{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" RHONDA N WADE","gend":1,"add":"2189 OAK HILL ROAD","city":"DANVILLE","state":"VA","zip":"24541-0807","dob":"1965-12-01","age":"","mstatus":"","insh":10053176,"cliId":"","pno":"4344833958, 4344833958","cno":"","email":"","ename":"","eno":"","pphy":"HASANAJ, XAJE","ppno":3366235021,"pcpadd":"507 Highland Park Dr, ","pcpcity":"Eden","pcpstate":"NC","pcpzip":272884936,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP - VIRGINIA PREMIER","program":"MEDICAID","lob":"MLTSS","region":"WESTERN","aligned":"","ano":"","add2":"LOT 4","add3":"","madd1":"2189 OAK HILL ROAD","madd2":"                                                            ","madd3":"","mcity":"DANVILLE","mstate":"VA","mzip":"24541-0807","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F33.3","M79.7","M94.0","R06.02","J44.1","R00.1","Z90.49","F17.200","I10","F32.9","Z79.899","R68.89","L60.0","M79.671","M20.11","M79.672","M20.12","M79.674","M79.675","M51.9","Z98.890","Z01.818","Z87.891","N18.2","Z12.11","K63.5","J20.9","R05","F33.2","Z01.810","M47.27","J44.9","G89.29","T88.9XXA","R69","D27.1","G89.4","N39.0","M54.5","M62.830","Z98.1","M54.41","R07.9","E11.22","I12.9","N18.30","E78.5","Z72.0","Z88.8","G43.919","Z68.39","M79.604","Z88.5","M54.2","Z87.01","M25.561","M54.31","M54.32","F31.4","Z48.89","M79.606","K58.0","R12","R13.10","R10.84","R52","R51","S79.911A","S39.93XA","M25.551","R10.2","J06.9","Z20.828","R94.31","M48.061","M51.36","N18.3","Z11.59","M54.9","R10.31","R10.32","Z12.4","S02.5XXA","L03.211","J32.0","K08.89","R68.84","E66.01","Z68.37","F17.210","F41.9","Z88.6","M54.16","M70.62","G43.109","M17.12","M25.562","J30.1","M19.90","R07.89","F31.9","R10.9","I88.0","M79.605","D64.9","N76.0","F14.10","B96.89","R06.00","E66.9","Z71.6","Z88.0","R06.09","M48.062","T81.31XA","T81.89XA","G89.18","R10.30","N18.9","R11.0","R20.0","X50.0XXA","R51.9","N83.202","M54.42","R20.2","M79.652","M79.651","R35.0","K58.9","R93.89","K65.4","R74.8","Z68.35","Z01.812","M54.30","S31.159A","R53.1","R19.7","R26.9","M47.896","M43.26","N89.8","I70.0","G43.909","M51.86","M47.816","H65.23","J11.1","N28.9","M47.26","M51.16","J43.9","I42.9","F40.240","J30.89","Z68.36","Z68.38","N30.00","B37.3","G44.319","R11.2","F51.04","E55.9","Z01.419","R87.612","A68.1","K57.30","K64.8","K20.9","K44.9","F19.11","R55","S31.130A","W59.11XA","Y92.9","Y99.9","L76.34","G43.009","Z11.52","R29.3","M51.17","Z98.51","M62.838","K52.9","Z20.822","M70.61","M46.1","N83.292","F31.89","Z01.411","M25.511","Z88.4","K51.00","R06.2","Z83.2","R50.9","M25.519","J30.9"],"date":["2021-04-06","2021-05-06","2019-07-29","2021-01-03","2020-07-15","2019-11-20","2021-04-30","2021-01-03","2021-05-14","2021-01-14","2021-04-30","2021-02-26","2019-08-06","2019-08-06","2019-08-06","2019-08-06","2019-08-06","2019-08-06","2019-08-06","2021-05-21","2019-10-09","2021-02-17","2019-11-20","2021-05-06","2019-12-04","2019-12-04","2020-02-04","2021-01-05","2021-03-15","2020-08-25","2020-08-31","2021-04-30","2021-04-09","2020-09-07","2021-05-23","2020-12-30","2021-05-14","2021-03-31","2021-05-14","2021-03