{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LAUREN   J HORST","gend":1,"add":"6825   ARBOR  LAKE DRIVE                                    ","city":"CHESTER                       ","state":"VA","zip":"23831-8735","dob":"1987-05-03","age":"","mstatus":"","insh":10049326,"cliId":"","pno":8048698745,"cno":8048698745,"email":"","ename":"","eno":"","pphy":"BUSH, JAMES A","ppno":"","pcpadd":"815 W POYTHRESS ST,Ste A","pcpcity":"HOPEWELL                      ","pcpstate":"VA","pcpzip":238602532,"pcpcounty":"","pcpid":"P0118404","pcpname":"HOPEWELL MEDICAL CENTER","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"CENTRAL","aligned":"","ano":"","add2":"APT 104                                                     ","add3":"","madd1":"6825   ARBOR  LAKE DRIVE                                    ","madd2":"APT 104                                                     ","madd3":"","mcity":"CHESTER                       ","mstate":"VA","mzip":"23831-8735","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F33.2","J34.2","J34.3","R09.81","J34.89","J31.0","J00","J01.10","G43.009","G50.1","G43.909","F43.12","G43.011","Z68.41","I49.9","R07.2","R07.9","R06.02","F43.10","F41.8","K58.9","E66.9","N83.202","R10.31","R11.2","F32.9","R91.8","R10.9","R09.1","G89.29","R10.2","N80.9","H66.001","R05","R07.89","R74.0","R06.2","R06.89","R10.11","R10.10","R19.7","H66.91","Z90.49","R10.84","R40.4","G44.89","R93.3","H90.41","K21.9","H90.5","M26.609","M26.601","H91.91","J20.9","B34.9","J45.909","R50.9","Z68.39","S80.01XA","S90.01XA","J40","M54.16","M54.5","V43.52XA","Y92.410","M47.27","V87.7XXD","R39.15","R11.0","R10.12","R10.32","R16.0","M51.26","M51.16","N39.0","R41.82","T21.22XA","N21.9","R35.0","R35.8","M47.26","M47.816","G95.19","M51.27","T21.22XD","R10.13","M54.9","M51.36","N83.201","N89.8","B37.9","R11.10","F41.9","D25.9","N80.0","E66.01","Z68.37","Z90.710","R32","R21","K57.30","R30.0","R52","N90.9","S63.502A","S93.491A","S56.911A","S39.012A","M79.605","S76.011A","M25.551","M54.2","V89.2XXA","R51","T14.90XA","G43.919","R53.1","Z86.69","N76.0","M79.7","H93.13","H92.09","M54.41","R15.9","M54.42","A04.72","E87.6","H47.10","R94.31","Z03.89","R53.81","H53.8","M51.37","F41.1","E06.3","I47.1","F43.21","F45.9","Z79.899","Z82.49","Z87.42","G97.1","R11.11","H53.9","Z88.1","Z79.2","R10.33","R10.30","K52.89","K64.8","M79.10","N95.1","J02.9","R00.2","J30.9","G56.93","M25.511","M54.12","R20.0","X50.0XXA","Y93.01","S49.91XA","S46.011A","N93.9","M50.20","G56.03","M50.10","M50.23","M50.222","N30.00","E86.0","R42","R20.2","M19.011","M75.41","R45.851","Z79.890","F60.3","Z76.5","T38.0X5A","G89.4","M75.81","B37.3","M75.51","M67.40","M67.911","G54.0","S46.811A","S40.861A","E89.41","S40.861D","F17.200","R00.0","A04.71","K58.0","I21.29","K58.8","Z20.828","Z68.38","Z81.1","Z83.3","F39","F60.9","M50.322","M79.601","M79.89","M50.223","M79.631","G56.01","G56.02","G89.18","N30.01","R11.12","R29.898","Z47.89","A60.04","Z11.3","Z11.4","R39.9","N76.1","M25.562","M22.42","J98.4","R79.1","R53.83","Z20.822","Z11.52","R93.89","J45.990","Z71.9","R07.1","R51.9","R07.81","K92.1","K31.9","D64.9","Z86.010","S83.92XA","S89.92XA","S99.911A","X50.1XXA","K04.7","S40.021A","S40.021D","R55","M23.92","M67.471","M67.472","M25.572","M25.571","R22.42","R22.41","R60.0","M65.871","M62.89","Z01.812","D48.9","M79.673","L98.9","D48.1","L92.0","I95.9","F12.90","Z88.2","H57.11"],"date":["2021-10-02","2019-01-22","2019-01-22","2019-01-22","2019-01-22","2019-01-22","2019-01-22","2019-01-22","2020-11-20","2019-01-22","2021-01-08","2021-11-29","2019-02-08","2019-11-04","2019-02-02","2019-02-02","2021-02-03","2021-03-11","2020-09-25","2019-02-02","2020-06-08","2021-10-05","2019-02-05","2019-11-13","2021-04-17","2021-01-08","2019-03-09","2021-04-17","2019-02-06","2