{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SHIRLEY   W SMITH","gend":1,"add":"PO BOX 184                                                  ","city":"MELFA                         ","state":"VA","zip":"23410-0184","dob":"1948-12-04","age":"","mstatus":"","insh":10047769,"cliId":"","pno":7577878596,"cno":7577878596,"email":"","ename":"","eno":"","pphy":"HALLS, ALBERT JOHN                                          ","ppno":"","pcpadd":"20306 Badger Ln","pcpcity":"Onancock                      ","pcpstate":"VA","pcpzip":234171224,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"TIDEWATER","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"PO BOX 184                                                  ","madd2":"                                                            ","madd3":"","mcity":"MELFA                         ","mstate":"VA","mzip":"23410-0184","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11.42","N18.3","G62.9","I10","E55.9","S82.891D","R68.89","M16.11","M25.559","M62.838","M25.551","M16.10","E11.9","Z79.84","E78.5","I25.10","Z86.73","Z79.02","F17.210","Z79.899","R79.89","Z87.81","S82.841A","M25.512","G89.29","M25.571","M25.511","E78.00","Z00.00","I12.9","E11.22","N18.2","S82.891A","S82.841D","R80.9","E79.0","R06.2","I67.89","R41.3","M25.562","L30.4","Z71.3","M25.552","M19.90","M17.12","M16.12","E66.9","Z68.41","N28.9","R20.2","R20.0","T14.90XA","R53.1","K21.9","Z28.21","N18.9","M62.81","E21.3","M48.02","M54.2","E87.6","E83.42","R25.2","Z09","N39.3","R39.81","Z99.3","Z12.2","Z87.891","Z71.9","M54.12","I63.511","E11.649","E66.01","R41.82","F41.9","F32.9","R06.02","R29.6","T38.3X5A","R47.81","R00.1","R94.31","T38.3X5D","M16.0","I69.351","Z91.81","H61.23","G31.84","N25.81","M79.652","N18.31","E87.2","M47.27","M51.17","M47.26","M51.16","M43.17","M43.16","M54.16","E08.41","E11.40","J43.9","N18.32","G57.92","Z72.0","F03.90","M19.041","M19.042","E66.09","Z68.33","Z23","Z92.29","G30.0"],"date":["2021-11-29","2020-06-02","2020-12-30","2021-08-23","2021-07-19","2019-01-02","2020-05-02","2019-01-07","2019-01-07","2020-02-07","2019-01-14","2019-01-07","2021-03-03","2020-09-10","2021-11-29","2021-11-29","2020-09-10","2020-09-10","2021-05-27","2020-09-10","2019-01-14","2020-06-02","2019-02-04","2019-11-07","2020-09-10","2019-01-30","2019-11-07","2019-01-30","2019-02-04","2021-07-06","2021-07-19","2020-02-07","2019-06-01","2019-03-04","2021-07-19","2021-07-19","2019-04-18","2020-05-01","2020-06-02","2019-06-14","2019-07-13","2020-10-16","2021-11-29","2020-05-01","2021-02-18","2019-08-21","2020-10-22","2020-06-02","2019-10-30","2019-11-07","2019-12-17","2019-10-30","2019-10-30","2021-08-23","2020-10-16","2019-11-06","2021-07-27","2021-07-19","2020-06-02","2019-11-15","2021-07-06","2019-12-12","2019-12-12","2020-05-07","2019-12-17","2021-07-27","2021-07-27","2021-02-18","2020-01-29","2020-02-11","2020-08-13","2020-02-26","2020-06-02","2020-06-02","2020-05-01","2020-09-10","2020-09-10","2020-05-01","2020-05-01","2020-05-01","2020-05-01","2020-05-01","2020-05-01","2020-06-02","2020-06-02","2020-06-02","2020-06-02","2020-08-14","2021-08-23","2021-07-06","2021-08-23","2021-02-11","2021-02-11","2021-01-25","2021-01-25","2021-01-25","2021-01-25","2021-01-25","2021-01-25","2021-01-25","2021-02-18","2021-02-18","2021-02-18","2021-08-23","2021-08-23","2021-02-24","2021-03-03","2021-05-27","2021-05-27","2