{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JACQUELINE   E COFFEY","gend":1,"add":"1050 W. WASHINGTON STREET                                   ","city":"WYTHEVILLE                    ","state":"VA","zip":"24382-2478","dob":"1961-09-14","age":"","mstatus":"","insh":10054606,"cliId":"","pno":2762007160,"cno":2766204486,"email":"","ename":"","eno":"","pphy":"KAATZ, MATTHEW S                                            ","ppno":"","pcpadd":"101 1st St NW","pcpcity":"PULASKI                       ","pcpstate":"VA","pcpzip":243015603,"pcpcounty":"","pcpid":"P9058766","pcpname":"KAATZ MATTHEW S MD PC","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"APT. C-10                                                   ","add3":"","madd1":"1050 W. WASHINGTON STREET                                   ","madd2":"APT. C-10                                                   ","madd3":"","mcity":"WYTHEVILLE                    ","mstate":"VA","mzip":"24382-2478","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F31.9","F43.10","M51.26","M51.36","M54.16","M25.512","M25.522","M79.642","J45.909","K21.9","R51","I10","E03.9","G40.909","Z88.6","Z79.899","M79.89","S59.902A","E11.9","J44.9","E78.5","R30.0","R68.89","M25.532","F31.32","E78.2","F44.5","E11.42","Z12.31","M79.605","T14.90XA","Z87.828","M25.442","R20.2","R74.0","M65.9","N39.0","R10.11","N30.00","M47.22","G56.03","G56.23","M76.72","M25.572","M25.372","B35.1","M79.675","M79.672","M79.2","R42","R56.9","R53.1","Z79.02","Z79.890","I63.9","G31.9","Z86.73","G56.02","G56.22","M25.642","E11.65","R01.1","G40.919","G43.019","F32.9","E78.01","Z01.818","G56.01","M24.542","M67.432","M67.824","E78.00","D17.22","R05","J02.9","G62.9","M72.2","M79.671","M65.871","M19.071","M65.872","M19.072","I69.910","M54.12","E11.49","F31.73","G44.209","G43.909","M19.90","N76.0","R81","R60.9","M54.5","R60.0","E87.6","L30.9","L60.3","M79.674","R13.10","Z11.59","K21.0","K22.8","K44.9","Z20.828","Z79.84","Z79.01","R12","R16.1","R31.0","E11.40","I20.8","M79.669","I73.9","M79.606","R10.9","F41.1","K21.00","N13.30","K76.0","N89.8","N39.41","E11.69","M25.571","M76.62","J20.9","R94.5","R07.9","I47.1","R39.9","I08.1","I09.89","F41.9","F33.9","I31.3","G60.9","N92.1","M25.561","M53.3","M79.604","R29.6","S30.0XXA","M25.551","W18.30XA","Y93.9","Y92.9","Z91.81","Z88.0","Z91.02","Z91.018","M79.9","G40.89","G40.802","Z90.49","Z90.710","Z88.5","Z12.39","M17.9","Z68.29","Z72.3","R11.2","R19.7","H25.13","H25.11","G89.29","Z01.419","Z11.51","Z12.72","Z00.00","E66.3","H25.12","M25.80","Z13.820","R49.0","J04.0","Z88.8","F17.210","M79.661","M79.662","G57.92","G57.91","R94.31","Z86.69","R51.9","R89.2","R09.02","Z91.030","R50.9","Z20.822","R53.83","R68.83","D50.9","Z86.010","K29.70","K57.30","K64.8","K63.5","D12.3","D12.0","K29.50","G56.00","D12.5","D13.2","K29.30","K20.90","D50.0","D64.9","R13.12","M54.50","W01.198A","Y92.002","W01.0XXA"],"date":["2021-11-13","2021-01-07","2019-01-16","2019-01-16","2020-08-06","2019-10-14","2020-02-19","2020-03-26","2021-10-12","2021-10-12","2020-04-28","2021-10-12","2021-11-12","2021-11-12","2021-10-12","2021-10-12","2019-01-29","2019-01-29","2021-11-12","2020-09-09","