{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"FELICIA EPLING","gend":1,"add":"108   IRVIN STREET                                          ","city":"NARROWS                       ","state":"VA","zip":"24124-2302","dob":"1986-09-30","age":"","mstatus":"","insh":10055229,"cliId":"","pno":5402350156,"cno":5402350156,"email":"","ename":"","eno":"","pphy":"LOUGH, ANDREA R                                             ","ppno":"","pcpadd":"1611 Wenonah Ave","pcpcity":"Pearisburg                    ","pcpstate":"VA","pcpzip":241341839,"pcpcounty":"","pcpid":"P0117771","pcpname":"CARILION FAMILY MEDICINE GILES COUNTY","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"108 Irvin St                                                ","madd2":"                                                            ","madd3":"","mcity":"Narrows                       ","mstate":"VA","mzip":"24124-2302","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F33.1","G43.009","K64.4","R68.89","Z03.89","R73.9","Z23","Z20.2","Z12.4","J06.9","R05","J45.909","Z86.14","F17.210","J40","R73.09","Z13.6","Z13.1","Z13.220","Z30.09","Z76.89","Z30.014","Z30.46","Z30.9","Z32.02","S69.91XA","Z53.21","T14.8XXA","M79.641","W19.XXXA","Z30.41","Z30.013","N76.0","R30.9","R82.81","N93.8","E55.9","Z13.228","Z13.0","N92.6","N83.209","N83.9","Z71.89","N91.2","Z87.42","Z86.32","Z84.89","Z14.8","Z34.81","Z11.3","R87.612","Z13.79","Z36.89","K04.7","N87.0","R79.89","N89.8","Z34.82","O99.810","Z68.30","Z3A.20","B49","R21","Z87.891","O99.342","O26.892","F43.9","R07.89","Z53.29","O99.512","Z3A.21","R45.7","R42","F41.9","F32.9","R09.81","R09.82","J02.9","R11.10","Z3A.25","Z20.822","O99.53","O36.63X0","O26.899","O24.414","O47.00","R10.2","O26.893","R10.9","Z3A.36","Z3A.35","O42.02","Z3A.37","Z3A.38","O24.424","O24.429","Z37.0","Z3A.39","N20.0","N13.30","D18.09","O86.12","N13.2","E87.2","R11.0","R68.83","B96.20","R74.02","Z79.51","F17.290","N85.8","R93.89","O90.4","N13.6","O86.29","O86.21","E87.1","O90.81","E83.51","O99.285","O99.63","N10","K86.2","R16.1","N20.1","N30.01","O73.0","Q62.11","A41.9","R94.5","Z46.6","N17.9","N12","R31.0","R39.15","R35.0","Z87.442","Z01.818","G89.18","R11.2","R19.7","Z96.0","M25.512","S49.92XA","W22.8XXA","Y93.9","Y92.9"],"date":["2021-11-05","2020-05-08","2019-02-25","2021-02-10","2019-07-12","2019-10-01","2021-01-13","2019-10-01","2019-10-01","2021-05-12","2021-05-12","2021-11-11","2021-05-12","2021-11-11","2019-11-11","2020-05-08","2020-05-08","2020-05-08","2020-05-08","2021-11-18","2020-05-08","2020-07-17","2020-07-17","2020-08-27","2020-07-17","2020-07-20","2020-07-20","2020-07-20","2020-07-20","2020-07-20","2020-08-27","2020-08-27","2020-09-29","2021-10-19","2020-09-29","2020-10-30","2020-10-30","2020-10-30","2020-10-30","2020-10-30","2020-10-30","2020-10-30","2020-12-08","2021-01-13","2021-01-13","2021-06-16","2021-04-23","2021-04-23","2021-02-10","2021-06-30","2021-03-02","2021-02-10","2021-04-06","2021-02-12","2021-03-02","2021-03-02","2021-03-02","2021-04-23","2021-03-26","2021-06-30","2021-04-06","2021-04-13","2021-10-19","2021-05-12","2021-04-20","2021-04-20","2021-04-20","2021-05-12","2021-04-20","2021-05-12","2021-04-23","2021-04-20","2021-04-20","2021-04-20","2021-04-23","2021-05-12","2021-05-12","2021-05-12","2021-05-12","2021-05-12","2021-09-03","2021-09-03","2021-07-30","2021-06-30","2021-08-23","2021-06-30","2021-09-02","2021-07-29","2021-11-11","2021-07-29","2021-07-30","2021-07-29","2021-08-10","2021-08-23","2021-08-24","2021-08-24","2021-09-03","2021-08-24","2021-11-17","2021-11-11","2021-09-02","2021-09-07","2021-09-04","2021-09-02","2021-09-02","2021-09-02","2021-09-03","2021-09-02","2021-09-02","2021-09-02","2021-09-03","2021-09-03","2021-09-03","2021-09-03","2021-09-03","2021-09-03","2021-09-03","2021-09-03","2021-09-03","2021-09-03","2021-09-03","2021-09-04","2021-09-04","2021-09-04","2021-09-07","2021-09-07","2021-09-04","2021-09-07","2021-09-04","2021-09-04","2021-09-05","2021-09-07","2021-09-07","2021-10-27","2021-10-27","2021-10-27","2021-10-27","