{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BETTY JOHNSON","gend":1,"add":"P O BOX 420                                                 ","city":"VICTORIA                      ","state":"VA","zip":"23974-9998","dob":"1956-06-09","age":"","mstatus":"","insh":10049700,"cliId":"","pno":4344301708,"cno":"","email":"","ename":"","eno":"","pphy":"POWERS, LINDA P                                             ","ppno":"","pcpadd":"514 W Atlantic St","pcpcity":"South Hill                    ","pcpstate":"VA","pcpzip":239701906,"pcpcounty":"","pcpid":"P0144597","pcpname":"SOUTH HILL FAMILY MEDICINE PRIVIA MEDICAL GROUP L","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"CENTRAL","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"P O BOX 420                                                 ","madd2":"                                                            ","madd3":"","mcity":"VICTORIA                      ","mstate":"VA","mzip":"23974-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11.9","I10","E66.3","E78.5","Z79.84","I25.10","M20.41","E11.42","M79.674","M79.675","B35.1","M79.671","Z68.34","S39.012A","K21.9","R13.10","K31.84","E78.00","Z12.31","Z12.11","E11.65","R68.89","M48.00","M54.9","M16.9","M54.5","R29.3","M62.830","R26.2","M62.81","M25.562","M65.30","M65.312","E11.40","Z00.01","Z01.419","Z23","Z68.33","Z79.4","M47.26","M51.16","M54.2","M62.838","M54.12","M75.40","M75.100","M51.36","M17.10","M50.30","M12.819","Z01.818","E11.43","I25.2","Z79.02","Z79.82","Z95.5","M65.311","M65.319","L72.3","E66.9","H25.13","H02.89","H10.45","H35.033","J45.909","Z68.31","M17.12","M25.512","Z98.890","M12.812","M19.019","D50.9","Z79.899","Z20.828","Z88.0","Z87.891","Z83.3","Z82.49","Z79.1","K22.2","G56.01","G56.03","R21","Z86.010","M46.92","Z68.30","Z28.21","L30.9","G56.00","M25.552","G47.33","Z20.822","Z01.811","M11.269","M17.11","N63.0","M23.90","S83.242A","M25.462","R60.9","M10.9","M79.672","Z68.32","M23.42","Z68.41","M20.42"],"date":["2020-10-22","2021-08-27","2019-04-12","2021-04-16","2021-09-03","2021-09-03","2021-06-03","2021-09-23","2021-09-23","2021-09-23","2021-09-23","2019-04-11","2019-07-12","2019-06-14","2021-09-03","2020-10-29","2021-09-03","2021-08-27","2020-07-31","2019-07-12","2019-07-12","2021-02-25","2019-10-30","2019-10-17","2019-09-13","2021-05-14","2019-10-04","2019-10-04","2019-10-04","2019-11-22","2021-07-23","2020-02-21","2020-08-31","2021-08-27","2020-10-30","2019-10-18","2020-10-30","2020-02-06","2021-05-14","2019-10-30","2019-10-30","2019-11-22","2019-11-22","2021-09-03","2020-07-30","2019-11-06","2021-09-03","2020-04-09","2019-12-30","2019-12-30","2019-12-20","2021-09-03","2021-09-03","2019-12-30","2021-05-14","2021-04-14","2020-08-31","2020-07-30","2020-02-06","2021-04-16","2020-03-11","2020-03-11","2020-03-11","2020-03-11","2020-07-23","2021-02-05","2021-09-03","2020-07-24","2021-05-12","2020-07-30","2020-08-26","2021-09-03","2020-09-03","2020-09-03","2021-09-03","2021-04-14","2020-08-26","2020-09-03","2020-09-03","2020-10-29","2021-04-14","2020-10-22","2021-01-22","2021-09-03","2021-05-14","2021-05-14","2020-10-30","2020-12-18","2021-05-28","2021-02-05","2021-04-14","2021-04-14","2021-04-14","2021-05-28","2021-05-12","2021-07-08","2021-06-10","2021-09-14","2021-07-08","2021-07-08","2021-08-27","2021-08-27","2021-08-27","2021-09-03","2021-09-03","2021-09-23"],"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":[["","59267100001","PFIZER","COVID-19","0.3","Select","Select",""],["","00591084410","GLIPIZIDE","5MG","90","Select","Select",""],["","00088221905","LANTUS","100\/ML","15","Select","Select",""],["","65862086001","FAMOTIDINE","40MG","90","Select","Select",""],["","65162006205","SUCRALFATE","1GM\/10ML","600","Select","Select",""],["","69097015815","MELOXICAM","7.5MG","30","Select","Select",""],["","50742022515","TIZANIDINE","4MG","60","Select","Select",""],["","68462026390","ROSUVASTATIN","20MG","30","Select","Select",""],["","65862056099","PANTOPRAZOLE","40MG","180","Select","Select",""],["","62756014202","METFORMIN","500MG