{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TAMMY   L TAYLOR","gend":1,"add":"1575   RICHMOND  BOULEVARD                                  ","city":"DANVILLE                      ","state":"VA","zip":"24540-3934","dob":"1973-08-31","age":"","mstatus":"","insh":10053286,"cliId":"","pno":4348223971,"cno":4344290797,"email":"","ename":"","eno":"","pphy":"STEPHENS, AMBER                                             ","ppno":"","pcpadd":"2767 Franklin Tpke","pcpcity":"Danville                      ","pcpstate":"VA","pcpzip":245405273,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"APT B20                                                     ","add3":"","madd1":"1575   RICHMOND  BOULEVARD                                  ","madd2":"APT B20                                                     ","madd3":"","mcity":"DANVILLE                      ","mstate":"VA","mzip":"24540-3934","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M70.50","R60.0","F43.21","N30.90","J18.9","F41.9","J45.909","F32.9","K21.9","E11.9","E78.00","I10","R56.9","R05","R06.02","Z86.73","Z88.1","Z88.6","K02.9","K08.89","Q65.89","Z72.0","E78.2","E03.9","G40.89","G40.909","N39.0","R53.81","Z88.5","Z88.8","R06.00","L29.9","R07.89","R51","E78.5","R07.9","R09.02","I51.7","R40.20","R40.4","R42","R53.1","R52","G45.9","R53.83","K29.00","Z79.82","Z79.899","R10.9","R11.0","R10.10","M54.5","L03.90","R07.2","I16.0","F31.9","G62.9","Z79.1","I24.9","G43.909","R41.0","R45.6","E66.01","F33.1","R11.2","L30.9","S46.011A","M25.511","X50.1XXA","Y93.89","Y92.9","Y99.9","X50.0XXA","R10.13","R13.10","K29.70","K76.0","Z12.11","K44.9","K29.50","E66.9","Z68.41","M19.90","L20.84","R21","F17.210","B86","Z87.891","L82.1","D22.39","D22.5","L91.8","D48.5","L21.8","L29.8","L82.0","L81.4","L30.8","L98.499","L81.3","R06.9","I95.9","Z01.419","N90.89","C44.319","C51.9","Z68.42","Z96.641","Z96.642","R94.31","Z01.812","Z01.810","G89.29","R68.89","Z01.89","I07.1","Z08","Z85.44","C44.01","M25.561","W19.XXXA","S89.91XA","M17.11","W18.30XA","W18.39XA","F25.0","Z00.00","G44.89","R51.9","Z11.8","R35.0","A59.01","Z12.31","R39.15","R35.1","B02.9","M54.2","R20.8","M79.603","A41.9","G06.1","Z20.822","L03.811","M60.009","R50.9","A40.0","K57.92","L02.11","M46.20","R00.0","M62.89","R22.1","Z48.00","M79.601","M25.562","Z23","N39.3","M25.559","R26.89"],"date":["2019-01-17","2019-05-30","2019-05-30","2019-01-17","2019-02-11","2021-06-20","2021-06-19","2021-06-19","2021-10-11","2021-06-20","2020-01-31","2021-10-11","2021-06-20","2019-02-11","2019-08-01","2021-06-19","2021-07-02","2021-07-02","2019-03-31","2019-03-31","2020-07-23","2019-03-31","2021-10-11","2021-10-11","2020-03-23","2019-08-13","2019-06-12","2021-05-19","2021-07-02","2021-07-02","2019-07-20","2021-06-13","2019-09-27","2019-10-14","2021-06-19","2019-09-27","2019-08-15","2019-08-12","2019-08-12","2019-08-12","2021-05-19","2021-06-19","2021-06-13","2019-08-15","2021-04-16","2019-08-29","2021-06-20","2021-06-20","2019-08-29","2019-11-12","2019-08-29","2019-09-08","2021-06-19","2019-09-26","2019-09-26","2021-10-11","2019-09-26","2019-09-26","2019-09-27","2019-10-14","2019-10-14","2019-10-14","2021-06-20","2021-11-01","2020-03-06","2020-03-09","2019-12-09","2020-01-02","2019-12-09","