{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KIMBERLY   M FULKERSON","gend":1,"add":"PO BOX 53                                                   ","city":"PORT ROYAL                    ","state":"VA","zip":"22535-0053","dob":"2001-05-16","age":"","mstatus":"","insh":10049053,"cliId":"","pno":5404134956,"cno":5407838335,"email":"","ename":"","eno":"","pphy":"DEDWYLDER, ROSIER D                                         ","ppno":"","pcpadd":"5254 Potomac Dr","pcpcity":"King George                   ","pcpstate":"VA","pcpzip":224855832,"pcpcounty":"","pcpid":"P0149790","pcpname":"MARY WASHINGTON MEDICAL GROUP","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"CENTRAL","aligned":"","ano":"","add2":"APT 3                                                       ","add3":"","madd1":"PO BOX 53                                                   ","madd2":"APT 3                                                       ","madd3":"","mcity":"PORT ROYAL                    ","mstate":"VA","mzip":"22535-0053","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R68.89","J30.2","J06.9","N93.8","R10.30","R10.9","O20.9","Z11.3","N76.0","Z32.02","N89.8","N30.00","B37.3","R21","N92.0","Z30.9","J01.91","N39.0","J02.9","J45.901","R06.02","R42","F17.200","R07.89","R07.9","L50.9","R05","J40","N91.2","N93.9","O26.891","O99.511","J45.909","O99.331","Z3A.00","N92.1","N94.6","Z23","E87.6","F41.9","Z20.828","Z01.812","R94.31","Z03.818","R07.0","A59.9","N85.00","R31.9","R93.5","R93.89","F17.210","Z87.42","Z87.59","R10.2","R10.84","R52","I95.9","R30.0","H92.03","N91.1","O23.43","O26.23","Z3A.32","O26.893","O99.333","O99.513","O20.8","Z3A.33","O47.9","O03.9","O47.03","O36.8131","O36.8130","O24.419","O09.33","Z3A.39","O47.1","O48.0","O77.0","O76","O69.81X0","O62.1","O62.0","O99.214","E66.9","O99.52","O40.3XX0","O32.6XX0","Z3A.40","Z37.0","Z37.9","M54.89","Z09","Z91.011","R35.0","Z39.2","Z30.09","L22","R09.81"],"date":["2020-12-10","2019-04-19","2020-01-14","2019-05-05","2021-09-05","2021-07-27","2019-05-06","2020-01-17","2021-10-14","2020-01-17","2021-04-06","2019-07-30","2021-05-25","2019-07-30","2020-12-09","2019-10-03","2019-10-11","2020-12-09","2020-10-07","2019-12-24","2020-10-07","2019-12-24","2021-07-18","2019-12-24","2019-12-24","2019-12-24","2019-12-24","2020-01-03","2021-06-22","2020-10-14","2020-02-29","2020-02-29","2021-09-13","2020-02-29","2020-02-29","2020-03-24","2020-06-10","2020-04-15","2020-10-07","2020-10-07","2020-10-07","2020-10-07","2020-10-07","2020-10-07","2020-10-07","2020-12-09","2020-12-09","2020-12-09","2020-12-09","2020-12-09","2020-12-09","2020-12-09","2020-12-09","2020-12-09","2021-09-05","2021-07-27","2020-12-09","2021-10-14","2021-04-06","2021-05-25","2021-07-18","2021-07-18","2021-07-18","2021-07-27","2021-07-18","2021-09-05","2021-07-18","2021-07-28","2021-09-05","2021-09-05","2021-07-28","2021-07-30","2021-08-23","2021-09-05","2021-09-05","2021-09-05","2021-09-05","2021-09-13","2021-09-13","2021-09-13","2021-09-13","2021-09-14","2021-09-13","2021-09-13","2021-09-13","2021-09-13","2021-09-13","2021-09-13","2021-09-14","2021-09-14","2021-09-14","2021-09-05","2021-09-22","2021-10-06","2021-10-14","2021-10-27","2021-10-27","2021-11-02","2021-11-02"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",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":[["","67877032105","IBUPROFEN","800MG","30","Select","Select",""],["","00555901658","SPRINTEC","28 