{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DIANNA   A GRIFFITH","gend":1,"add":"826 LONG AVENUE","city":"COVINGTON","state":"VA","zip":"24426-2185","dob":"1985-10-17","age":"","mstatus":"","insh":10055604,"cliId":"","pno":5403350467,"cno":5406916105,"email":"","ename":"","eno":"","pphy":"HENDERSON, ROBERT J","ppno":5408626659,"pcpadd":"2145 Mount Pleasant Blvd SE, ","pcpcity":"Roanoke","pcpstate":"VA","pcpzip":240143632,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":5406916105,"add2":"APT H4","add3":"","madd1":"826 long avenue","madd2":"apt H4","madd3":"","mcity":"COVINGTON","mstate":"VA","mzip":"24426-1126","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z01.810","M51.9","M23.91","E11.9","I10","E78.5","S83.241A","S83.511A","M67.51","F17.200","Z88.0","Z91.018","Z88.6","Z98.890","Z79.899","J45.909","E11.40","K21.9","E66.01","F41.9","F39","F90.2","M70.61","M70.62","M76.02","M76.01","S39.012A","V49.40XA","F31.9","G43.909","Z68.42","F17.210","M54.42","M51.36","M54.16","M25.551","J44.9","R87.810","I25.119","I11.0","I50.9","E78.49","Z79.82","Z79.51","Z79.84","Z68.43","M96.1","M25.552","N83.9","N13.4","R63.3","Z98.84","R05","R11.2","R10.12","R10.13","N83.201","N83.202","N85.4","R60.0","D50.9","E16.2","J30.9","E55.9","E11.649","M25.561","M54.5","Z01.818","G25.81","G89.29","Z71.89","Z71.3","I25.10","I48.91","Z95.5","Z79.01","I20.8","E78.2","Z87.891","R07.9","R10.9","Z20.822","Z90.49","Z90.710","Z79.4","R55","I48.0","R06.09","Y92.410","R06.02","R06.2","Z23","R68.89","K44.9","Z72.0","R11.10","N39.0","N83.8","N13.30","F45.42","G89.4","Z79.891","J06.9","R53.1","Z20.828","Z53.29","R19.00","R07.81","K31.9","M79.18","E66.9","M54.32","Z04.1","F43.20","R07.89","F17.290","M25.569","I20.0","E46","Z09","B97.89","R19.07","Z01.812","E11.8","M54.9","R10.2","M25.559","J18.9","J20.9","J44.1","M15.9","E11.69","K21.0","F43.10","R11.0","G47.00","R53.83","K28.9","Z68.38","R19.09","Z68.36","Z87.09","Z80.3","D27.0","N83.11","N83.02","N83.292","N81.10","N81.6","N83.511","K66.0","N93.8","J45.40","M54.41","D27.1","Z80.9","J40","M47.816","M51.86","F31.5","M43.17","M41.86","R63.5","Z86.2","Z87.19","R73.09","E66.2","F32.9","F42.9","R06.00","Z82.49","Z86.59","Z13.79","M54.31","I25.111","N95.1","R20.0","F60.3","L02.416","Z01.419","Z29.9","K59.00","N83.209","Z71.6"],"date":["2021-02-16","2019-08-02","2019-03-05","2021-02-19","2021-04-01","2021-04-01","2019-03-05","2019-03-05","2019-03-05","2020-12-23","2019-03-05","2019-03-05","2019-03-05","2021-02-16","2021-02-17","2020-05-28","2019-03-05","2021-02-15","2021-02-17","2021-02-09","2019-11-23","2019-06-18","2021-05-04","2020-10-22","2019-07-24","2019-07-24","2019-08-26","2019-08-26","2021-05-13","2020-05-28","2020-05-28","2021-03-30","2020-10-22","2021-05-04","2021-05-04","2020-05-07","2021-02-22","2020-02-25","2021-02-19","2020-10-23","2020-10-23","2020-12-23","2020-10-23","2020-10-15","2020-04-22","2020-06-12","2021-05-04","2020-07-02","2021-02-16","2020-07-29","2020-07-29","2021-04-01","2020-10-15","2021-04-27","2021-04-01","2021-01-01","2021-02-22","2021-01-20","2021-01-20","2021-02-19","2021-02-19","2021-04-27","2021-02-19","2021-02-19","2021-04-01","2019-01-14","2021-02-09","2019-11-14","2020-06-12","2020-05-28","2019-11-14","2019-11-14","2021-04-01","2019-11-23","2019-11-23","2019-11-23","2019-11-25","2020-12-21","2021-04-01","2020-12-23","2021-04-01","2021-04-01","2021-04-01","2021-04-01","2021-04-01","2021-04-27","2019-08-15","2019-08-15","2019-08-26","2019-09-25","2020-01-24","2021-02-16","2020-03-19","2020-12-21","2020-10-15","2020-07-29","2020-07-29","2021-02-22","2020-07-29","2020-08-24","2020-08-24","2020-08-24","2020-10-15","2021-03-04","2020-10-15","2020-12-21","2021-02-16","2021-03-23","2021-03-23","2021-03-30","2020-05-28","2020-05-07","2019-08-26","2019-12-17","2020-03-12","2019-11-24","2020-05-07","2020-04