{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SUSAN   M DALTON","gend":1,"add":"327 PAYNE STREET                                            ","city":"GRETNA                        ","state":"VA","zip":"24557-4988","dob":"1966-12-26","age":"","mstatus":"","insh":10052299,"cliId":"","pno":4344323701,"cno":4344323701,"email":"","ename":"","eno":"","pphy":"BIRD, WILLIAM C                                             ","ppno":"","pcpadd":"3997 Beckley Rd","pcpcity":"Princeton                     ","pcpstate":"WV","pcpzip":247407660,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"APARTMENT 47                                                ","add3":"","madd1":"327 PAYNE STREET                                            ","madd2":"APARTMENT 47                                                ","madd3":"","mcity":"GRETNA                        ","mstate":"VA","mzip":"24557-4988","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F99","F20.0","F43.10","F60.3","F90.2","G47.33","F33.0","R11.2","E11.65","E78.00","E78.5","F31.81","I10","G47.00","Z79.84","Z88.0","Z88.2","Z88.5","F17.210","G47.30","E66.9","R94.2","Z72.0","E11.9","J40","R05","R07.9","F17.200","E16.2","F41.9","F90.0","F17.218","R06.2","R06.00","N39.0","R39.9","G43.009","R41.3","F31.31","E03.9","J10.1","I48.92","E87.1","E66.01","R00.0","Z68.41","Z79.899","R73.9","R50.9","N17.9","R68.89","F44.9","F34.1","F41.1","E78.2","K58.0","R61","R63.4","F33.2","F31.9","K58.9","Z78.0","N95.1","J44.1","R60.9","F41.8","R10.9","R19.7","E11.69","E11.59","F51.04","L53.8","L30.4","M54.81","Z20.828","J02.9","N39.9","N32.81","T78.40XA"],"date":["2019-02-15","2021-11-21","2021-05-04","2021-10-06","2021-05-04","2021-11-22","2019-08-19","2019-02-27","2019-02-25","2019-10-29","2021-04-13","2021-10-06","2021-04-13","2021-07-30","2020-03-12","2019-02-25","2019-02-25","2019-02-25","2020-03-12","2019-02-26","2019-02-26","2019-02-26","2020-10-22","2021-07-30","2019-04-04","2021-01-15","2020-03-18","2021-08-04","2019-04-24","2021-07-30","2019-06-10","2019-10-29","2019-09-13","2020-03-12","2019-10-29","2020-10-07","2021-11-22","2021-08-25","2021-11-22","2021-04-13","2020-03-18","2020-03-13","2020-03-13","2020-03-12","2020-03-18","2020-03-12","2020-03-12","2020-03-12","2020-03-12","2020-03-12","2021-10-18","2020-08-13","2020-08-13","2020-08-13","2020-08-13","2020-08-13","2020-08-13","2020-05-29","2020-07-19","2021-07-30","2020-10-22","2020-10-22","2020-10-22","2020-12-12","2020-12-28","2021-01-15","2021-10-30","2021-03-27","2021-04-13","2021-04-13","2021-07-30","2021-07-21","2021-07-21","2021-11-22","2021-10-18","2021-10-18","2021-10-30","2021-10-30","2021-10-30"],"priorHcc":["",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":[["","67877025001","QUETIAPINE","100MG","60","Select","Select",""],["","67877032101","IBUPROFEN","800MG","90","Select","Select",""],["","00591079401","DICYCLOMINE","10MG","80","Select","Select",""],["","47781065110","LEVOTHYROXIN","100MCG","30","Select","Select",""],["","45802065087","LORATADINE","10MG","30","Select","Select",""],["","63824000815","MUCINEX","600MG ER","30","Select","Select",""],["","68180096301","ALBUTEROL","HFA","8.5","Select","Select",""],["","00002879759","HUMALOG","75\/25KWP","15","Select","Select",""],["","08222095831","PEN NEEDLES","31GX8MM","100","Select","Select",""],["","57664016758","METOPROL","100MG","60","Select","Select",""],["","74312017621","D3","50MCG","30","Select","Select",""],["","16729000201","GLIMEPIRIDE","2MG","90","Select","Select",""],["","67877022305","GABAPENTIN","300MG","60","Select","Select",""],["","45802043411","CLOTRIMAZOLE","1%","30","Select","Select",""],["","10702001110","HYDROXYZ","25MG","120","Select","Select",""],["","62175061743","PANTOPRAZOLE","40MG","30","Select","Select",""],["","16729017217","AMITRIPTYLIN","25MG","60","Select","Select",""],["","70377000812","ROSUVASTATIN","20MG","90","Select","Select",""],["","27241009990","DULOXETINE","60MG","30","Select","Select",""],["","70710101002","OSELTAMIVIR","