{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"VICKY   C WRIGHT","gend":1,"add":"840 VICTORIA AVENUE","city":"LYNCHBURG","state":"VA","zip":"24504-2156","dob":"1964-03-08","age":"","mstatus":"","insh":10053418,"cliId":"","pno":4348450370,"cno":4344776695,"email":"","ename":"","eno":"","pphy":"THOMAS E DOBYNS MD","ppno":4345284312,"pcpadd":"4579 S Amherst Hwy, ","pcpcity":"MADISON HEIGHTS","pcpstate":"VA","pcpzip":245725343,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":4344776695,"add2":"APARTMENT 7","add3":"","madd1":"840 VICTORIA AVENUE","madd2":"APARTMENT 7","madd3":"","mcity":"LYNCHBURG","mstate":"VA","mzip":"24504-2156","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G56.00","R68.89","L22","N39.3","E11.9","E11.42","G89.4","S91.311D","I87.2","I10","J43.9","E66.01","Z91.81","Z68.44","Z79.4","Z87.891","L03.116","L03.115","R23.8","J44.9","J45.20","Z95.0","M79.89","R09.89","A41.9","R06.89","E66.9","R06.02","R09.02","M54.5","Z51.81","R60.9","E11.65","M79.604","E87.2","I89.0","R74.8","E87.1","E87.6","K21.9","I48.0","I11.0","I50.33","E11.40","F17.210","E03.9","G47.33","F43.10","I44.2","N17.9","B02.8","E86.0","F11.20","G25.0","N39.0","B96.20","J44.1","R65.10","B00.9","E11.621","L97.211","L97.311","L97.811","L97.221","L97.821","Z48.00","F32.9","C50.919","E55.9","G25.81","K44.9","K59.00","C50.911","Z20.822","S81.802A","E08.42","L03.119","I51.7","R05","M51.87","M50.90","M19.90","R60.0","Z79.01","Z79.82","Z79.899","L03.90","M17.12","M72.6","E11.51","I25.10","J96.11","G60.9","M79.605","Z20.828","R50.9","Z99.81","R07.9","R78.81","R27.9","Z74.3","R06.9","R52","R06.00","I48.91","B02.9","Z68.43","Z23","C50.411","N63.10","N64.53","R59.0","Z80.0","C50.811","C50.211","C77.3","Z17.0","I50.30","B34.9","L60.3","L84","B35.3","B35.1","E11.8","R03.0","M62.81","I50.32","G93.41","Z66","J81.1","R10.84","J45.909","Z68.45","R65.20","Z74.1","E11.21","Z45.2","R91.8","I50.9","Z72.0","S81.801D","S81.802D","R53.1","R53.81","D72.828","E78.5","N63.0","N64.59","R11.0","Z79.891","D49.9","E87.3","R93.89","M65.341","M65.331","M25.541","M25.641","E87.70","Z48.3"],"date":["2020-12-11","2021-02-15","2021-05-22","2021-05-22","2021-04-02","2021-03-01","2021-04-20","2019-07-02","2020-10-01","2021-04-02","2021-04-30","2021-04-14","2019-07-02","2021-04-14","2020-02-25","2020-08-19","2020-02-25","2020-09-01","2019-07-02","2021-04-14","2020-12-11","2021-04-14","2021-04-18","2020-08-19","2020-09-01","2021-05-01","2020-09-11","2021-05-01","2020-03-25","2021-05-11","2021-02-15","2020-12-11","2020-12-11","2021-04-18","2020-09-01","2021-03-01","2020-03-23","2020-09-01","2020-09-01","2021-03-01","2021-04-14","2021-04-30","2020-09-01","2021-04-14","2020-09-01","2021-04-14","2021-04-30","2020-10-01","2021-03-01","2020-08-23","2020-08-19","2020-08-19","2020-08-19","2020-10-01","2020-09-01","2020-09-01","2020-09-01","2020-08-23","2020-08-23","2021-03-01","2021-03-01","2021-03-01","2021-03-01","2021-03-01","2021-03-01","2021-03-01","2021-03-01","2021-05-19","2021-03-30","2021-03-30","2021-04-07","2021-04-07","2021-05-05","2021-05-05","2021-01-28","2021-01-28","2021-01-28","2020-03-18","2019-07-26","2020-12-11","2020-12-11","2020-12-11","2020-03-18","2021-04-14","2021-04-14","2019-08-16","2020-02-26","2019-07-22","2019-07-22","2021-04-20","2019-09-05","2019-09-05","2019-09-05","2021-04-18","2020-10-29","2019-07-26","2019-02-27","2020-03-18","2019-07-27","2019-07-29","2020-03-25","2020-03-18","2020-03-18","2020-03-19","2021-04-02","2020-09-25","2020-09-25","2020-09-25","2021-03-11","2021-03-11","2021-03-11","2021-03-11","2021-03-11","2021-05-05","2021-04-14","2021-04-14","2021-04-14","2021-04-20","2019-02-28","2019-04-04","2019-04-04","2019-04-04","2019-04-04","2019-04-04","2019-06-09","2020-09-01","2021-04-30","2019-07-27","2020-03-18","2020-03-21","2019-07-22","2019-04-11","2019-06-12","2019-07-27","2020-09-01","2020-09-01","2021-05-12","2020-03-21","2020-03-21","2020-03-23","2020-08-03","2020-08-03","2020-08-19","2020-08-19","2020-09-01","2020-08-28","2021-03-11","2021-03-11","2021-05-19","2019-08-16","2021-04-02","2019-07-22","2019-07-27","2019-10-16","2019-10-16","2019-10-16","2019-10-16","2020-03-18","2021-04-20"],"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","50","Select","Select",""],["","00378395305","ATORVASTATIN ","TAB 80MG","30","Select","Select",""],["","53489014401","SPIRONO\/HCTZ ","TAB 25\/25","30","Select","Select",""],["","00093171601","WARFARIN ","TAB 4MG","30","Select","Select",""],["","71093012105","GABAPENTIN ","CAP 300MG","120","Select","Select",""],["","00186037020","SYMBICORT ","AER 160-4.5","10.2","Select","Select",""],["","08290328418","INSULIN ","MIS 1ML\/31G","100","Select","Select",""],["","55111064534","OMEPRAZOLE ","CAP 40MG","30","Select","Select",""],["","00169633910","NOVOLOG ","INJ FLEXPEN","30","Select","Select",""],["","62175026037","NIFEDIPINE ","TAB 30MG ER","30","Select","Select",""],["","59746011306","PROCHLORPER ","TAB 5MG","30","Select","Select",""],["","53746020301","OXYCOD\/APAP ","TAB 5-325MG","7","Select","Select",""],["","69452015120","VITAMIN ","CAP 50000UNT","4","Select","Select",""],["","55111012705","CIPROFLOXACN ","TAB 500MG","14","Select","Select",""],["","00456120130","LINZESS ","CAP 145MCG","30","Select","Select",""],["","00832003810","OXYBUTYNIN ","TAB 5MG","60","Select","Select",""],["","00378415105","TRAMADOL ","TAB 50MG","180","Select","Select",""],["","00310653004","BYDUREON ","INJ 2MG","4","Select","Select",""],["","00597014030","TRADJENTA ","TAB 5MG","30","Select","Select",""],["","00002143480","TRULICITY ","INJ 1.5\/0.5","2","Select","Select",""],["","08396900218","PEN  NEEDLES  ","MIS 31GX8MM","100","Select","Select",""],["","47781064390","LEVOTHYROXIN ","TAB 50MCG","30","Select","Select",""],["","62332003331","ROPINIROLE ","TAB 2MG","30","Select","Select",""],["","65862006399","METOPROL ","TAB 50MG","60","Select","Select",""],["","68180012202","CEPHALEXIN ","CAP 500MG","40","Select","Select",""],["","51672130308","ECONAZOLE ","CRE 0.01","85","Select","Select",""],["","00003089321","ELIQUIS ","TAB 2.5MG","60","Select","Select",""],["","76204020060","ALBUTEROL ","NEB 0.00083","360","Select","Select",""],["","57237023305","SMZ-TMP ","TAB 800-160","20","Select","Select",""],["","69315011710","FUROSEMIDE ","TAB 40MG","60","Select","Select",""],["","65862018830","ONDANSETRON ","TAB 8MG","30","Select","Select",""],["","68462035701","POT  CHLORIDE","CAP 10MEQ ER","60","Select","Select",""],["","00143211250","DOXYCYCL ","TAB 100MG","14","Select","Select",""],["","00406012301","HYDROCO\/APAP ","TAB 5-325MG","3","Select","Select",""],["","69618004410","DOCUSATE ","CAP 100MG","60","Select","Select",""],["","00378967130","IPRATROPIUM\/ ","SOL ALBUTER","90","Select","Select",""],["","31722070530","VALACYCLOVIR ","TAB 1GM","30","Select","Select",""],["","00378905593","LIDOCAINE ","PAD 0.05","15","Select","Select",""],["","16729022601","SPIRONOLACT ","TAB 50MG","15","Select","Select",""],["","00054001825","PREDNISONE ","TAB 20MG","4","Select","Select",""],["","68382013616","LOSARTAN ","TAB 50MG","30","Select","Select",""],["","45802011222","MUPIROCIN ","2%","22","Select","Select",""],["","08214058733","UNILET ","33G","100","Select","Select",""],["","00193737701","CONTOUR ","NEXT","1","Select","Select",""],["","00002751001","HUMALOG ","100\/ML","10","Select","Select",""],["","10702001850","OXYCODONE ","5MG","5","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":""}]}]}