2021-11-12","2021-03-11","2021-02-15","2019-10-30","2020-03-24","2021-01-05","2019-05-17","2021-11-15","2021-10-13","2021-07-05","2021-07-05","2019-05-29","2019-10-30","2019-10-30","2019-08-16","2019-10-30","2021-08-14","2021-03-31","2019-08-21","2019-09-26","2019-11-25","2019-09-26","2021-03-19","2021-06-07","2021-01-11","2021-08-31","2020-11-30","2021-11-15","2019-10-16","2021-07-27","2021-09-15","2019-10-17","2021-10-12","2019-10-17","2019-11-13","2019-10-23","2020-09-09","2020-02-11","2020-01-23","2020-01-23","2019-10-30","2019-11-06","2021-10-18","2021-09-15","2021-09-15","2019-11-25","2020-01-10","2020-01-23","2020-02-19","2020-01-23","2020-01-23","2020-09-30","2020-01-23","2021-08-14","2020-01-27","2021-10-18","2020-03-02","2021-11-15","2021-11-01","2020-10-19","2021-11-01","2021-03-19","2020-04-28","2020-04-28","2020-11-30","2021-01-07","2020-04-24","2020-06-05","2020-07-09","2020-05-19","2020-06-12","2020-07-15","2021-03-02","2021-03-03","2021-08-19","2020-08-10","2020-11-30","2020-11-30","2021-08-16","2020-09-04","2020-09-09","2020-09-09","2021-08-19","2020-09-09","2021-10-12","2021-03-04","2021-08-19","2020-09-21","2020-09-21","2021-11-12","2020-09-30","2020-10-12","2020-10-12","2020-10-12","2020-11-20","2021-11-12","2021-10-06","2020-11-20","2020-11-18","2020-11-20","2020-11-20","2021-02-10","2021-06-07","2020-11-30","2021-01-28","2020-12-15","2021-10-29","2021-07-22","2021-01-13","2021-01-14","2021-01-14","2021-01-15","2021-06-29","2021-01-27","2021-02-10","2021-02-22","2021-03-02","2021-07-05","2021-07-05","2021-10-18","2021-10-12","2021-03-02","2021-03-02","2021-10-12","2021-03-02","2021-03-02","2021-10-12","2021-07-27","2021-10-12","2021-03-03","2021-03-04","2021-03-04","2021-03-04","2021-05-04","2021-10-12","2021-03-09","2021-03-09","2021-05-11","2021-05-11","2021-03-31","2021-03-31","2021-04-02","2021-06-08","2021-04-22","2021-05-04","2021-05-04","2021-05-04","2021-05-11","2021-05-11","2021-05-20","2021-06-15","2021-07-05","2021-07-05","2021-07-05","2021-07-05","2021-07-05","2021-07-05","2021-07-05","2021-07-15","2021-07-15","2021-10-29","2021-07-22","2021-07-27","2021-07-27","2021-07-27","2021-08-11","2021-08-14","2021-08-14","2021-08-14","2021-08-14","2021-11-12","2021-10-06","2021-08-24","2021-10-06","2021-10-06","2021-08-24","2021-10-06","2021-10-06","2021-08-24","2021-08-19","2021-08-24","2021-08-24","2021-10-06","2021-08-24","2021-11-22","2021-09-15","2021-10-13","2021-10-12","2021-10-12","2021-10-12","2021-10-12"],"priorHcc":[null,"","","","","","","","","","","",null,null,"","","","",null,"",null,"","","","","","",null,"","","","","","","","","","","","","","","","","","","",null,"","","","","","","","","","","","","","",null,"","","","","","","","","","","","",null,"",null,"","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",null,"","","","","",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":[["","55111032001","GLIMEPIRIDE","1MG","30","Select","Select",""],["","00781148901","AMITRIPTYLIN","75MG","30","Select","Select",""],["","57237018390","PRAMIPEXOLE","0.75MG","60","Select","Select",""],["","00054429731","FUROSEMIDE","20MG","30","Select","Select",""],