2019-12-09","2019-12-09","2019-12-09","2019-12-09","2020-03-06","2020-03-06","2020-03-06","2020-03-06","2020-03-06","2020-03-06","2020-01-31","2020-01-31","2021-06-20","2020-01-31","2020-02-03","2020-03-09","2021-07-02","2020-03-01","2020-03-09","2020-03-19","2020-03-19","2020-03-19","2020-03-19","2020-03-19","2020-03-19","2020-03-19","2020-03-19","2020-03-19","2020-03-19","2020-03-19","2020-03-19","2020-03-23","2020-03-23","2021-05-19","2021-05-19","2020-04-02","2020-08-11","2021-04-16","2020-04-09","2020-04-09","2020-04-20","2020-04-20","2020-04-20","2021-03-02","2021-01-19","2020-07-23","2020-07-23","2020-07-23","2020-07-23","2021-01-11","2020-12-26","2020-12-26","2020-12-26","2020-12-26","2020-12-26","2020-12-26","2021-06-11","2021-04-16","2021-05-19","2021-06-19","2021-05-19","2021-05-27","2021-05-19","2021-05-19","2021-05-27","2021-05-27","2021-06-20","2021-06-19","2021-06-13","2021-06-13","2021-06-20","2021-06-25","2021-06-19","2021-06-19","2021-06-19","2021-06-23","2021-06-20","2021-06-20","2021-06-20","2021-07-20","2021-06-20","2021-06-21","2021-06-23","2021-07-02","2021-07-02","2021-09-27","2021-10-11","2021-11-02","2021-11-02","2021-11-02"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",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":[["","65862052305","GABAPENTIN","600MG","90","Select","Select",""],["","59746017310","PREDNISONE","10MG","35","Select","Select",""],["","68180032002","BUPROPN","300MG XL","30","Select","Select",""],["","68180035302","SERTRALINE","100MG","30","Select","Select",""],["","68382041205","OMEPRAZOLE","20MG","30","Select","Select",""],["","67877024910","QUETIAPINE","50MG","30","Select","Select",""],["","65862019399","FLUOXETINE","20MG","30","Select","Select",""],["","45802046564","KETOCONAZOLE","2%","120","Select","Select",""],["","69315011610","FUROSEMIDE","20MG","30","Select","Select",""],["","00093221001","SUCRALFATE","1GM","60","Select","Select",""],["","00093720298","PRAVASTATIN","40MG","30","Select","Select",""],["","62107002732","ASPIRIN","81MG EC","30","Select","Select",""],["","00378001801","METOPROL","25MG","180","Select","Select",""],["","11845014922","FISH","1200MG","90","Select","Select",""],["","68180096503","LEVOTHYROXIN","25MCG","90","Select","Select",""],["","61442012110","FAMOTIDINE","20MG","60","Select","Select",""],["","00904770470","ASPIR-LOW","81MG EC","30","Select","Select",""],["","65862018730","ONDANSETRON","4MG","30","Select","Select",""],["","47335032688","NALTREXONE","50MG","30","Select","Select",""],["","00591354260","BUPROPION","200MG SR","30","Select","Select",""],["","00591352530","LIDOCAINE","5%","10","Select","Select",""],["","67877032105","IBUPROFEN","800MG","20","Select","Select",""],["","69097012415","TOPIRAMATE","100MG","30","Select","Select",""],["","16729018317","HYDROCHLOROT","25MG","30","Select","Select",""],["","00168005760","BETAMETH","0.05%","60","Select","Select",""],["","50458058030","XARELTO","10MG","14","Select","Select",""],["","59746032530","VALACYCLOVIR","1GM","21","Select","Select",""],["","53746010905","HYDROCO\/APAP","5-325MG","10","Select","Select",""],["","50111056102","TRAZODONE","100MG","30","Select","Select",""],["","47335038283","DULOXETINE","30MG","30","Select