{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BOBBI   J TUMBLIN","gend":1,"add":"825  W 11TH STREET                                          ","city":"FRONT ROYAL                   ","state":"VA","zip":"22630-2905","dob":"1968-07-18","age":"","mstatus":"","insh":10046161,"cliId":"","pno":3042708518,"cno":5405144508,"email":"","ename":"","eno":"","pphy":"MILLER, STACY MICHELLE                                      ","ppno":"","pcpadd":"525 Amherst St","pcpcity":"Winchester                    ","pcpstate":"VA","pcpzip":226013881,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"NORTHERN\/ WINCHESTER","aligned":"","ano":"","add2":"RM 115                                                      ","add3":"","madd1":"825  W 11TH STREET                                          ","madd2":"RM 115                                                      ","madd3":"","mcity":"FRONT ROYAL                   ","mstate":"VA","mzip":"22630-2905","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G46.4","F11.20","R68.89","G60.9","L60.0","B35.1","B35.3","F12.20","Z02.89","I11.9","Z79.899","R41.3","R51","M51.36","M54.40","G89.29","E78.5","I10","K21.9","M54.5","N32.81","R63.4","R69","L85.9","S70.02XA","S70.12XA","M79.89","S01.80XA","F41.9","J20.9","I63.9","F32.9","F33.9","E78.2","F33.0","Z68.26","G44.209","M79.675","M79.674","F19.20","F33.1","F41.1","F14.20","F15.20","F33.2","F41.0","L85.1","M25.572","F11.23","M25.562","M71.22","M25.561","L97.521","M25.512","M54.42"],"date":["2019-01-02","2021-04-30","2021-01-19","2021-03-08","2019-09-12","2021-03-08","2019-09-12","2019-05-02","2019-02-21","2019-10-01","2019-03-21","2020-06-12","2020-06-12","2019-03-28","2019-03-28","2019-03-28","2021-03-11","2021-03-11","2019-03-29","2020-02-13","2019-03-29","2019-03-29","2019-06-01","2021-03-08","2019-07-23","2019-07-23","2019-07-23","2019-08-01","2020-10-19","2019-09-26","2019-12-08","2021-03-11","2020-05-26","2020-03-26","2020-03-26","2020-03-26","2020-03-26","2020-04-28","2020-04-28","2020-06-02","2020-10-21","2020-11-04","2020-06-17","2020-06-17","2020-11-04","2020-08-24","2020-07-14","2020-09-29","2020-12-16","2021-03-09","2021-03-05","2021-03-05","2021-03-08","2021-03-11","2021-03-11"],"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":[["","68382013905","TOPIRAMATE","50MG","60","Select","Select",""],["","68001033508","LISINOPRIL","20MG","30","Select","Select",""],["","64380080707","IBUPROFEN","800MG","45","Select","Select",""],["","68180031909","BUPROPN","150MG XL","30","Select","Select",""],["","68462012605","GABAPENTIN","600MG","120","Select","Select",""],["","49483048110","ASPIRIN","81MG EC","30","Select","Select",""],["","12496120803","SUBOXONE","8-2MG","7","Select","Select",""],["","70377000415","SIMVASTATIN","40MG","30","Select","Select",""],["","60505015801","BUPROPION","75MG","7","Select","Select",""],["","00115180401","HYDROXYZ","50MG","30","Select","Select",""],["","55111017915","TIZANIDINE","2MG","56","Select","Select",""],["","68382080605","TRAZODONE","100MG","30","Select","Select",""],["","65862001205","SERTRALINE","50MG","30","Select","Select",""],["","70010075401","METHOCARBAM","500MG","45","Select","Select",""],["","51991074710","DULOXETINE","30MG","30","Select","Select",""],["","68001019600","ESCITALOPRAM","10MG","30","Select","Select",""],["","16571020210","DICLOFENAC","50MG DR","60","Select","Select",""],["","72647033104","METHYLPRED","4MG","21","Select","Select",""],["","58160082311","SHINGRIX","50MCG","1","Select","Select",""],["","55111068405","IBU","800MG","45","Select","Select",""],["","33332032001","AFLURIA","2020-21","0.5","Select","Select",""],["","00006483703","PNEUMOVAX","25\/0.5","0.5","Select","Select",""],["","69547035302","NARCAN","","2","Select","Select",""],["","16714074703","OMEPRAZOLE","20MG","7","Select","Select",""],["","68382013905","TOPIRAMATE ","TAB 50MG","60","Select","Select",""],["","68001033508","LISINOPRIL ","TAB 20MG","30","Select","Select",""],["","64380080707","IBUPROFEN ","TAB 800MG","45","Select","Select",""],["","68180031909","BUPROPN ","TAB 150MG XL","30","Select","Select",""],["","68462012605","GABAPENTIN ","TAB 600MG","120","Select","Select",""],["","49483048110","ASPIRIN ","TAB 81MG EC","30","Select","Select",""],["","12496120803","SUBOXONE ","MIS 8-2MG","7","Select","Select",""],["","70377000415","SIMVASTATIN ","TAB 40MG","30","Select","Select",""],["","60505015801","BUPROPION ","TAB 75MG","7","Select","Select",""],["","00115180401","HYDROXYZ ","CAP 50MG","30","Select","Select",""],["","55111017915","TIZANIDINE ","TAB 2MG","56","Select","Select",""],["","68382080605","TRAZODONE ","TAB 100MG","30","Select","Select",""],["","65862001205","SERTRALINE ","TAB 50MG","30","Select","Select",""],["","70010075401","METHOCARBAM ","TAB 500MG","45","Select","Select",""],["","51991074710","DULOXETINE ","CAP 30MG","30","Select","Select",""],["","68001019600","ESCITALOPRAM ","TAB 10MG","30","Select","Select",""],["","16571020210","DICLOFENAC ","TAB 50MG DR","60","Select","Select",""],["","72647033104","METHYLPRED ","TAB 4MG","21","Select","Select",""],["","58160082311","SHINGRIX ","INJ 50MCG","1","Select","Select",""],["","55111068405","IBU ","TAB 800MG","45","Select","Select",""],["","33332032001","AFLURIA ","INJ 2020-21","0.5","Select","Select",""],["","00006483703","PNEUMOVAX ","INJ 25\/0.5","0.5","Select","Select",""],["","69547035302","NARCAN ","SPR ","2","Select","Select",""],["","16714074703","OMEPRAZOLE ","CAP 20MG","7","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","",""],["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":""}]}]}