["","37864091001","VITAMIN","100MG","30","Select","Select",""],["","65862001001","METFORMIN","1000MG","60","Select","Select",""],["","65862069201","PHENYTOIN","100MG","150","Select","Select",""],["","68382018201","BUSPIRONE","15MG","60","Select","Select",""],["","59762531001","PRAZOSIN","1MG","30","Select","Select",""],["","68180011316","LEVETIRACETA","500MG","90","Select","Select",""],["","67877042905","GABAPENTIN","800MG","120","Select","Select",""],["","31722071390","PANTOPRAZOLE","40MG","90","Select","Select",""],["","16729013600","CLONAZEPAM","0.5MG","30","Select","Select",""],["","00193730850","BAYER","XT 50CT","100","Select","Select",""],["","16729011917","MONTELUKAST","10MG","90","Select","Select",""],["","68462026290","ROSUVASTATIN","10MG","30","Select","Select",""],["","65862035790","CLOPIDOGREL","75MG","30","Select","Select",""],["","40985027113","B-12","5000MCG","30","Select","Select",""],["","58657050016","CODEINE\/GG","10-100\/5","180","Select","Select",""],["","16729022501","SPIRONOLACT","25MG","30","Select","Select",""],["","68462047205","POT CL MICRO","20MEQ ER","30","Select","Select",""],["","59762330403","NITROGLYCERN","0.4MG","25","Select","Select",""],["","57237000511","FLUCONAZOLE","150MG","5","Select","Select",""],["","00093317431","ALBUTEROL","E","8.5","Select","Select",""],["","69315013601","BENZTROPINE","0.5MG","60","Select","Select",""],["","50428043019","CVS","100MG","30","Select","Select",""],["","69097015907","MELOXICAM","15MG","30","Select","Select",""],["","00193658621","MICROLET","LANCETS","100","Select","Select",""],["","61874011530","VRAYLAR","1.5MG","30","Select","Select",""],["","60758011905","PREDNISOLONE","1% OP","5","Select","Select",""],["","61314012605","KETOROLAC","0.50%","5","Select","Select",""],["","69315030805","CIPROFLOXACN","0.3% OP","5","Select","Select",""],["","00193731221","CONTOUR","NEXT","100","Select","Select",""],["","00045083824","TYLENOL","650MG","24","Select","Select",""],["","71093015504","ZOLPIDEM","5MG","30","Select","Select",""],["","69292053201","PROPRANOLOL","20MG","60","Select","Select",""],["","00000000000","","","180","Select","Select",""],["","65862001201","SERTRALINE","50MG","30","Select","Select",""],["","29300022746","METRONIDAZOL","500MG","14","Select","Select",""],["","00185012201","NITROFURANTN","100MG","14","Select","Select",""],["","57237007710","ONDANSETRON","4MG ODT","12","Select","Select",""],["","69543013611","TRAMADOL","50MG","20","Select","Select",""],["","50383008716","GUAIATUSS","100-10\/5","180","Select","Select",""],["","11534016501","FOLIC","1MG","30","Select","Select",""],["","35046000116","B-1","100MG","60","Select","Select",""],["","00168005515","BETAMETH","0.05%","15","Select","Select",""],["","65862096730","ESZOPICLONE","1MG","14","Select","Select",""],["","80777027399","MODERNA","COVID-19","0.5","Select","Select",""],["","00310828060","QUETIAPINE","50MG ER","14","Select","Select",""],["","49502010202","EPINEPHRINE","0.3MG","2","Select","Select",""],["","13668033001","TRAZODONE","50MG","30","Select","Select",""],["","00591352530","LIDOCAINE","5%","30","Select","Select",""],["","23155050110","HYDROXYZ","25MG","30","Select","Select",""],["","67877021905","CEPHALEXIN","500MG","20","Select","Select",""],["","70010013505","POT