-06-10","2019-07-31","2020-09-22","2020-09-22","2020-12-19"],"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":[["","65162036111","FOLIC ","TAB 1MG","30","Select","Select",""],["","00186037020","SYMBICORT ","AER 160-4.5","10.2","Select","Select",""],["","51991074890","DULOXETINE ","CAP 60MG","30","Select","Select",""],["","70710122701","AMITRIPTYLIN ","TAB 50MG","30","Select","Select",""],["","16729009712","QUETIAPINE ","TAB 400MG ER","60","Select","Select",""],["","00527150237","AMPHET\/DEXTR ","TAB 10MG","60","Select","Select",""],["","50458057930","XARELTO ","TAB 20MG","30","Select","Select",""],["","00115166003","PROPRANOLOL ","TAB 20MG","30","Select","Select",""],["","65862052305","GABAPENTIN ","TAB 600MG","60","Select","Select",""],["","62175061743","PANTOPRAZOLE ","TAB 40MG","30","Select","Select",""],["","00378021610","FUROSEMIDE ","TAB 40MG","60","Select","Select",""],["","00193654621","BAYER ","MIS LANCETS","100","Select","Select",""],["","68180098003","LISINOPRIL ","TAB 10MG","90","Select","Select",""],["","65862057490","MONTELUKAST ","TAB 10MG","90","Select","Select",""],["","68180012202","CEPHALEXIN ","CAP 500MG","42","Select","Select",""],["","00093720198","PRAVASTATIN ","TAB 20MG","90","Select","Select",""],["","08290320749","BD  PEN NEEDL","MIS 32GX6MM","100","Select","Select",""],["","57664050658","METOPROL ","TAB 25MG","180","Select","Select",""],["","65862067905","ALPRAZOLAM ","TAB 2MG","75","Select","Select",""],["","00245531911","KLOR-CON ","TAB 20MEQ ER","30","Select","Select",""],["","55111032101","GLIMEPIRIDE ","TAB 2MG","30","Select","Select",""],["","63824007236","MUCINEX ","TAB 60-1200","28","Select","Select",""],["","45802091987","CETIRIZINE ","TAB 10MG","30","Select","Select",""],["","71093014005","METHOCARBAM ","TAB 500MG","60","Select","Select",""],["","50428587618","CHEST ","OIN MEDICATE","100","Select","Select",""],["","65862050320","AMOX\/K ","TAB 875-125","20","Select","Select",""],["","59779048478","PAIN ","TAB 500MG","60","Select","Select",""],["","69452015120","VITAMIN ","CAP 50000UNT","4","Select","Select",""],["","66993001968","ALBUTEROL ","AER HFA","18","Select","Select",""],["","52268001201","SUPREP ","SOL PREP KIT","354","Select","Select",""],["","00536589553","NICOTINE ","DIS 14MG\/24H","14","Select","Select",""],["","65862096901","ESZOPICLONE ","TAB 3MG","30","Select","Select",""],["","00597008717","ATROVENT ","AER 17MCG","12.9","Select","Select",""],["","68180065208","DOXYCYC ","CAP 100MG","28","Select","Select",""],["","13668013601","ESCITALOPRAM ","TAB 10MG","30","Select","Select",""],["","00378967130","IPRATROPIUM\/ ","SOL ALBUTER","360","Select","Select",""],["","66689000802","NYSTATIN ","SUS 100000","280","Select","Select",""],["","68180095603","CLOBETASOL ","CRE 0.0005","45","Select","Select",""],["","00193731025","CONTOUR ","TES NEXT","50","Select","Select",""],["","86790001930","SLOW ","TAB 45MG","30","Select","Select",""],["","16571020210","DICLOFENAC ","TAB 50MG DR","14","Select","Select",""],["","53885014201","ONETOUCH ","MIS LANC DEV","1","Select","Select",""],["","57664049983","MIRTAZAPINE ","TAB 15MG","30","Select","Select",""],["","59779061239","ALLERGY ","TAB 10MG","30","Select","Select",""],["","64380080307","RANITIDINE ","TAB 150MG","60","Select","Select",""],["","43598075201","BUPROPION ","TAB 150MG SR","30","Select","Select",""],["","00591544310","PREDNISONE ","TAB 20MG","18","Select","Select",""],["","31722070530","VALACYCLOVIR ","TAB 1GM","21","Select","Select",""],["","68180030360","CEFUROXIME ","TAB 500MG","20","Select","Select",""],["","49281042050","FLUZONE ","INJ 2020-21","0.5","Select","Select",""],["","14539067401","HYDROXYZ ","CAP 25MG","60","Select","Select",""],["","00591565810","CYCLOBENZAPR ","TAB 10MG","20","Select","Select",""],["","43199001101","HYOSCYAMINE ","SUB 0.125MG","60","Select","Select",""],["","53746010901","HYDROCO\/APAP ","TAB 5-325MG","10","Select","Select",""],["","65162052110","PROMETHAZINE ","TAB 25MG","30","Select","Select",""],["","55111029236","SUMATRIPTAN ","TAB 50MG","9","Select","Select",""],["","68180016013","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","41100080247","CLARITIN ","TAB 10MG","30","Select","Select",""],["","00169643810","LEVEMIR ","INJ FLEXTOUC","45","Select","Select",""],["","00093310905","AMOXICILLIN ","CAP 500MG","30","Select","Select",""],["","31722054301","INDOMETHACIN ","CAP 50MG","90","Select","Select",""],["","49281072010","FLUBLOK ","INJ 2020-21","0.5","Select","Select",""],["","65862007701","CIPROFLOXACN ","TAB 500MG","14","Select","Select",""],["","57237001401","TAMSULOSIN ","CAP 0.4MG","5","Select","Select",""],["","00093005805","TRAMADOL ","TAB 50MG","12","Select","Select",""],["","00536100901","FERROUS ","TAB 325MG","60","Select","Select",""],["","00005197102","PREVNAR ","INJ ","0.5","Select","Select",""],["","00006483703","PNEUMOVAX ","INJ 25\/0.5","0.5","Select","Select",""],["","00597007541","SPIRIVA ","CAP HANDIHLR","90","Select","Select",""],["","70069000510","CYANOCOBALAM ","INJ 1000MCG","1","Select","Select",""],["","59746000103","METHYLPRED ","TAB 4MG","21","Select","Select",""],["","55111017915","TIZANIDINE ","2MG","45","Select","Select",""],["","00093031401","KETOROLAC ","10MG","20","Select","Select",""],["","00169255013","TRESIBA ","200UNIT","9","Select","Select",""],["","52565005630","TRIAMCINOLON ","0.10%","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":""}]}]}