021-11-29","2021-11-29","2021-10-05","2021-10-05","2021-11-29"],"priorHcc":[null,"","","","","","","","","","","","","",null,null,"","","","","","","","","","","","","","","","","","","","","","","","","","",null,"","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",null,null,"","",null]}},{"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":[["","55111032201","GLIMEPIRIDE","4MG","30","Select","Select",""],["","00193731150","CONTOUR","NEXT","50","Select","Select",""],["","62175061743","PANTOPRAZOLE","40MG","90","Select","Select",""],["","50742061510","METOPROL","25MG ER","30","Select","Select",""],["","70377003012","ATORVASTATIN","80MG","30","Select","Select",""],["","71093014005","METHOCARBAM","500MG","60","Select","Select",""],["","65862035790","CLOPIDOGREL","75MG","30","Select","Select",""],["","31722070190","LOSARTAN","50MG","90","Select","Select",""],["","59746033090","DONEPEZIL","10MG","30","Select","Select",""],["","69452015120","VITAMIN","50000UNT","8","Select","Select",""],["","00093727298","PIOGLITAZONE","30MG","90","Select","Select",""],["","00054000725","CALCITRIOL","0.25MCG","30","Select","Select",""],["","59779048478","PAIN","500MG","90","Select","Select",""],["","69097084507","CYCLOBENZAPR","5MG","30","Select","Select",""],["","00054429931","FUROSEMIDE","40MG","60","Select","Select",""],["","69097015807","MELOXICAM","7.5MG","30","Select","Select",""],["","50428054208","CVS","4%","76.5","Select","Select",""],["","00245531911","KLOR-CON","20MEQ ER","90","Select","Select",""],["","50742062101","NIFEDIPINE","60MG ER","90","Select","Select",""],["","00904672059","ACETAMIN","500MG","90","Select","Select",""],["","00536126720","LIDOCAINE","4%","15","Select","Select",""],["","50428038706","ACETAMINOPHN","500MG","225","Select","Select",""],["","55111032201","GLIMEPIRIDE ","TAB 4MG","30","Select","Select",""],["","50742061510","METOPROL ","TAB 25MG ER","90","Select","Select",""],["","00193731150","CONTOUR ","TES NEXT","50","Select","Select",""],["","62175061743","PANTOPRAZOLE ","TAB 40MG","90","Select","Select",""],["","70377003012","ATORVASTATIN ","TAB 80MG","30","Select","Select",""],["","71093014005","METHOCARBAM ","TAB 500MG","60","Select","Select",""],["","65862035790","CLOPIDOGREL ","TAB 75MG","30","Select","Select",""],["","31722070190","LOSARTAN ","TAB 50MG","90","Select","Select",""],["","59746033090","DONEPEZIL ","TAB 10MG","30","Select","Select",""],["","69452015120","VITAMIN ","CAP 50000UNT","8","Select","Select",""],["","00093727298","PIOGLITAZONE ","TAB 30MG","90","Select","Select",""],["","00054000725","CALCITRIOL ","CAP 0.25MCG","30","Select","Select",""],["","59779048478","PAIN ","TAB 500MG","90","Select","Select",""],["","69097084507","CYCLOBENZAPR ","TAB 5MG","30","Select","Select",""],["","00054429931","FUROSEMIDE ","TAB 40MG","60","Select","Select",""],["","69097015807","MELOXICAM ","TAB 7.5MG","30","Select","Select",""],["","50428054208","CVS ","CRE 0.04","76.5","Select","Select",""],["","00245531911","KLOR-CON ","TAB 20MEQ ER","90","Select","Select",""],["","50742062101","NIFEDIPINE ","TAB 60MG ER","90","Select","Select",""],["","00904672059","ACETAMIN ","TAB 500MG","90","Select","Select",""],["","00536126720","LIDOCAINE ","CRE 0.04","15","Select","Select",""],["","50428038706","ACETAMINOPHN ","TAB 500MG","225","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":""}]}]}