-07","2021-05-21","2021-05-14","2021-03-31","2021-03-31","2021-04-30","2021-04-30","2021-03-31","2021-03-31","2021-05-14","2021-05-06","2021-05-06","2021-05-14","2021-05-14","2021-05-21","2019-01-06","2019-05-31","2019-04-23","2019-04-23","2019-08-13","2020-10-14","2019-08-14","2019-08-20","2019-12-04","2019-12-04","2020-10-10","2020-02-02","2020-02-02","2020-06-26","2020-06-26","2020-06-26","2020-11-17","2020-07-15","2021-01-05","2020-08-12","2021-01-14","2021-03-07","2020-09-27","2020-09-07","2020-10-10","2020-10-10","2020-10-10","2020-11-17","2020-12-28","2020-12-28","2020-12-28","2020-12-28","2020-12-28","2021-01-14","2021-01-14","2021-04-30","2021-01-14","2021-01-14","2021-02-22","2021-02-22","2019-04-17","2019-05-31","2019-05-31","2019-11-18","2019-09-16","2019-09-30","2020-03-16","2020-10-10","2019-10-21","2020-06-29","2020-06-29","2020-04-08","2020-04-08","2020-04-08","2021-01-08","2021-01-08","2021-01-08","2020-06-29","2020-07-01","2020-08-27","2020-09-08","2020-09-08","2020-10-09","2020-10-10","2020-11-19","2020-10-10","2021-02-02","2021-02-02","2021-04-30","2019-01-04","2020-08-27","2019-03-21","2019-03-21","2019-03-21","2019-11-04","2019-11-04","2019-11-26","2019-11-26","2019-11-26","2019-12-17","2020-04-14","2020-07-02","2020-08-15","2020-08-15","2021-01-03","2020-09-03","2020-12-15","2021-04-30","2021-05-06","2021-01-03","2019-06-27","2019-08-14","2019-10-24","2019-11-18","2020-02-02","2020-02-02","2020-10-06","2021-03-23","2020-09-07","2020-09-07","2020-09-07","2021-05-06","2020-09-17","2021-03-17","2021-05-06","2021-03-11","2021-04-30","2019-02-12","2019-02-12","2019-02-12","2019-02-19","2019-02-19","2019-06-19","2019-12-04","2019-12-04","2019-12-04","2019-12-04","2019-12-04","2019-12-24","2020-08-15","2020-08-15","2020-08-15","2020-08-15","2020-09-07","2020-11-19","2021-01-05","2021-01-20","2019-10-09","2019-02-12","2019-12-24","2020-03-16","2021-01-03","2021-02-22","2021-03-23","2019-02-19","2019-02-12","2019-02-19","2019-04-16","2019-04-16","2019-10-21","2019-11-19","2019-11-19","2020-05-31","2020-06-16","2020-06-16"],"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":[["","00186037020","SYMBICORT ","AER 160-4.5","10.2","Select","Select",""],["","69097012303","TOPIRAMATE ","TAB 50MG","60","Select","Select",""],["","68180072103","AMLODIPINE ","TAB 10MG","30","Select","Select",""],["","64380080307","RANITIDINE ","TAB 150MG","60","Select","Select",""],["","65162083366","DICLOFENAC ","GEL 0.01","100","Select","Select",""],["","50458059250","RISPERIDONE ","TAB 1MG","60","Select","Select",""],["","59746000103","METHYLPRED ","TAB 4MG","21","Select","Select",""],["","68180052001","LISINOP\/HCTZ ","TAB 20-25MG","30","Select","Select",""],["","43547040610","CLONAZEPAM ","TAB 0.5MG","90","Select","Select",""],["","50742061610","METOPROL ","TAB 50MG ER","30","Select","Select",""],["","68382080605","TRAZODONE ","TAB 100MG","60","Select","Select",""],["","00093005401","BUSPIRONE ","TAB 10MG","45","Select","Select",""],["","23155050101","HYDROXYZ ","TAB 25MG","120","Select","Select",""],["","00378064110","PREDNISONE ","TAB 