{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JUANITA   G TOONE","gend":1,"add":"978 HENDRICK CROW ROAD                                      ","city":"BOYDTON                       ","state":"VA","zip":"23917-3014","dob":"1955-10-27","age":"","mstatus":"","insh":10051040,"cliId":"","pno":4342109184,"cno":4342654809,"email":"","ename":"","eno":"","pphy":"HUNDLEY, SUSAN D                                            ","ppno":"","pcpadd":"705 Main St","pcpcity":"Danville                      ","pcpstate":"VA","pcpzip":245411803,"pcpcounty":"","pcpid":"P0114250","pcpname":"HEALTH CENTER OF THE PIEDMONT BOYDTON","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"CENTRAL","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"978 HENDRICK CROW ROAD                                      ","madd2":"                                                            ","madd3":"","mcity":"BOYDTON                       ","mstate":"VA","mzip":"23917-3014","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G89.4","R30.0","E11.43","K21.9","J30.2","F51.05","I10","R68.89","J01.00","E55.9","J41.0","R09.89","R05","J98.11","S30.0XXA","J40","W19.XXXA","S79.911A","M54.5","R51","R29.6","S19.9XXA","S09.90XA","S29.9XXA","S39.93XA","S32.009A","R91.8","N39.0","S32.019A","S32.039A","I35.0","I51.7","J18.9","J98.4","J81.0","M51.36","M48.061","E27.9","I50.32","J44.9","E78.5","E78.00","F03.90","F17.210","I11.0","F31.9","E11.42","G89.29","S32.008A","E11.9","S32.018A","Z91.81","Z03.89","M99.53","D35.00","M47.816","S32.018D","M19.90","W19.XXXS","Z79.899","R60.0","R10.2","R82.90","W57.XXXA","N30.90","R35.8","A49.8","R46.89","E11.65","D17.79","Z23","E27.8","R19.09","C79.72","Z01.812","Z01.810","R11.0","R53.1","R06.02","I50.30","Z95.2","F41.9","J43.9","J47.9","I34.2","I34.8","R07.9","I25.10","Z95.4","M25.552","Z79.01","E13.65","Z20.822","I42.9","H40.9","E11.40","E66.9","L68.0","Z90.710","Z83.3","Z82.49","I95.9","Z95.3","D35.02","Z79.4","D17.72","Z48.89","I67.82","R68.83","S79.912A","R94.31","J96.01","G93.41","F05","J44.0","Z81.8","Z79.51","E83.42","E87.6","R41.0","R41.82","E11.59","B96.1","Z87.01"],"date":["2020-07-10","2021-11-02","2021-09-28","2019-03-01","2019-06-14","2019-03-01","2021-09-28","2019-03-14","2019-03-14","2021-07-06","2019-06-14","2019-04-16","2019-04-16","2019-05-19","2019-05-19","2019-05-19","2019-05-21","2019-05-19","2019-05-21","2019-05-21","2020-01-28","2019-05-21","2019-05-21","2019-05-21","2019-05-21","2019-05-21","2021-09-05","2021-09-10","2019-05-21","2019-05-21","2019-05-22","2019-05-22","2021-09-10","2019-05-22","2019-05-22","2019-05-26","2019-07-01","2021-07-13","2021-09-10","2021-09-06","2021-06-01","2019-05-22","2019-07-01","2021-09-08","2021-09-10","2021-09-10","2021-09-10","2021-07-20","2019-05-22","2021-07-13","2019-05-22","2019-05-22","2019-05-22","2019-05-22","2021-08-03","2019-07-01","2019-05-31","2020-01-28","2019-07-03","2021-09-28","2019-08-20","2020-05-04","2020-05-04","2021-09-28","2020-05-04","2020-03-05","2020-05-04","2020-11-16","2021-07-24","2021-07-22","2021-09-21","2021-04-05","2021-06-18","2021-07-13","2021-07-13","2021-06-29","2021-05-13","2021-09-05","2021-06-28","2021-06-01","2021-09-08","2021-06-07","2021-06-18","2021-06-18","2021-06-28","2021-06-28","2021-06-28","2021-07-20","2021-06-29","2021-07-06","2021-07-13","2021-07-19","2021-07-19","2021-07-20","2021-07-20","2021-07-20","2021-07-20","2021-07-20","2021-07-20","2021-09-08","2021-09-08","2021-07-20","2021-07-20","2021-07-24","2021-09-09","2021-07-22","2021-08-03","2021-09-05","2021-09-05","2021-09-05","2021-09-07","2021-09-09","2021-09-10","2021-09-08","2021-09-10","2021-09-08","2021-09-08","2021-09-10","2021-09-08","2021-09-05","2021-09-06","2021-09-06","2021-09-10","2021-09-10"],"priorHcc":["",null,"","","","","","","","","","","","","","","","","","","","","","","","","",null,"","","","",null,"","","","","",null,null,"","","","",null,null,null,"","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",null,"","","","","","",null,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":[["","00054429731","FUROSEMIDE","20MG","60","Select","Select",""],["","53489014310","SPIRONOLACT","25MG","60","Select","Select",""],["","68180035302","SERTRALINE","100MG","60","Select","Select",""],["","64380073706","VITAMIN","50000UNT","4","Select","Select",""],["","33342006015","CLOPIDOGREL","75MG","30","Select","Select",""],["","16729017201","AMITRIPTYLIN","25MG","60","Select","Select",""],["","31722073890","DONEPEZIL","10MG","30","Select","Select",""],["","16729028715","ROSUVASTATIN","40MG","15","Select","Select",""],["","45963055750","GABAPENTIN","400MG","180","Select","Select",""],["","57664037718","TRAMADOL","50MG","180","Select","Select",""],["","00088222033","LANTUS","100\/ML","10","Select","Select",""],["","56151173301","INSULIN","1ML\/31G","100","Select","Select",""],["","23155010205","METFORMIN","500MG","120","Select","Select",""],["","56151014201","TRUEDRAW","LANC