CHLORIDE","20MEQ ER","30","Select","Select",""],["","50111078855","AZITHROMYCIN","500MG","3","Select","Select",""],["","59762109106","ASENAPINE","2.5MG","30","Select","Select",""],["","40093010168","C\/ROSE","500MG","60","Select","Select",""],["","53746010901","HYDROCO\/APAP","5-325MG","28","Select","Select",""],["","65862042005","SMZ\/TMP","800-160","20","Select","Select",""],["","45802065087","LORATADINE","10MG","30","Select","Select",""],["","50742017501","ISOSORB","30MG ER","90","Select","Select",""],["","54629001893","OMEGA-3","1000MG","60","Select","Select",""],["","16729000710","SIMVASTATIN","80MG","30","Select","Select",""],["","50383066730","LIDO\/PRILOCN","2.5-2.5%","30","Select","Select",""],["","00527169505","BUT\/APAP\/CAF","","30","Select","Select",""],["","47335032683","NALTREXONE","50MG","30","Select","Select",""],["","63824000834","MUCINEX","600MG ER","120","Select","Select",""],["","51672404801","CLOTRIM\/BETA","DIPROP","15","Select","Select",""],["","57237001106","MIRTAZAPINE","15MG ODT","30","Select","Select",""],["","55111032001","GLIMEPIRIDE ","TAB 1MG","30","Select","Select",""],["","00781148901","AMITRIPTYLIN ","TAB 75MG","30","Select","Select",""],["","57237018390","PRAMIPEXOLE ","TAB 0.75MG","60","Select","Select",""],["","00054429731","FUROSEMIDE ","TAB 20MG","30","Select","Select",""],["","37864091001","VITAMIN ","TAB 100MG","30","Select","Select",""],["","65862001001","METFORMIN ","TAB 1000MG","60","Select","Select",""],["","65862069201","PHENYTOIN ","CAP 100MG","150","Select","Select",""],["","68382018201","BUSPIRONE ","TAB 15MG","60","Select","Select",""],["","59762531001","PRAZOSIN ","CAP 1MG","30","Select","Select",""],["","68180011316","LEVETIRACETA ","TAB 500MG","90","Select","Select",""],["","67877042905","GABAPENTIN ","TAB 800MG","120","Select","Select",""],["","31722071390","PANTOPRAZOLE ","TAB 40MG","90","Select","Select",""],["","16729013600","CLONAZEPAM ","TAB 0.5MG","30","Select","Select",""],["","00193730850","BAYER ","NE XT 50CT","100","Select","Select",""],["","65862086001","FAMOTIDINE ","TAB 40MG","30","Select","Select",""],["","16729011917","MONTELUKAST ","TAB 10MG","90","Select","Select",""],["","69315013601","BENZTROPINE ","TAB 0.5MG","60","Select","Select",""],["","68462026290","ROSUVASTATIN ","TAB 10MG","30","Select","Select",""],["","65862035790","CLOPIDOGREL ","TAB 75MG","30","Select","Select",""],["","40985027113","B-12 ","SUB 5000MCG","30","Select","Select",""],["","58657050016","CODEINE\/GG ","SOL 10-100\/5","180","Select","Select",""],["","16729022501","SPIRONOLACT ","TAB 25MG","30","Select","Select",""],["","68462047205","POT  CL MICRO","TAB 20MEQ ER","30","Select","Select",""],["","59762330403","NITROGLYCERN ","SUB 0.4MG","25","Select","Select",""],["","57237000511","FLUCONAZOLE ","TAB 150MG","5","Select","Select",""],["","00093317431","ALBUTEROL ","FAT E","8.5","Select","Select",""],["","50428043019","CVS ","TAB 100MG","30","Select","Select",""],["","69097015907","MELOXICAM ","TAB 