{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SHARON   A HARRIS","gend":1,"add":"853 BRIGHTWELL MILL ROAD","city":"MADISON HEIGHTS","state":"VA","zip":"24572-5756","dob":"1971-05-21","age":"","mstatus":"","insh":10051896,"cliId":"","pno":4346654678,"cno":4346654678,"email":"","ename":"","eno":"","pphy":"BOLUSA-SABUGO, AHGNES U","ppno":4349475967,"pcpadd":"320 Federal St, ","pcpcity":"Lynchburg","pcpstate":"VA","pcpzip":245042306,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"853 BRIGHTWELL MILL ROAD","madd2":"                                                            ","madd3":"","mcity":"MADISON HEIGHTS","mstate":"VA","mzip":"24572-5756","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R29.898","I12.9","N18.3","E11.9","E78.00","D33.2","E11.3291","E11.3292","M79.671","M25.571","M21.371","E11.42","Z71.3","E66.01","Z68.44","K76.89","Z01.818","K31.89","I86.4","K25.9","I49.3","I50.33","I45.9","K75.81","I10","N39.3","I85.00","K76.6","N18.30","E11.22","K74.60","Z98.84","R13.10","Z68.43","K22.2","G47.33","I50.32","H10.45","H43.393","H52.4","I50.31","E11.65","Z79.4","E78.5","E66.2","I67.1","Z23","G40.909","F32.1","K31.9","I11.0","I50.9","K76.0","N94.89","J18.9","L03.119","J02.0","I48.91","K21.9","I72.9","L03.115","R16.1","N83.8","R11.2","E11.21","N25.81","I13.0","I62.9","G47.30","Z79.82","E11.40","M75.41","M25.511","J45.909","Z86.73","R93.2","R13.12","E55.9","Z91.89","G62.9","Z01.810","E11.69","M79.604","K74.69","I85.10","I72.8","S50.811A","W55.03XA","R42","Z09","R94.31","F32.9","E66.9","Z63.4","R60.0","Z53.9","T18.8XXA","D69.6","G47.10","I63.9","N17.9","I25.2","I25.9","R13.19","M19.011","Z99.81","M79.89","Z88.0","Z88.8"],"date":["2019-03-05","2021-02-17","2020-07-21","2021-05-08","2020-01-08","2020-08-27","2020-08-27","2020-08-27","2020-04-14","2020-04-14","2020-05-12","2020-04-14","2021-01-26","2021-04-20","2021-03-16","2020-06-10","2020-06-10","2020-11-13","2021-04-01","2020-06-10","2020-06-23","2020-10-01","2020-09-04","2021-04-01","2021-05-08","2021-05-08","2020-11-13","2020-12-04","2021-02-17","2021-03-26","2021-04-01","2021-05-11","2021-04-20","2021-05-11","2021-05-11","2020-12-04","2020-07-20","2019-06-21","2019-06-21","2019-06-21","2020-10-01","2021-04-20","2021-04-20","2020-12-04","2020-06-12","2021-05-08","2020-09-30","2021-05-08","2020-02-28","2020-06-10","2020-06-23","2020-12-04","2020-10-01","2020-06-25","2020-07-20","2020-07-21","2020-08-03","2020-07-21","2021-01-26","2020-07-20","2020-08-03","2020-11-13","2020-11-13","2021-03-26","2019-06-11","2019-06-11","2019-06-18","2019-06-18","2019-06-18","2020-07-20","2021-03-16","2020-06-05","2020-06-05","2021-01-26","2020-12-04","2020-08-20","2019-04-12","2021-02-17","2019-10-11","2020-05-15","2019-11-11","2020-05-12","2020-07-20","2020-09-30","2020-11-13","2021-01-23","2021-02-25","2021-02-25","2021-03-26","2019-07-02","2019-11-11","2020-04-09","2020-04-09","2020-04-09","2020-07-08","2020-08-11","2020-11-13","2021-04-01","2019-04-23","2020-07-21","2020-12-04","2020-12-04","2020-12-04","2021-05-11","2020-06-05","2020-06-23","2020-07-08","2020-07-08","2020-07-08"],"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":[["","00088222033","LANTUS ","INJ 100\/ML","30","Select","Select",""],["","00093106101","SOTALOL ","TAB 80MG","30","Select","Select",""],["","60432060416","PROMETHAZINE ","SYP DM","450","Select","Select",""],["","00406055201","OXYCODONE ","TAB 5MG","25","Select","Select",""],["","00310653004","BYDUREON ","INJ 2MG","4","Select","Select",""],["","59310057922","PROAIR ","AER ","8.5","Select","Select",""],["","69547035302","NARCAN ","SPR ","2","Select","Select",""],["","57896063412","MAG ","TAB 400MG","30","Select","Select",""],["","64380073706","VITAMIN ","CAP 50000UNT","4","Select","Select",""],["","69097084507","CYCLOBENZAPR ","TAB 5MG","90","Select","Select",""],["","08317880128","TECHLITE ","MIS LANCETS","100","Select","Select",""],["","56151210201","PEN  NEEDLES  ","MIS 31GX6MM","100","Select","Select",""],["","68382060010","POT  CHLORIDE","TAB 10MEQ ER","30","Select","Select",""],["","59651000305","OMEPRAZOLE ","CAP 40MG","30","Select","Select",""],["","00093317431","ALBUTEROL ","FAT E","8.5","Select","Select",""],["","43598043611","NITROGLYCERN ","SUB 0.4MG","25","Select","Select",""],["","67877022205","GABAPENTIN ","CAP 100MG","90","Select","Select",""],["","00002822259","INSULIN ","INJ 100\/ML","15","Select","Select",""],["","65862024708","LEVETIRACETA ","TAB 750MG","60","Select","Select",""],["","57237001830","DULOXETINE ","CAP 30MG","90","Select","Select",""],["","68645048154","ATORVASTATIN ","TAB 20MG","90","Select","Select",""],["","50111091801","TORSEMIDE ","TAB 100MG","60","Select","Select",""],["","00002831501","HUMULIN ","INJ U-100","30","Select","Select",""],["","16714002610","ENOXAPARIN ","INJ 60\/0.6ML","36","Select","Select",""],["","68645055054","LISINOPRIL ","TAB 2.5MG","30","Select","Select",""],["","00093101042","MUPIROCIN ","OIN 0.02","22","Select","Select",""],["","57599080000","FREESTY ","KIT 2 SENSOR","2","Select","Select",""],["","63304069205","CLINDAMYCIN ","CAP 150MG","90","Select","Select",""],["","00193731150","CONTOUR ","TES NEXT","100","Select","Select",""],["","00169633910","NOVOLOG ","INJ FLEXPEN","15","Select","Select",""],["","70710122501","AMITRIPTYLIN ","TAB 10MG","30","Select","Select",""],["","66758016005","KLOR-CON ","TAB 10MEQ ER","60","Select","Select",""],["","00085113204","PROVENTIL ","AER HFA","6.7","Select","Select",""],["","00172392670","DIAZEPAM ","TAB 5MG","1","Select","Select",""],["","00527221537","METOLAZONE ","TAB 2.5MG","8","Select","Select",""],["","67877021905","CEPHALEXIN ","CAP 500MG","36","Select","Select",""],["","53746051105","SPIRONOLACT ","TAB 25MG","30","Select","Select",""],["","80777027399","MODERNA ","INJ COVID-19","0.5","Select","Select",""],["","55111015330","ONDANSETRON ","TAB 4MG","20","Select","Select",""],["","08396901634","RELION ","MIS 31GX8MM","100","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":""}]}]}