DAY","28","Select","Select",""],["","00555088702","ESTRADIOL","2MG","18","Select","Select",""],["","42858010201","OXYCOD\/APAP","5-325MG","28","Select","Select",""],["","14539067401","HYDROXYZ","25MG","20","Select","Select",""],["","10006073038","MAG","400MG","14","Select","Select",""],["","00245531911","KLOR-CON","20MEQ ER","14","Select","Select",""],["","68180012202","CEPHALEXIN","500MG","14","Select","Select",""],["","65862050320","AMOX\/K","875-125","14","Select","Select",""],["","50428026496","CVS","8.6MG","30","Select","Select",""],["","70710113908","FLUCONAZOLE","150MG","1","Select","Select",""],["","50111033401","METRONIDAZOL","500MG","14","Select","Select",""],["","65862042005","SMZ\/TMP","800-160","28","Select","Select",""],["","00093031401","KETOROLAC","10MG","20","Select","Select",""],["","50383077504","LIDOCAINE","2% VISC","100","Select","Select",""],["","00378827052","ALBUTEROL","0.08%","150","Select","Select",""],["","00378064110","PREDNISONE","10MG","21","Select","Select",""],["","45802048678","DOCUSATE","100MG","60","Select","Select",""],["","00555904358","APRI","","28","Select","Select",""],["","00536100901","FERROUS","325MG","60","Select","Select",""],["","65862039010","ONDANSETRON","4MG ODT","20","Select","Select",""],["","67877025130","TRIAMCINOLON","0.10%","30","Select","Select",""],["","00555077902","MEDROXYPR","10MG","10","Select","Select",""],["","00536408501","PRENATAL","28-0.8MG","90","Select","Select",""],["","67877032105","IBUPROFEN ","TAB 800MG","30","Select","Select",""],["","00555901658","SPRINTEC ","TAB 28 DAY","28","Select","Select",""],["","00555088702","ESTRADIOL ","TAB 2MG","18","Select","Select",""],["","66689000816","NYSTATIN ","SUS 100000","60","Select","Select",""],["","42858010201","OXYCOD\/APAP ","TAB 5-325MG","28","Select","Select",""],["","14539067401","HYDROXYZ ","CAP 25MG","20","Select","Select",""],["","10006073038","MAG ","TAB 400MG","14","Select","Select",""],["","00245531911","KLOR-CON ","TAB 20MEQ ER","14","Select","Select",""],["","50111033401","METRONIDAZOL ","TAB 500MG","14","Select","Select",""],["","47781030301","NITROFURANTN ","CAP 100MG","14","Select","Select",""],["","70710113908","FLUCONAZOLE ","TAB 150MG","1","Select","Select",""],["","51672404801","CLOTRIM\/BETA ","CRE DIPROP","15","Select","Select",""],["","68180012202","CEPHALEXIN ","CAP 500MG","14","Select","Select",""],["","65862050320","AMOX\/K ","TAB 875-125","14","Select","Select",""],["","50428026496","CVS ","TAB 8.6MG","30","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","28","Select","Select",""],["","00093031401","KETOROLAC ","TAB 10MG","20","Select","Select",""],["","50383077504","LIDOCAINE ","SOL 2% VISC","100","Select","Select",""],["","00378827052","ALBUTEROL ","NEB 0.00083","150","Select","Select",""],["","00378064110","PREDNISONE ","TAB 10MG","21","Select","Select",""],["","45802048678","DOCUSATE ","CAP 100MG","60","Select","Select",""],["","00555904358","APRI ","TAB ","28","Select","Select",""],["","00536100901","FERROUS ","TAB 325MG","60","Select","Select",""],["","65862039010","ONDANSETRON ","TAB 4MG ODT","20","Select","Select",""],["","67877025130","TRIAMCINOLON ","CRE 0.001","30","Select","Select",""],["","00555077902","MEDROXYPR ","TAB 10MG","10","Select","Select",""],["","00536408501","PRENATAL ","TAB 28-0.8MG","90","Select","Select",""],["","00093101042","MUPIROCIN ","OIN 0.02","22","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","",""],["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":""}]}]}