2021-11-06","2021-11-11","2021-11-11","2021-11-11","2021-11-11","2021-11-17","2021-11-17","2021-11-17","2021-11-17","2021-11-17"],"priorHcc":[null,"","","","","","","","","","",null,"",null,"","","","","",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":[["","00002821501","HUMULIN","U-100","10","Select","Select",""],["","08290328466","INSULIN","0.5\/30G","100","Select","Select",""],["","00093314705","CEPHALEXIN","500MG","20","Select","Select",""],["","00781707787","METRONIDAZOL","0.75%VAG","70","Select","Select",""],["","13811071910","NITROFURANTN","100MG","14","Select","Select",""],["","65862050320","AMOX\/K","875-125","14","Select","Select",""],["","62756052069","SUMATRIPTAN","25MG","9","Select","Select",""],["","00254100752","ALBUTEROL","HFA","6.7","Select","Select",""],["","00472173607","MICONAZOLE","100MG","7","Select","Select",""],["","00115166001","PROPRANOLOL","20MG","60","Select","Select",""],["","65862094088","AUROVELA","Jan-20","28","Select","Select",""],["","65862001305","SERTRALINE","100MG","30","Select","Select",""],["","51672200306","CLOTRIMAZOLE","1% VAG","45","Select","Select",""],["","57599517501","PREC","FREESTYL","1","Select","Select",""],["","99073013001","FREESTYLE MIS LANCETS","LANCETS","100","Select","Select",""],["","57599157701","FREESTYLE TES PREC NEO","PREC NEO","25","Select","Select",""],["","57237004105","PENICILLN","500MG","21","Select","Select",""],["","00116200116","CHLORHEX","0.12%","473","Select","Select",""],["","59651036205","IBUPROFEN","800MG","30","Select","Select",""],["","00904672059","ACETAMIN","500MG","30","Select","Select",""],["","00904759080","FEROSUL","325MG","30","Select","Select",""],["","59762453802","MEDROXYPR","150MG\/ML","1","Select","Select",""],["","51672131201","MUPIROCIN","2%","30","Select","Select",""],["","00002821501","HUMULIN ","INJ U-100","10","Select","Select",""],["","08290328466","INSULIN ","MIS 0.5\/30G","100","Select","Select",""],["","00093314705","CEPHALEXIN ","CAP 500MG","20","Select","Select",""],["","00781707787","METRONIDAZOL ","GEL 0.75%VAG","70","Select","Select",""],["","13811071910","NITROFURANTN ","CAP 100MG","14","Select","Select",""],["","65862050320","AMOX\/K ","TAB 875-125","14","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","14","Select","Select",""],["","00378113401","KETOROLAC ","TAB 10MG","5","Select","Select",""],["","62756052069","SUMATRIPTAN ","TAB 25MG","9","Select","Select",""],["","00254100752","ALBUTEROL ","AER HFA","6.7","Select","Select",""],["","51293061101","PHENAZOPYRID ","TAB 100MG","21","Select","Select",""],["","00472173607","MICONAZOLE ","SUP 100MG","7","Select","Select",""],["","00115166001","PROPRANOLOL ","TAB 20MG","60","Select","Select",""],["","68462015713","ONDANSETRON ","TAB 4MG ODT","10","Select","Select",""],["","65862094088","AUROVELA ","TAB 43831","28","Select","Select",""],["","00406055201","OXYCODONE ","TAB 5MG","12","Select","Select",""],["","65862001305","SERTRALINE ","TAB 100MG","30","Select","Select",""],["","51672200306","CLOTRIMAZOLE ","CRE 1% VAG","45","Select","Select",""],["","68382013201","TAMSULOSIN ","CAP 0.4MG","30","Select","Select",""],["","57599517501","PREC ","KIT FREESTYL","1","Select","Select",""],["","99073013001","FREESTYLE    MIS LANCETS","MIS LANCETS","100","Select","Select",""],["","57599157701","FREESTYLE    TES PREC NEO","TES PREC NEO","25","Select","Select",""],["","57237004105","PENICILLN ","TAB 500MG","21","Select","Select",""],["","00116200116","CHLORHEX ","SOL 0.0012","473","Select","Select",""],["","59651036205","IBUPROFEN ","TAB 800MG","30","Select","Select",""],["","00904672059","ACETAMIN ","TAB 500MG","30","Select","Select",""],["","00904759080","FEROSUL ","TAB 325MG","30","Select","Select",""],["","59762453802","MEDROXYPR ","INJ 150MG\/ML","1","Select","Select",""],["","51672131201","MUPIROCIN ","OIN 0.02","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":[[["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["No","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":""}]}]}