","Select",""],["","00378561578","LEVETIRACETA","500MG","60","Select","Select",""],["","00093553756","ESZOPICLONE","1MG","30","Select","Select",""],["","68180065208","DOXYCYC","100MG","20","Select","Select",""],["","23155065205","METRONIDAZOL","500MG","4","Select","Select",""],["","67877021905","CEPHALEXIN","500MG","4","Select","Select",""],["","00472024260","PERMETHRIN","5%","60","Select","Select",""],["","10702020110","OXYBUTYNIN","5MG","180","Select","Select",""],["","65862052305","GABAPENTIN ","TAB 600MG","90","Select","Select",""],["","59746017310","PREDNISONE ","TAB 10MG","35","Select","Select",""],["","50111056101","TRAZODONE ","TAB 100MG","30","Select","Select",""],["","68180032002","BUPROPN ","TAB 300MG XL","30","Select","Select",""],["","49483048110","ASPIRIN ","TAB 81MG EC","30","Select","Select",""],["","43547029010","BUPROPION ","TAB 200MG SR","30","Select","Select",""],["","57237016199","OMEPRAZOLE ","CAP 20MG","30","Select","Select",""],["","68382014005","TOPIRAMATE ","TAB 100MG","30","Select","Select",""],["","00093221005","SUCRALFATE ","TAB 1GM","60","Select","Select",""],["","68180035302","SERTRALINE ","TAB 100MG","30","Select","Select",""],["","67877024910","QUETIAPINE ","TAB 50MG","30","Select","Select",""],["","65862019399","FLUOXETINE ","CAP 20MG","30","Select","Select",""],["","45802046564","KETOCONAZOLE ","SHA 0.02","120","Select","Select",""],["","69315011610","FUROSEMIDE ","TAB 20MG","30","Select","Select",""],["","00093720298","PRAVASTATIN ","TAB 40MG","30","Select","Select",""],["","00378001801","METOPROL ","TAB 25MG","180","Select","Select",""],["","11845014922","FISH ","CAP 1200MG","90","Select","Select",""],["","68180096503","LEVOTHYROXIN ","TAB 25MCG","90","Select","Select",""],["","61442012110","FAMOTIDINE ","TAB 20MG","60","Select","Select",""],["","00904770470","ASPIR-LOW ","TAB 81MG EC","30","Select","Select",""],["","65862018730","ONDANSETRON ","TAB 4MG","30","Select","Select",""],["","47335032688","NALTREXONE ","TAB 50MG","30","Select","Select",""],["","00591352530","LIDOCAINE ","PAD 0.05","10","Select","Select",""],["","67877032105","IBUPROFEN ","TAB 800MG","20","Select","Select",""],["","70954000530","OXYBUTYNIN ","TAB 5MG","60","Select","Select",""],["","16729018317","HYDROCHLOROT ","TAB 25MG","30","Select","Select",""],["","00168005760","BETAMETH ","LOT 0.0005","60","Select","Select",""],["","50458058030","XARELTO ","TAB 10MG","14","Select","Select",""],["","59746032530","VALACYCLOVIR ","TAB 1GM","21","Select","Select",""],["","53746010905","HYDROCO\/APAP ","TAB 5-325MG","10","Select","Select",""],["","47335038283","DULOXETINE ","CAP 30MG","30","Select","Select",""],["","00378561578","LEVETIRACETA ","TAB 500MG","60","Select","Select",""],["","00093553756","ESZOPICLONE ","TAB 1MG","30","Select","Select",""],["","68180065208","DOXYCYC ","CAP 100MG","20","Select","Select",""],["","23155065205","METRONIDAZOL ","TAB 500MG","4","Select","Select",""],["","67877021905","CEPHALEXIN ","CAP 500MG","4","Select","Select",""],["","00472024260","PERMETHRIN ","CRE 0.05","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":[[["Yes","Select","","","","","Select","",""],["Yes","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":""}]}]}