{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LISHBERRY NIEVES-SANTIAGO","gend":1,"add":"1241  N MAIN STREET                                         ","city":"HARRISONBURG                  ","state":"VA","zip":"22802-4632","dob":"1992-04-24","age":"","mstatus":"","insh":10053157,"cliId":"","pno":5405609551,"cno":5408109397,"email":"","ename":"","eno":"","pphy":"LONG, KEITH C                                               ","ppno":"","pcpadd":"1661 S Main St","pcpcity":"Harrisonburg                  ","pcpstate":"VA","pcpzip":228012728,"pcpcounty":"","pcpid":"P9059035","pcpname":"RMH TIMBERVILLE HEALTH CENTER","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"APARTMENT D                                                 ","add3":"","madd1":"1241  N MAIN STREET                                         ","madd2":"APARTMENT D                                                 ","madd3":"","mcity":"HARRISONBURG                  ","mstate":"VA","mzip":"22802-4632","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F25.9","R68.89","N30.00","F23","R44.0","R35.0","R30.0","F20.9","F17.210","Z79.899","Z91.013","F25.0","N39.0","Z68.42","G47.00","F41.9","G43.909","K21.9","F12.11","F15.11","F14.11","E66.9","Z87.440","Z91.5","F20.0","R11.0","R19.7","E67.3","F20.81","E55.9","J02.9","R50.9","R51","M54.9","R11.2","M79.10","N12","F90.2","F10.11","F22","R10.9","N20.0","K42.9","K44.9","R10.32","R44.3","R44.2","F39","Z04.89","Z59.0","Z86.59","Z53.21","O28.8","Z3A.35","R07.89","R10.84","R07.9","M79.7","Z00.00","F31.81","G44.221","Z23","R73.03","R44.1","F29","Z20.828","Z03.818","Y04.0XXA","F12.959","A59.9","F19.94","Z78.1","S29.9XXA","S39.91XA","K76.0","R45.851","R45.850","T43.592A","R45.1","R10.11","R51.9","T56.892A","F19.10","K59.00","E66.01","Z68.38","F32.9","R05","Z20.9","R53.81","Z87.891","B34.9","R52","N72","R06.00","R06.02","G44.89","Z11.3","Z68.43","Z20.822","Z62.810","Z62.811","Z83.3","Z82.49","R45.7","D72.829","D64.9","Z28.21","Z79.1","I51.7","N83.291","N83.201","G43.809","M54.5","M54.6","R25.2"],"date":["2020-11-05","2021-02-09","2019-06-02","2021-02-04","2021-03-03","2019-06-02","2021-02-23","2021-02-15","2021-03-03","2021-04-08","2021-03-03","2021-05-03","2019-08-14","2020-12-05","2021-02-04","2021-01-28","2019-06-05","2021-02-04","2019-07-29","2019-06-05","2019-06-04","2021-02-23","2019-06-04","2021-02-04","2019-06-11","2019-06-11","2019-08-14","2019-06-06","2019-06-06","2019-06-11","2019-06-29","2020-12-05","2019-08-14","2019-06-29","2020-11-20","2019-06-29","2019-06-29","2019-07-29","2019-07-29","2021-02-15","2021-02-23","2021-02-23","2019-08-14","2019-08-14","2021-02-23","2021-03-03","2020-10-15","2019-09-01","2019-09-01","2020-12-05","2019-09-01","2019-09-01","2019-10-17","2019-10-17","2021-02-15","2020-11-20","2021-02-16","2021-01-06","2020-07-30","2020-07-30","2020-07-30","2020-10-01","2021-01-06","2021-03-03","2020-11-28","2020-12-20","2021-02-04","2020-10-16","2020-10-16","2020-10-16","2020-10-16","2020-10-16","2020-10-27","2020-10-27","2020-11-20","2021-02-04","2020-11-20","2020-11-20","2020-11-20","2020-11-20","2021-03-03","2020-11-20","2020-11-21","2020-12-05","2020-11-21","2020-11-21","2020-11-22","2020-12-20","2020-12-05","2020-12-05","2020-12-20","2020-12-20","2020-12-20","2020-12-20","2020-12-20","2020-12-20","2020-12-20","2021-01-06","2021-02-23","2021-02-04","2021-02-04","2021-02-04","2021-01-28","2021-01-28","2021-01-28","2021-02-04","2021-02-04","2021-02-04","2021-02-15","2021-02-16","2021-02-23","2021-02-23","2021-03-03","2021-03-03","2021-03-03","2021-03-03"],"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":[["","00603548221","PROPRANOLOL","10MG","90","Select","Select",""],["","00185061501","HYDROXYZ","50MG","60","Select","Select",""],["","29300012510","MELOXICAM","15MG","30","Select","Select",""],["","68382007901","HALOPERIDOL","5MG","60","Select","Select",""],["","31722054501","LITHIUM","300MG","150","Select","Select",""],["","65862059501","DIVALPROEX","500MG ER","120","Select","Select",""],["","13668009030","OLANZAPINE","20MG ODT","30","Select","Select",""],["","45802004811","NYSTATIN","100000","30","Select","Select",""],["","62175011843","OMEPRAZOLE","20MG","30","Select","Select",""],["","65162019011","NAPROXEN","500MG","20","Select","Select",""],["","68382080505","TRAZODONE","50MG","30","Select","Select",""],["","63402030430","LATUDA","40MG","4","Select","Select",""],["","00904645760","DOK","100MG","60","Select","Select",""],["","10702000709","CYCLOBENZAPR","10MG","30","Select","Select",""],["","00054327099","FLUTICASONE","50MCG","16","Select","Select",""],["","55111015330","ONDANSETRON","4MG","20","Select","Select",""],["","65862049501","QUETIAPINE","400MG","60","Select","Select",""],["","00603548221","PROPRANOLOL ","TAB 10MG","90","Select","Select",""],["","00185061501","HYDROXYZ ","CAP 50MG","60","Select","Select",""],["","29300012510","MELOXICAM ","TAB 15MG","30","Select","Select",""],["","68382007901","HALOPERIDOL ","TAB 5MG","60","Select","Select",""],["","31722054501","LITHIUM ","CAP 300MG","150","Select","Select",""],["","65862059501","DIVALPROEX ","TAB 500MG ER","120","Select","Select",""],["","13668009030","OLANZAPINE ","TAB 20MG ODT","30","Select","Select",""],["","45802004811","NYSTATIN ","OIN 100000","30","Select","Select",""],["","62175011843","OMEPRAZOLE ","CAP 20MG","30","Select","Select",""],["","65162019011","NAPROXEN ","TAB 500MG","20","Select","Select",""],["","68382080505","TRAZODONE ","TAB 50MG","30","Select","Select",""],["","63402030430","LATUDA ","TAB 40MG","4","Select","Select",""],["","00904645760","DOK ","CAP 100MG","60","Select","Select",""],["","10702000709","CYCLOBENZAPR ","TAB 10MG","30","Select","Select",""],["","00054327099","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","55111015330","ONDANSETRON ","TAB 4MG","20","Select","Select",""],["","65862049501","QUETIAPINE ","TAB 400MG","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":[[["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":""}]}]}