021-01-18","2020-02-09","2020-03-12","2019-02-14","2021-01-18","2021-02-03","2019-02-20","2021-01-18","2019-02-16","2019-08-13","2021-03-23","2021-03-25","2019-02-18","2020-09-25","2020-06-05","2019-02-18","2019-02-18","2019-02-18","2019-02-19","2021-10-05","2019-02-22","2019-03-01","2019-02-27","2019-03-01","2021-01-11","2020-05-29","2021-10-05","2019-03-04","2020-01-21","2019-03-13","2021-04-17","2021-01-25","2019-04-09","2019-06-10","2019-09-17","2019-04-09","2019-04-11","2019-04-11","2019-07-09","2021-02-03","2020-06-10","2019-11-15","2019-04-13","2019-06-11","2019-06-11","2020-03-13","2019-04-16","2019-04-23","2019-04-28","2020-11-20","2019-04-24","2021-08-26","2019-04-25","2019-04-25","2019-04-25","2019-04-28","2021-03-30","2021-01-18","2019-10-17","2019-07-09","2020-12-04","2019-07-15","2021-03-23","2021-01-08","2019-08-08","2019-08-08","2020-06-10","2019-08-02","2020-06-08","2019-10-17","2019-08-13","2019-10-11","2020-12-04","2019-08-27","2019-12-02","2019-09-11","2019-09-11","2019-09-11","2019-09-17","2019-09-17","2019-09-17","2019-09-17","2020-06-30","2019-09-25","2020-06-05","2019-09-25","2019-10-31","2020-06-30","2019-09-29","2021-06-08","2021-10-05","2019-10-15","2019-10-15","2019-10-17","2019-10-17","2019-10-17","2020-05-30","2021-02-03","2019-10-30","2021-02-03","2019-10-24","2019-10-28","2019-10-29","2019-10-30","2020-03-16","2021-10-05","2019-10-30","2019-10-30","2019-10-30","2021-11-30","2019-10-30","2019-10-30","2019-10-30","2019-11-05","2019-11-06","2021-10-05","2019-11-13","2019-11-13","2019-11-13","2019-11-15","2019-11-15","2019-12-02","2019-12-02","2020-04-24","2019-12-17","2019-12-17","2020-01-21","2020-05-18","2020-07-06","2020-07-06","2020-01-31","2020-01-31","2020-02-07","2020-02-07","2020-02-09","2020-02-10","2020-10-08","2020-02-18","2020-02-18","2020-07-05","2020-02-29","2020-06-26","2020-06-05","2020-07-06","2020-03-11","2020-05-18","2020-03-13","2021-02-03","2020-03-12","2020-06-30","2020-03-12","2020-03-13","2020-03-15","2021-06-08","2020-05-06","2020-05-06","2020-05-18","2020-05-18","2020-05-18","2020-05-18","2020-11-20","2020-05-29","2021-02-03","2021-10-05","2020-06-10","2020-06-10","2020-06-08","2020-06-08","2021-01-25","2021-10-05","2020-06-08","2020-06-08","2020-06-12","2020-06-10","2020-06-30","2020-06-30","2021-08-30","2020-07-05","2020-07-05","2020-07-20","2020-08-31","2020-08-31","2020-09-09","2020-09-25","2020-10-08","2020-10-08","2020-10-08","2020-10-08","2020-10-08","2020-11-20","2020-11-20","2021-04-17","2021-04-27","2021-01-08","2021-01-08","2021-01-08","2021-10-01","2021-01-12","2021-01-29","2021-03-11","2021-01-29","2021-02-03","2021-02-03","2021-02-03","2021-03-29","2021-03-30","2021-03-30","2021-03-29","2021-04-10","2021-04-17","2021-04-17","2021-04-17","2021-06-08","2021-07-05","2021-07-05","2021-07-05","2021-08-26","2021-08-16","2021-08-16","2021-08-30","2021-08-30","2021-09-02","2021-10-05","2021-08-30","2021-08-30","2021-08-30","2021-10-01","2021-10-01","2021-10-01","2021-09-24","2021-10-05","2021-10-05","2021-10-05","2021-10-05","2021-10-05","2021-10-10"],"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":[["","65162010250","GABAPENTIN","300MG","180","Select","Select",""],["","00406048410","APAP\/CODEINE","300-30MG","21","Select","Select",""],["","00591079501","DICYCLOMINE","20MG","12","Select","Select",""],["","00046110281","PREMARIN","0.625MG","25","Select","Select",""],["","00378230201","PRAZOSIN","2MG","60","Select","Select",""],["","00115166101","PROPRANOLOL","40MG","60","Select","Select",""],["","67877024760","QUETIAPINE","300MG","30","Select","Select",""],["","68382014005","TOPIRAMATE","100MG","24","Select","Select",""],["","68462034690","LEVOCETIRIZI","5MG","11","Select","Select",""],["","27241009706","DULOXETINE","20MG","30","Select","Select",""],["","70954000520","OXYBUTYNIN","5MG","30","Select","Select",""],["","10702000350","PROMETHAZINE","25MG","12","Select","Select",""],["","00093520006","BUSPIRONE","30MG","60","Select","Select",""],["","57237007710","ONDANSETRON","4MG