-09","2020-09-03","2020-09-03","2020-10-15","2021-02-17","2019-01-07","2019-01-07","2019-04-04","2019-04-04","2019-04-04","2019-10-25","2020-01-24","2020-02-07","2020-05-28","2020-05-28","2020-06-12","2020-06-12","2020-08-03","2020-11-30","2020-07-29","2020-10-23","2020-10-23","2021-02-09","2021-02-09","2021-02-09","2021-04-15","2021-02-22","2021-02-16","2021-02-16","2021-02-16","2021-02-16","2021-02-16","2021-02-16","2021-02-16","2021-02-16","2021-02-16","2021-05-04","2021-02-22","2021-02-22","2019-04-24","2019-07-17","2019-07-17","2019-07-17","2019-07-17","2019-07-17","2019-09-25","2019-10-03","2019-10-03","2019-10-03","2019-10-03","2020-06-12","2020-06-12","2020-12-23","2020-12-23","2020-12-23","2021-04-15","2019-06-11","2019-02-07","2019-02-07","2019-04-04","2019-05-01","2019-09-26","2019-11-05","2020-01-10","2020-11-30","2021-01-20","2020-04-29"],"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":[["","80777027399","MODERNA ","INJ COVID-19","0.5","Select","Select",""],["","43547026910","ROPINIROLE ","TAB 0.5MG","30","Select","Select",""],["","69097014260","ALBUTEROL ","AER HFA","6.7","Select","Select",""],["","65862039110","ONDANSETRON ","TAB 8MG ODT","30","Select","Select",""],["","53746010905","HYDROCO\/APAP ","TAB 5-325MG","30","Select","Select",""],["","50428707932","STOOL ","TAB 8.6-50MG","30","Select","Select",""],["","65862069705","VENLAFAXINE ","CAP 150MG ER","30","Select","Select",""],["","51991029405","OXCARBAZEPIN ","TAB 600MG","60","Select","Select",""],["","00904671980","ACETAMINOPHEN ","TA B 325","60","Select","Select",""],["","16729017201","AMITRIPTYLIN ","TAB 25MG","30","Select","Select",""],["","67877022305","GABAPENTIN ","CAP 300MG","180","Select","Select",""],["","29300016915","TIZANIDINE ","TAB 4MG","90","Select","Select",""],["","00003089421","ELIQUIS ","TAB 5MG","60","Select","Select",""],["","57599000101","FREESTYLE    KIT SENSOR","KIT SENSOR","1","Select","Select",""],["","10702005601","OXYCODONE ","TAB 10MG","90","Select","Select",""],["","00168008031","HYDROCORT ","CRE 0.025","30","Select","Select",""],["","63402030430","LATUDA ","TAB 40MG","30","Select","Select",""],["","67877049090","EZETIMIBE ","TAB 10MG","30","Select","Select",""],["","68180032201","ESZOPICLONE ","TAB 1MG","30","Select","Select",""],["","08214070734","ADV ","MIS DEVICE","1","Select","Select",""],["","16729020001","BUSPIRONE ","TAB 5MG","90","Select","Select",""],["","67877024760","QUETIAPINE ","TAB 300MG","30","Select","Select",""],["","56151014701","TRUPLUS ","MIS 33G","100","Select","Select",""],["","68462026430","ROSUVASTATIN ","TAB 40MG","30","Select","Select",""],["","69547035302","NARCAN ","SPR ","2","Select","Select",""],["","29300022019","MONTELUKAST ","TAB 10MG","30","Select","Select",""],["","68462063945","NITROGLYCERN ","SUB 0.4MG","25","Select","Select",""],["","65862001205","SERTRALINE ","TAB 50MG","30","Select","Select",""],["","69315011610","FUROSEMIDE ","TAB 20MG","30","Select","Select",""],["","16729013616","CLONAZEPAM ","TAB 0.5MG","30","Select","Select",""],["","68382011414","RISPERIDONE ","TAB 1MG","30","Select","Select",""],["","00603533821","PREDNISONE ","TAB 10MG","48","Select","Select",""],["","62175011843","OMEPRAZOLE ","CAP 20MG","30","Select","Select",""],["","00069047103","CHANTIX ","PAK 0.5& 1MG","53","Select","Select",""],["","60505079204","ENOXAPARIN ","INJ 40\/0.4ML","12","Select","Select",""],["","60505082901","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","64380080438","RANITIDINE ","TAB 300MG","30","Select","Select",""],["","00186037220","SYMBICORT ","AER 80-4.5","10.2","Select","Select",""],["","70000010801","ENEMA ","ENE TO-USE","133","Select","Select",""],["","00904679480","ASPIRIN ","CHW 81MG","30","Select","Select",""],["","43547028810","BUPROPION ","TAB 100MG SR","60","Select","Select",""],["","00378003210","METOPROL ","TAB 50MG","60","Select","Select",""],["","57599000200","FREESTYLE    MIS READER","MIS READER","1","Select","Select",""],["","00536124701","SENEXON-S ","TAB 8.6-50MG","30","Select","Select",""],["","00378247401","DICLOFEN ","TAB 50MG","60","Select","Select",""],["","00536110301","ALCOHOL ","PAD 0.7","100","Select","Select",""],["","69097012715","AMLODIPINE ","TAB 5MG","30","Select","Select",""],["","64380073706","VITAMIN ","CAP 50000UNT","4","Select","Select",""],["","68180036309","FENOFIBRATE ","TAB 160MG","30","Select","Select",""],["","68382065005","ISOSORB ","TAB 30MG ER","30","Select","Select",""],["","70010075401","METHOCARBAM ","TAB 500MG","40","Select","Select",""],["","45963067611","METOPROLOL ","TAB 50MG ER","60","Select","Select",""],["","12843013105","BAYER ","CHW 81MG","30","Select","Select",""],["","00904645780","DOK ","CAP 100MG","20","Select","Select",""],["","68382075810","METFORMIN ","TAB 500MG","30","Select","Select",""],["","00143980350","DOXYCYCL ","CAP 100MG","20","Select","Select",""],["","59746000103","METHYLPRED ","TAB 4MG","21","Select","Select",""],["","43598044556","NICOTINE ","KIT TRANSDER","56","Select","Select",""],["","51672131200","MUPIROCIN ","OIN 0.02","22","Select","Select",""],["","00245531711","KLOR-CON ","TAB 10MEQ ER","30","Select","Select",""],["","69097094705","ATORVASTATIN ","TAB 80MG","30","Select","Select",""],["","68382059616","DILTIAZEM ","CAP 180MG ER","30","Select","Select",""],["","69097084615","CYCLOBENZAPR ","TAB 10MG","15","Select","Select",""],["","55111028050","LEVOFLOXACIN ","TAB 500MG","5","Select","Select",""],["","65862067905","ALPRAZOLAM ","TAB 2MG","90","Select","Select",""],["","69097082607","BENZTROPINE ","TAB 0.5MG","60","Select","Select",""],["","69097017364","IPRATROPIUM\/ ","SOL ALBUTER","180","Select","Select",""],["","50458058030","XARELTO ","TAB 10MG","30","Select","Select",""],["","00169406013","VICTOZA ","INJ 18MG\/3ML","9","Select","Select",""],["","11845014775","D ","CAP 1000UNIT","60","Select","Select",""],["","00173069600","ADVAIR ","AER 250\/50","60","Select","Select",""],["","65162074510","PROMETHAZINE ","TAB 12.5MG","120","Select","Select",""],["","50111043402","TRAZODONE ","TAB 100MG","30","Select","Select",""],["","16729044316","BUPROPN ","TAB 150MG XL","30","Select","Select",""],["","10019055303","TRANSDERM-SC ","DIS 1MG\/3DAY","9","Select","Select",""],["","65862005190","SIMVASTATIN ","TAB 10MG","90","Select","Select",""],["","62332042731","BENZONATATE ","CAP 200MG","20","Select","Select",""],["","70710101002","OSELTAMIVIR ","CAP 75MG","10","Select","Select",""],["","00228212750","CLONIDINE ","TAB 0.1MG","30","Select","Select",""],["","65862037401","ESCITALOPRAM ","TAB 10MG","30","Select","Select",""],["","55111029336","SUMATRIPTAN ","TAB 100MG","9","Select","Select",""],["","65702048110","ACCU-CHEK ","KIT FASTCLIX","1","Select","Select",""],["","50111078751","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","00172572960","FAMOTIDINE ","TAB 40MG","30","Select","Select",""],["","00832125030","RAMELTEON ","TAB 8MG","30","Select","Select",""],["","31722071310","PANTOPRAZOLE ","TAB 40MG","90","Select","Select",""],["","43386016006","MISOPROSTOL ","TAB 100MCG","60","Select","Select",""],["","31722070110","LOSARTAN ","TAB 50MG","30","Select","Select",""],["","00093221001","SUCRALFATE ","TAB 1GM","120","Select","Select",""],["","00603107556","CHERATUSSIN ","SYP AC","120","Select","Select",""],["","00185012201","NITROFURANTN ","CAP 100MG","14","Select","Select",""],["","53489064801","TEMAZEPAM ","7.5MG","7","Select","Select",""],["","00603188016","LIDOCAINE ","5%","30","Select","Select",""],["","13107003134","MIRTAZAPINE ","15MG","30","Select","Select",""],["","69315090410","LORAZEPAM ","0.5MG","7","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":""}]}]}