DEV","1","Select","Select",""],["","00143992801","CIPROFLOXACN","500MG","20","Select","Select",""],["","16729011917","MONTELUKAST","10MG","30","Select","Select",""],["","62756079888","DIVALPROEX","500MG DR","90","Select","Select",""],["","55111016330","OLANZAPINE","2.5MG","30","Select","Select",""],["","16729020016","BUSPIRONE","5MG","90","Select","Select",""],["","00591544301","PREDNISONE","20MG","7","Select","Select",""],["","00472032126","HYDROCORT","1%","60","Select","Select",""],["","47781030301","NITROFURANTN","100MG","20","Select","Select",""],["","00085461001","DULERA","200-5MCG","39","Select","Select",""],["","00472024260","PERMETHRIN","5%","60","Select","Select",""],["","56151210401","PEN NEEDLES","32GX4MM","100","Select","Select",""],["","00169633910","NOVOLOG","FLEXPEN","15","Select","Select",""],["","00002831501","HUMULIN","U-100","30","Select","Select",""],["","69097052444","DICLOFENAC","1%","100","Select","Select",""],["","00002751001","HUMALOG","100\/ML","40","Select","Select",""],["","56151014401","TRUPLUS","30G","100","Select","Select",""],["","45802045537","HC","0.20%","60","Select","Select",""],["","23155050110","HYDROXYZ","25MG","120","Select","Select",""],["","00406055201","OXYCODONE","5MG","12","Select","Select",""],["","31722072250","LEVOFLOXACIN","500MG","10","Select","Select",""],["","00054418125","DEXAMETHASON","1MG","1","Select","Select",""],["","00054429731","FUROSEMIDE ","TAB 20MG","60","Select","Select",""],["","53489014310","SPIRONOLACT ","TAB 25MG","60","Select","Select",""],["","68180035302","SERTRALINE ","TAB 100MG","60","Select","Select",""],["","64380073706","VITAMIN ","CAP 50000UNT","4","Select","Select",""],["","33342006015","CLOPIDOGREL ","TAB 75MG","30","Select","Select",""],["","16729017201","AMITRIPTYLIN ","TAB 25MG","60","Select","Select",""],["","31722073890","DONEPEZIL ","TAB 10MG","30","Select","Select",""],["","16729028715","ROSUVASTATIN ","TAB 40MG","15","Select","Select",""],["","45963055750","GABAPENTIN ","CAP 400MG","180","Select","Select",""],["","57664037718","TRAMADOL ","TAB 50MG","180","Select","Select",""],["","55111012701","CIPROFLOXACN ","TAB 500MG","20","Select","Select",""],["","00088222033","LANTUS ","INJ 100\/ML","10","Select","Select",""],["","56151173301","INSULIN ","MIS 1ML\/31G","100","Select","Select",""],["","23155010205","METFORMIN ","TAB 500MG","120","Select","Select",""],["","56151014201","TRUEDRAW ","MIS LANC DEV","1","Select","Select",""],["","16729011917","MONTELUKAST ","TAB 10MG","30","Select","Select",""],["","62756079888","DIVALPROEX ","TAB 500MG DR","90","Select","Select",""],["","55111016330","OLANZAPINE ","TAB 2.5MG","30","Select","Select",""],["","16729020016","BUSPIRONE ","TAB 5MG","90","Select","Select",""],["","78206012601","DULERA ","AER 200-5MCG","13","Select","Select",""],["","00591544301","PREDNISONE ","TAB 20MG","7","Select","Select",""],["","00472032126","HYDROCORT ","CRE 0.01","60","Select","Select",""],["","47781030301","NITROFURANTN ","CAP 100MG","20","Select","Select",""],["","00472024260","PERMETHRIN ","CRE 0.05","60","Select","Select",""],["","56151210401","PEN  NEEDLES  ","MIS 32GX4MM","100","Select","Select",""],["","00169633910","NOVOLOG ","INJ FLEXPEN","15","Select","Select",""],["","00002831501","HUMULIN ","INJ U-100","30","Select","Select",""],["","33332032101","AFLURIA ","INJ 2021-22","0.5","Select","Select",""],["","69097052444","DICLOFENAC ","GEL 0.01","100","Select","Select",""],["","00002751001","HUMALOG ","INJ 100\/ML","40","Select","Select",""],["","08290320122","BD  PEN NEEDL","MIS 32GX4MM","100","Select","Select",""],["","56151014401","TRUPLUS ","MIS 30G","100","Select","Select",""],["","45802045537","HC ","CRE 0.002","60","Select","Select",""],["","23155050110","HYDROXYZ ","TAB 25MG","120","Select","Select",""],["","00406055201","OXYCODONE ","TAB 5MG","12","Select","Select",""],["","31722072250","LEVOFLOXACIN ","TAB 500MG","10","Select","Select",""],["","00054418125","DEXAMETHASON ","TAB 1MG","1","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":""}]}]}