ODT","10","Select","Select",""],["","50383077504","LIDOCAINE","2% VISC","100","Select","Select",""],["","69238110005","DOXYCYCL","100MG","20","Select","Select",""],["","00173069600","ADVAIR","250\/50","60","Select","Select",""],["","65862016001","ZOLPIDEM","10MG","30","Select","Select",""],["","16729013616","CLONAZEPAM","0.5MG","30","Select","Select",""],["","00527133701","BACLOFEN","20MG","90","Select","Select",""],["","70700011885","VIENVA","0.1-20","112","Select","Select",""],["","00555088602","ESTRADIOL","1MG","30","Select","Select",""],["","59762045001","COLESTIPOL","1GM","120","Select","Select",""],["","43199001401","HYOSCYAMINE","0.375 ER","10","Select","Select",""],["","52817033200","CYCLOBENZAPR","10MG","30","Select","Select",""],["","66993001968","ALBUTEROL","HFA","18","Select","Select",""],["","00185012201","NITROFURANTN","100MG","10","Select","Select",""],["","57237000511","FLUCONAZOLE","150MG","2","Select","Select",""],["","00591544210","PREDNISONE","10MG","30","Select","Select",""],["","00186037020","SYMBICORT","160-4.5","10.2","Select","Select",""],["","00574010770","CLOTRIMAZOLE","10MG","70","Select","Select",""],["","00168008915","NYSTAT\/TRIAM","","15","Select","Select",""],["","42571016242","AMOX\/K","875-125","20","Select","Select",""],["","00378427677","VALACYCLOVIR","1GM","20","Select","Select",""],["","00406012305","HYDROCO\/APAP","5-325MG","10","Select","Select",""],["","00115180301","HYDROXYZ","25MG","120","Select","Select",""],["","76204060060","IPRATROPIUM\/","ALBUTER","180","Select","Select",""],["","62559049001","DIPHEN\/ATROP","2.5MG","120","Select","Select",""],["","42192080201","PHENAZOPYRID","200MG","9","Select","Select",""],["","00555904558","AVIANE","","28","Select","Select",""],["","00781808926","AZITHROMYCIN","250MG","6","Select","Select",""],["","70010077001","METHOCARBAM","750MG","20","Select","Select",""],["","00406051201","OXYCOD\/APAP","5-325MG","8","Select","Select",""],["","65862042005","SMZ\/TMP","800-160","6","Select","Select",""],["","64380080707","IBUPROFEN","800MG","90","Select","Select",""],["","69543025216","VIRTUSSIN","100-10\/5","120","Select","Select",""],["","45802013970","METRONIDAZOL","0.75%VAG","70","Select","Select",""],["","69097052444","DICLOFENAC","1%","100","Select","Select",""],["","42494040901","CHLORD\/CLIDI","5-2.5MG","30","Select","Select",""],["","51672130200","TERCONAZOLE","0.80%","20","Select","Select",""],["","65162006205","SUCRALFATE","1GM\/10ML","420","Select","Select",""],["","62175011843","OMEPRAZOLE","20MG","20","Select","Select",""],["","68462013281","NORETH\/ETHIN","Jan-20","63","Select","Select",""],["","42806071401","BENZONATATE","100MG","15","Select","Select",""],["","00093031401","KETOROLAC","10MG","20","Select","Select",""],["","59746000103","METHYLPRED","4MG","21","Select","Select",""],["","59746011506","PROCHLORPER","10MG","15","Select","Select",""],["","65162010250","GABAPENTIN ","CAP 300MG","180","Select","Select",""],["","00406048410","APAP\/CODEINE ","TAB 300-30MG","21","Select","Select",""],["","00591079501","DICYCLOMINE ","TAB 20MG","12","Select","Select",""],["","00046110281","PREMARIN ","TAB 0.625MG","25","Select","Select",""],["","00378230201","PRAZOSIN ","CAP 2MG","60","Select","Select",""],["","00115166101","PROPRANOLOL ","TAB 40MG","60","Select","Select",""],["","67877024760","QUETIAPINE ","TAB 300MG","30","Select","Select",""],["","68382014005","TOPIRAMATE ","TAB 100MG","24","Select","Select",""],["","68462034690","LEVOCETIRIZI ","TAB 