10MG","21","Select","Select",""],["","69547035302","NARCAN ","SPR ","2","Select","Select",""],["","55111015810","OMEPRAZOLE ","CAP 20MG","30","Select","Select",""],["","65862037401","ESCITALOPRAM ","TAB 10MG","45","Select","Select",""],["","00172409660","BACLOFEN ","TAB 10MG","15","Select","Select",""],["","10702001801","OXYCODONE ","TAB 5MG","60","Select","Select",""],["","00093770198","LEVOCETIRIZI ","TAB 5MG","30","Select","Select",""],["","53746010905","HYDROCO\/APAP ","TAB 5-325MG","10","Select","Select",""],["","00093005805","TRAMADOL ","TAB 50MG","12","Select","Select",""],["","68382025601","OXYBUTYNIN ","TAB 10MG ER","30","Select","Select",""],["","50111033401","METRONIDAZOL ","TAB 500MG","10","Select","Select",""],["","65862007701","CIPROFLOXACN ","TAB 500MG","14","Select","Select",""],["","52817033200","CYCLOBENZAPR ","TAB 10MG","20","Select","Select",""],["","65862018501","CLINDAMYCIN ","CAP 150MG","63","Select","Select",""],["","00378020810","FUROSEMIDE ","TAB 20MG","15","Select","Select",""],["","00143980305","DOXYCYCL ","CAP 100MG","20","Select","Select",""],["","42192060716","BROM\/PSE\/DM ","SYP ","200","Select","Select",""],["","00591352530","LIDOCAINE ","PAD 0.05","10","Select","Select",""],["","00093226301","AMOXICILLIN ","TAB 500MG","15","Select","Select",""],["","68180012202","CEPHALEXIN ","CAP 500MG","30","Select","Select",""],["","60505025203","TIZANIDINE ","TAB 4MG","30","Select","Select",""],["","45802091987","CETIRIZINE ","TAB 10MG","30","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","14","Select","Select",""],["","51991074790","DULOXETINE ","CAP 30MG","30","Select","Select",""],["","69452015120","VITAMIN ","CAP 50000UNT","4","Select","Select",""],["","69842081266","MUCUS ","TAB 60-1200","60","Select","Select",""],["","67877057305","BENZONATATE ","CAP 100MG","15","Select","Select",""],["","43598044874","NICOTINE ","DIS 21MG\/24H","28","Select","Select",""],["","68180016013","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","42799011101","ETODOLAC ","TAB 400MG","60","Select","Select",""],["","57237000630","FLUCONAZOLE ","TAB 200MG","2","Select","Select",""],["","00591079501","DICYCLOMINE ","TAB 20MG","20","Select","Select",""],["","13668000905","CITALOPRAM ","TAB 10MG","45","Select","Select",""],["","43386009019","GAVILYTE-G ","SOL ","4,000.00","Select","Select",""],["","66685100100","AMOX\/K ","TAB 875-125","20","Select","Select",""],["","00254100752","ALBUTEROL ","AER HFA","6.7","Select","Select",""],["","43547040510","METHOCARBAM ","TAB 500MG","15","Select","Select",""],["","00591321901","BUT\/ASA\/CAFF ","CAP ","20","Select","Select",""],["","00172392670","DIAZEPAM ","TAB 5MG","2","Select","Select",""],["","00406048410","APAP\/CODEINE ","TAB 300-30MG","18","Select","Select",""],["","67877026218","RIZATRIPTAN ","TAB 10MG","10","Select","Select",""],["","65862086001","FAMOTIDINE ","TAB 40MG","90","Select","Select",""],["","69097081312","GABAPENTIN ","CAP 100MG","180","Select","Select",""],["","00185012201","NITROFURANTN ","CAP 100MG","20","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":""}]}]}