75MG","10","Select","Select",""],["","69315011610","FUROSEMIDE","20MG","5","Select","Select",""],["","68180016013","AZITHROMYCIN","250MG","6","Select","Select",""],["","31722070190","LOSARTAN","50MG","90","Select","Select",""],["","29300011101","LAMOTRIGINE","25MG","45","Select","Select",""],["","68180048809","PRAVASTATIN","80MG","30","Select","Select",""],["","00193731150","CONTOUR","NEXT","50","Select","Select",""],["","80777027310","MODERNA","COVID-19","0.5","Select","Select",""],["","62542030117","HYD","10-8\/5ML","240","Select","Select",""],["","00536589588","NICOTINE","14MG\/24H","14","Select","Select",""],["","65862018730","ONDANSETRON","4MG","10","Select","Select",""],["","70000024901","SLEEP","25MG","32","Select","Select",""],["","00193658621","MICROLET","LANCETS","100","Select","Select",""],["","00591544310","PREDNISONE","20MG","10","Select","Select",""],["","43547034750","PAROXETINE","10MG","30","Select","Select",""],["","00378459401","METOPROLOL","75MG","120","Select","Select",""],["","74312052802","MELATONIN","10MG","90","Select","Select",""],["","16729030101","TRAZODONE","150MG","30","Select","Select",""],["","00904675859","ROBAFEN","10-100MG","240","Select","Select",""],["","47781065110","LEVOTHYROXIN ","TAB 100MCG","30","Select","Select",""],["","45802065087","LORATADINE ","TAB 10MG","30","Select","Select",""],["","50228018005","GABAPENTIN ","CAP 300MG","180","Select","Select",""],["","63402030230","LATUDA ","TAB 20MG","28","Select","Select",""],["","67877032101","IBUPROFEN ","TAB 800MG","90","Select","Select",""],["","00002879759","HUMALOG ","INJ 75\/25KWP","15","Select","Select",""],["","00193731150","CONTOUR ","TES NEXT","100","Select","Select",""],["","67877025001","QUETIAPINE ","TAB 100MG","60","Select","Select",""],["","00591079401","DICYCLOMINE ","CAP 10MG","80","Select","Select",""],["","63824000815","MUCINEX ","TAB 600MG ER","30","Select","Select",""],["","68180096301","ALBUTEROL ","AER HFA","8.5","Select","Select",""],["","08222095831","PEN  NEEDLES  ","MIS 31GX8MM","100","Select","Select",""],["","57664016758","METOPROL ","TAB 100MG","60","Select","Select",""],["","74312017621","D3 ","CAP 50MCG","30","Select","Select",""],["","16729000201","GLIMEPIRIDE ","TAB 2MG","90","Select","Select",""],["","45802043411","CLOTRIMAZOLE ","CRE 0.01","30","Select","Select",""],["","10702001110","HYDROXYZ ","TAB 25MG","120","Select","Select",""],["","62175061743","PANTOPRAZOLE ","TAB 40MG","30","Select","Select",""],["","16729017217","AMITRIPTYLIN ","TAB 25MG","60","Select","Select",""],["","70377000812","ROSUVASTATIN ","TAB 20MG","90","Select","Select",""],["","27241009990","DULOXETINE ","CAP 60MG","30","Select","Select",""],["","70710101002","OSELTAMIVIR ","CAP 75MG","10","Select","Select",""],["","69315011610","FUROSEMIDE ","TAB 20MG","5","Select","Select",""],["","68180016013","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","31722070190","LOSARTAN ","TAB 50MG","90","Select","Select",""],["","29300011101","LAMOTRIGINE ","TAB 25MG","45","Select","Select",""],["","68180048809","PRAVASTATIN ","TAB 80MG","30","Select","Select",""],["","80777027310","MODERNA ","INJ COVID-19","0.5","Select","Select",""],["","62542030117","HYD ","SUS 10-8\/5ML","240","Select","Select",""],["","00536589588","NICOTINE ","DIS 14MG\/24H","14","Select","Select",""],["","65862018730","ONDANSETRON ","TAB 4MG","10","Select","Select",""],["","70000024901","SLEEP ","TAB 25MG","32","Select","Select",""],["","00193658621","MICROLET ","MIS LANCETS","100","Select","Select",""],["","00591544310","PREDNISONE ","TAB 20MG","10","Select","Select",""],["","43547034750","PAROXETINE ","TAB 10MG","30","Select","Select",""],["","00378459401","METOPROLOL ","TAB 75MG","120","Select","Select",""],["","74312052802","MELATONIN ","SUB 10MG","90","Select","Select",""],["","16729030101","TRAZODONE ","TAB 150MG","30","Select","Select",""],["","00904675859","ROBAFEN ","LIQ 10-100MG","240","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":""}]}]}