5MG","11","Select","Select",""],["","00406055201","OXYCODONE ","TAB 5MG","12","Select","Select",""],["","27241009706","DULOXETINE ","CAP 20MG","30","Select","Select",""],["","70954000520","OXYBUTYNIN ","TAB 5MG","30","Select","Select",""],["","10702000350","PROMETHAZINE ","TAB 25MG","12","Select","Select",""],["","00093520006","BUSPIRONE ","TAB 30MG","60","Select","Select",""],["","00527133701","BACLOFEN ","TAB 20MG","90","Select","Select",""],["","61314062810","POLYMYXIN ","SOL TRIMETHP","10","Select","Select",""],["","57237007710","ONDANSETRON ","TAB 4MG ODT","10","Select","Select",""],["","50383077504","LIDOCAINE ","SOL 2% VISC","100","Select","Select",""],["","69238110005","DOXYCYCL ","CAP 100MG","20","Select","Select",""],["","00173069600","ADVAIR ","AER 250\/50","60","Select","Select",""],["","65862016001","ZOLPIDEM ","TAB 10MG","30","Select","Select",""],["","16729013616","CLONAZEPAM ","TAB 0.5MG","30","Select","Select",""],["","70700011885","VIENVA ","TAB 0.1-20","112","Select","Select",""],["","00555088602","ESTRADIOL ","TAB 1MG","30","Select","Select",""],["","59762045001","COLESTIPOL ","TAB 1GM","120","Select","Select",""],["","43199001401","HYOSCYAMINE ","TAB 0.375 ER","10","Select","Select",""],["","52817033200","CYCLOBENZAPR ","TAB 10MG","30","Select","Select",""],["","66993001968","ALBUTEROL ","AER HFA","18","Select","Select",""],["","00185012201","NITROFURANTN ","CAP 100MG","10","Select","Select",""],["","57237000511","FLUCONAZOLE ","TAB 150MG","2","Select","Select",""],["","00591544210","PREDNISONE ","TAB 10MG","30","Select","Select",""],["","00186037020","SYMBICORT ","AER 160-4.5","10.2","Select","Select",""],["","00574010770","CLOTRIMAZOLE ","LOZ 10MG","70","Select","Select",""],["","00168008915","NYSTAT\/TRIAM ","OIN ","15","Select","Select",""],["","42571016242","AMOX\/K ","TAB 875-125","20","Select","Select",""],["","00378427677","VALACYCLOVIR ","TAB 1GM","20","Select","Select",""],["","00406012305","HYDROCO\/APAP ","TAB 5-325MG","10","Select","Select",""],["","00115180301","HYDROXYZ ","CAP 25MG","120","Select","Select",""],["","76204060060","IPRATROPIUM\/ ","SOL ALBUTER","180","Select","Select",""],["","62559049001","DIPHEN\/ATROP ","TAB 2.5MG","120","Select","Select",""],["","42192080201","PHENAZOPYRID ","TAB 200MG","9","Select","Select",""],["","00555904558","AVIANE ","TAB ","28","Select","Select",""],["","00781808926","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","70010077001","METHOCARBAM ","TAB 750MG","20","Select","Select",""],["","00406051201","OXYCOD\/APAP ","TAB 5-325MG","8","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","6","Select","Select",""],["","64380080707","IBUPROFEN ","TAB 800MG","90","Select","Select",""],["","69543025216","VIRTUSSIN ","SOL 100-10\/5","120","Select","Select",""],["","45802013970","METRONIDAZOL ","GEL 0.75%VAG","70","Select","Select",""],["","69097052444","DICLOFENAC ","GEL 0.01","100","Select","Select",""],["","42494040901","CHLORD\/CLIDI ","CAP 5-2.5MG","30","Select","Select",""],["","51672130200","TERCONAZOLE ","CRE 0.008","20","Select","Select",""],["","65162006205","SUCRALFATE ","SUS 1GM\/10ML","420","Select","Select",""],["","62175011843","OMEPRAZOLE ","CAP 20MG","20","Select","Select",""],["","68462013281","NORETH\/ETHIN ","TAB 43831","63","Select","Select",""],["","42806071401","BENZONATATE ","CAP 100MG","15","Select","Select",""],["","00093031401","KETOROLAC ","TAB 10MG","20","Select","Select",""],["","59746000103","METHYLPRED ","TAB 4MG","21","Select","Select",""],["","59746011506","PROCHLORPER ","TAB 10MG","15","Select","Select",""],["","69618001501","ASPIRIN ","TAB 325MG EC","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","",""],["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":""}]}]}