ER","30","Select","Select",""],["","45802008801","ALBUTEROL","HFA","8.5","Select","Select",""],["","50228014605","HYDROCHLOROT","12.5MG","30","Select","Select",""],["","53746010905","HYDROCO\/APAP","5-325MG","24","Select","Select",""],["","61314023710","CROMOLYN","4% OP","10","Select","Select",""],["","65162062711","TRAMADOL","50MG","10","Select","Select",""],["","65162025425","RANITIDINE","300MG","30","Select","Select",""],["","67877022310","GABAPENTIN","300MG","30","Select","Select",""],["","68382009505","CARVEDILOL","25MG","180","Select","Select",""],["","68180021509","LOSARTAN\/HCT","50-12.5","90","Select","Select",""],["","08290320122","BD PEN NEEDL","32GX4MM","100","Select","Select",""],["","00378064110","PREDNISONE","10MG","5","Select","Select",""],["","00143980350","DOXYCYCL","100MG","10","Select","Select",""],["","51672131200","MUPIROCIN","2%","22","Select","Select",""],["","45802037632","AUG","0.05%","50","Select","Select",""],["","59762330403","NITROGLYCERN","0.4MG","25","Select","Select",""],["","99073070827","FREESTYLE TES LITE","LITE","100","Select","Select",""],["","17478030512","OLOPATADINE","0.20%","2.5","Select","Select",""],["","61442010310","DICLOFENAC","75MG DR","60","Select","Select",""],["","59267100001","PFIZER ","INJ COVID-19","0.3","Select","Select",""],["","00591084410","GLIPIZIDE ","TAB 5MG","90","Select","Select",""],["","00088221905","LANTUS ","INJ 100\/ML","15","Select","Select",""],["","65862086001","FAMOTIDINE ","TAB 40MG","90","Select","Select",""],["","65162006205","SUCRALFATE ","SUS 1GM\/10ML","600","Select","Select",""],["","69097015815","MELOXICAM ","TAB 7.5MG","30","Select","Select",""],["","50742022515","TIZANIDINE ","CAP 4MG","60","Select","Select",""],["","68462026390","ROSUVASTATIN ","TAB 20MG","30","Select","Select",""],["","65862056099","PANTOPRAZOLE ","TAB 40MG","180","Select","Select",""],["","62756014202","METFORMIN ","TAB 500MG ER","30","Select","Select",""],["","45802008801","ALBUTEROL ","AER HFA","8.5","Select","Select",""],["","50228014605","HYDROCHLOROT ","CAP 12.5MG","30","Select","Select",""],["","53746010905","HYDROCO\/APAP ","TAB 5-325MG","24","Select","Select",""],["","61314023710","CROMOLYN ","SOL 4% OP","10","Select","Select",""],["","65162062711","TRAMADOL ","TAB 50MG","10","Select","Select",""],["","65162025425","RANITIDINE ","TAB 300MG","30","Select","Select",""],["","67877022310","GABAPENTIN ","CAP 300MG","30","Select","Select",""],["","68382009505","CARVEDILOL ","TAB 25MG","180","Select","Select",""],["","68180021509","LOSARTAN\/HCT ","TAB 50-12.5","90","Select","Select",""],["","08290320122","BD  PEN NEEDL","MIS 32GX4MM","100","Select","Select",""],["","00378064110","PREDNISONE ","TAB 10MG","5","Select","Select",""],["","00143980350","DOXYCYCL ","CAP 100MG","10","Select","Select",""],["","51672131200","MUPIROCIN ","OIN 0.02","22","Select","Select",""],["","45802037632","AUG ","CRE 0.0005","50","Select","Select",""],["","59762330403","NITROGLYCERN ","SUB 0.4MG","25","Select","Select",""],["","99073070827","FREESTYLE    TES LITE","TES LITE","100","Select","Select",""],["","17478030512","OLOPATADINE ","SOL 0.002","2.5","Select","Select",""],["","61442010310","DICLOFENAC ","TAB 75MG DR","60","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":""}]}]}