{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"FRANCES CARR","gend":1,"add":"2211 ACORN ROAD","city":"NATHALIE","state":"VA","zip":"24577-3617","dob":"1978-12-24","age":"","mstatus":"","insh":10051342,"cliId":"","pno":5402222590,"cno":4342282601,"email":"","ename":"","eno":"","pphy":"SCANLON-ROWLETT, NICOLE R","ppno":4343091165,"pcpadd":"1280 Main St Ste A, ","pcpcity":"Altavista","pcpstate":"VA","pcpzip":245171465,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":4342282601,"add2":"                                                            ","add3":"","madd1":"2211 ACORN ROAD","madd2":"                                                            ","madd3":"","mcity":"NATHALIE","mstate":"VA","mzip":"24577-3617","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K42.9","K80.20","I27.81","E66.2","E66.01","J96.00","D50.9","R06.00","L30.9","I10","J45.991","R07.9","K21.9","M79.606","J96.02","R68.89","Z12.31","J96.01","G47.33","D63.8","I27.20","E83.42","R20.2","I27.9","Z78.9","R10.84","R60.0","R10.9","R26.2","R22.42","D48.5","I89.0","R07.89","M25.561","Z23","Z12.4","R06.02","R06.09","R06.81","R06.89","I51.7","D64.9","J45.909","J30.9","H66.002","Z76.0","M54.5","M25.569","R26.89","E78.5","Z91.81","N92.6","K08.89","Z11.3","N95.9","M54.6","S29.9XXA","M79.10","Z98.51","N92.1","K92.1","K58.1","Z80.0","E61.1","Z71.9","J96.21","N17.9","E87.1","Z68.45","J96.22","E87.2","G43.909","I50.810","I11.0","Z87.891","R44.2","J40","Z79.82","R51","E78.2","E66.9","Z79.02","R93.89","N91.5","G47.30","G47.10","R06.83","Z80.3","N95.0","E66.3","I31.3","R91.8","I50.33","K59.00","Z20.828","R10.30","Z01.419","Z72.51","N92.0","L53.8","L30.4","R59.0","R63.4","R60.9","L72.9","R10.13","R11.0","R19.4","M54.9","R09.02","R09.89","I26.09"],"date":["2019-08-21","2020-04-08","2020-05-20","2021-01-08","2021-03-09","2019-11-01","2020-02-12","2019-09-23","2019-09-28","2020-10-16","2020-10-09","2020-09-12","2020-02-18","2019-09-23","2020-02-14","2021-02-12","2021-01-25","2020-02-18","2021-04-21","2020-07-08","2020-02-18","2020-03-02","2020-04-08","2020-10-09","2020-03-02","2020-04-06","2020-04-08","2020-04-08","2020-09-08","2020-06-09","2020-06-09","2020-06-09","2020-09-12","2020-11-19","2020-10-09","2020-06-22","2020-02-12","2020-02-12","2019-08-05","2020-02-12","2020-09-12","2020-11-12","2021-04-19","2020-06-22","2019-11-06","2019-11-06","2020-10-10","2020-01-02","2020-01-02","2020-02-12","2020-01-02","2020-06-19","2020-06-10","2020-06-22","2020-06-30","2020-10-10","2020-10-10","2020-10-10","2020-10-10","2021-03-16","2021-03-09","2021-03-09","2021-03-09","2021-03-09","2021-03-09","2020-02-12","2019-09-28","2019-09-28","2020-02-12","2020-02-12","2020-02-12","2019-09-18","2019-09-18","2020-02-12","2019-09-18","2019-09-28","2020-02-12","2020-02-12","2020-06-08","2021-02-03","2020-03-05","2019-09-18","2020-06-19","2021-05-11","2020-07-29","2020-07-29","2020-07-29","2021-01-25","2020-06-30","2020-06-30","2019-09-18","2020-02-12","2020-02-12","2020-04-30","2020-02-12","2020-06-08","2020-06-22","2020-06-22","2020-06-22","2020-10-16","2020-10-16","2019-09-20","2019-10-23","2020-04-08","2020-04-08","2020-04-20","2020-04-20","2020-04-20","2020-10-16","2019-09-18","2020-02-12","2020-02-18"],"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":[["","68308015260","NYSTATIN ","POW 100000","60","Select","Select",""],["","59746028490","PANTOPRAZOLE ","TAB 40MG","7","Select","Select",""],["","00536100901","FERROUS ","TAB 325MG","60","Select","Select",""],["","59779030603","CVS ","POW ","510","Select","Select",""],["","10006073038","MAG ","TAB 400MG","60","Select","Select",""],["","70377002811","ATORVASTATIN ","TAB 20MG","30","Select","Select",""],["","45802065078","LORATADINE ","TAB 10MG","30","Select","Select",""],["","45802048678","DOCUSATE ","CAP 100MG","60","Select","Select",""],["","66993001968","ALBUTEROL ","AER HFA","18","Select","Select",""],["","00378020810","FUROSEMIDE ","TAB 20MG","90","Select","Select",""],["","69097015807","MELOXICAM ","TAB 7.5MG","90","Select","Select",""],["","70436001002","BUPROPN ","TAB 150MG XL","30","Select","Select",""],["","68462010530","ONDANSETRON ","TAB 4MG","15","Select","Select",""],["","00245531911","KLOR-CON ","TAB 20MEQ ER","90","Select","Select",""],["","00832105410","BACLOFEN ","TAB 10MG","60","Select","Select",""],["","00603233832","APAP\/CODEINE ","TAB 300-30MG","5","Select","Select",""],["","00093310905","AMOXICILLIN ","CAP 500MG","28","Select","Select",""],["","00456120230","LINZESS ","CAP 290MCG","90","Select","Select",""],["","00527221537","METOLAZONE ","TAB 2.5MG","30","Select","Select",""],["","68180047301","AMLOD\/BENAZP ","CAP 10-40MG","15","Select","Select",""],["","00555077902","MEDROXYPR ","TAB 10MG","10","Select","Select",""],["","49281042050","FLUZONE ","INJ 2020-21","0.5","Select","Select",""],["","29300012810","HYDROCHLOROT ","TAB 25MG","15","Select","Select",""],["","50428264783","STOOL ","CAP 100MG","60","Select","Select",""],["","67618010160","COLACE ","CAP 100MG","60","Select","Select",""],["","80777027399","MODERNA ","INJ COVID-19","0.5","Select","Select",""],["","59746000103","METHYLPRED ","TAB 4MG","21","Select","Select",""],["","67877032105","IBUPROFEN ","TAB 800MG","30","Select","Select",""],["","00143973910","PREDNISONE ","TAB 10MG","20","Select","Select",""],["","65162055310","METAXALONE ","TAB 800MG","21","Select","Select",""],["","75834002001","VITAMIN ","CAP 50000UNT","12","Select","Select",""],["","67877057305","BENZONATATE ","CAP 100MG","30","Select","Select",""],["","65862057490","MONTELUKAST ","10MG","90","Select","Select",""],["","50428166363","BISACODYL ","5MG EC","2","Select","Select",""],["","53489011905","DOXYCYCL ","100MG","20","Select","Select",""],["","53746010901","HYDROCO\/APAP ","5-325MG","12","Select","Select",""],["","68180012202","CEPHALEXIN ","500MG","30","Select","Select",""],["","65162019050","NAPROXEN ","500MG","60","Select","Select",""],["","68180016006","AZITHROMYCIN ","250MG","6","Select","Select",""],["","71930002643","BROM\/PSE\/DM ","","180","Select","Select",""],["","69584061150","METHOCARBAM ","500MG","18","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":""}]}]}