15MG","30","Select","Select",""],["","00193658621","MICROLET ","MIS LANCETS","100","Select","Select",""],["","13668033001","TRAZODONE ","TAB 50MG","60","Select","Select",""],["","61874011530","VRAYLAR ","CAP 1.5MG","30","Select","Select",""],["","60758011905","PREDNISOLONE ","SUS 1% OP","5","Select","Select",""],["","61314012605","KETOROLAC ","SOL 0.005","5","Select","Select",""],["","69315030805","CIPROFLOXACN ","SOL 0.3% OP","5","Select","Select",""],["","00193731221","CONTOUR ","TES NEXT","100","Select","Select",""],["","00045083824","TYLENOL ","TAB 650MG","24","Select","Select",""],["","71093015504","ZOLPIDEM ","TAB 5MG","30","Select","Select",""],["","69292053201","PROPRANOLOL ","TAB 20MG","60","Select","Select",""],["","65862001201","SERTRALINE ","TAB 50MG","30","Select","Select",""],["","29300022746","METRONIDAZOL ","TAB 500MG","14","Select","Select",""],["","00185012201","NITROFURANTN ","CAP 100MG","14","Select","Select",""],["","57237007710","ONDANSETRON ","TAB 4MG ODT","12","Select","Select",""],["","69543013611","TRAMADOL ","TAB 50MG","20","Select","Select",""],["","54629001893","OMEGA-3 ","CAP 1000MG","120","Select","Select",""],["","50383008716","GUAIATUSS ","SYP 100-10\/5","180","Select","Select",""],["","11534016501","FOLIC ","TAB 1MG","30","Select","Select",""],["","00904699860","DOCUSATE ","CAP 100MG","20","Select","Select",""],["","35046000116","B-1 ","TAB 100MG","60","Select","Select",""],["","00168005515","BETAMETH ","CRE 0.0005","15","Select","Select",""],["","65862096730","ESZOPICLONE ","TAB 1MG","14","Select","Select",""],["","80777027399","MODERNA ","INJ COVID-19","0.5","Select","Select",""],["","00310828060","QUETIAPINE ","TAB 50MG ER","14","Select","Select",""],["","49502010202","EPINEPHRINE ","INJ 0.3MG","2","Select","Select",""],["","00591352530","LIDOCAINE ","PAD 0.05","30","Select","Select",""],["","23155050110","HYDROXYZ ","TAB 25MG","30","Select","Select",""],["","67877021905","CEPHALEXIN ","CAP 500MG","20","Select","Select",""],["","70010013505","POT  CHLORIDE","TAB 20MEQ ER","30","Select","Select",""],["","50111078855","AZITHROMYCIN ","TAB 500MG","3","Select","Select",""],["","59762109106","ASENAPINE ","SUB 2.5MG","30","Select","Select",""],["","40093010168","C\/ROSE ","CHW 500MG","60","Select","Select",""],["","53746010901","HYDROCO\/APAP ","TAB 5-325MG","28","Select","Select",""],["","50742017501","ISOSORB ","TAB 30MG ER","90","Select","Select",""],["","27241009803","DULOXETINE ","CAP 30MG","30","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","20","Select","Select",""],["","45802065087","LORATADINE ","TAB 10MG","30","Select","Select",""],["","16729000710","SIMVASTATIN ","TAB 80MG","30","Select","Select",""],["","50383066730","LIDO\/PRILOCN ","CRE 2.5-2.5%","30","Select","Select",""],["","00527169505","BUT\/APAP\/CAF ","TAB ","30","Select","Select",""],["","47335032683","NALTREXONE ","TAB 50MG","30","Select","Select",""],["","63824000834","MUCINEX ","TAB 600MG ER","120","Select","Select",""],["","51672404801","CLOTRIM\/BETA ","CRE DIPROP","15","Select","Select",""],["","57237001106","MIRTAZAPINE ","TAB 15MG ODT","30","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":""}]}]}