{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ELLEN   M HARRIS","gend":1,"add":"P O BOX 92                                                  ","city":"RIPPLEMEAD                    ","state":"VA","zip":"24150-0092","dob":"1964-01-12","age":"","mstatus":"","insh":10055804,"cliId":"","pno":5405997660,"cno":5405997660,"email":"","ename":"","eno":"","pphy":"LEWIS, SARAH H                                              ","ppno":"","pcpadd":"430 BOXWOOD LANE","pcpcity":"PEARISBURG                    ","pcpstate":"VA","pcpzip":241342285,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"P O BOX 92                                                  ","madd2":"                                                            ","madd3":"","mcity":"RIPPLEMEAD                    ","mstate":"VA","mzip":"24150-0092","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11.65","Z79.4","Z71.3","R39.81","G89.29","M48.02","M50.30","M47.816","M46.06","Z79.891","M54.2","M54.6","M54.5","M51.35","M51.36","N95.0","R53.1","D25.9","N93.9","Z97.5","N83.292","N71.1","E03.9","Z12.31","F17.200","R06.02","R07.1","R07.9","J44.9","E11.9","E78.5","I10","Z85.41","F17.210","Z79.82","I45.81","R94.31","R07.89","K21.9","G47.33","Z79.899","F10.10","R53.81","Z74.3","M25.511","E11.40","Z76.0","G89.4","M54.17","Z72.0","Z99.89","K12.0","S09.90XA","R42","X58.XXXA","Y93.9","Y92.9","Z79.84","G44.309","B37.2","R21","F41.8","B37.0","G44.89","R51","R20.0","E86.0","G92","T42.6X5A","F32.9","G43.909","G47.00","I95.9","R94.6","R94.01","I63.9","R41.0","R29.90","I36.1","I67.848","G40.909","M54.42","G47.30","M47.22","M47.26","B37.3","J20.9","R63.5","R91.8","Z00.00","M53.87","Z01.411","N76.0","Z12.4","B96.89","N95.2","N39.46","N60.19","R73.9","Z90.49","G93.40","R29.818","K52.89","E87.2","R53.83","D72.829","R40.0","Z20.822","K52.9","K76.0","R41.82","G04.30","J96.02","G93.1","G93.41","G81.91","J96.22","J44.1","N39.0","B37.9","E11.42","E11.649","E66.01","Z46.82","R11.0","I69.351","N17.9","B37.49","E72.20","I69.391","R13.12","E11.43","I69.322","I69.398","K59.00","K31.84","E87.6","R26.9","H53.9","M50.20","J43.8","R60.0","R51.9","M47.897","Z87.891","Z98.51","G93.89","I67.2","N94.10","R79.1","U07.1","R05","M79.10","R13.10","R15.9","R32","M54.9","M48.061","R10.2","Z23","Z12.11","D12.8","K63.5","K64.1","Z80.0","Z79.51"],"date":["2021-08-04","2021-10-07","2019-01-22","2021-11-21","2021-01-30","2019-04-15","2021-08-03","2021-09-30","2019-04-15","2019-03-18","2021-11-01","2021-11-29","2021-09-30","2019-04-15","2020-08-04","2021-05-20","2021-09-07","2021-05-10","2021-05-19","2019-04-11","2019-04-11","2019-04-12","2021-07-11","2021-06-29","2020-02-05","2021-09-07","2019-05-11","2021-07-11","2021-10-07","2021-08-03","2021-07-11","2021-10-07","2021-05-09","2021-05-10","2021-08-03","2019-05-12","2021-09-07","2021-09-07","2021-10-07","2021-10-07","2021-10-04","2019-05-12","2021-05-23","2019-05-12","2019-06-25","2019-08-07","2019-06-21","2021-10-04","2021-11-29","2019-09-25","2020-04-07","2019-10-09","2019-10-15","2019-10-15","2019-10-16","2019-10-15","2019-10-15","2019-10-15","2019-10-16","2019-11-18","2019-11-18","2021-01-13","2021-05-18","2021-07-11","2020-02-04","2021-09-28","2020-02-05","2020-02-05","2020-02-05","2021-08-03","2020-02-05","2020-02-05","2021-09-07","2020-02-05","2020-02-05","2021-08-04","2021-05-09","2020-02-05","2020-02-06","2020-06-16","2020-06-16","2020-04-07","2020-04-07","2021-11-29","2021-09-02","2021-04-11","2020-08-26","2020-08-26","2020-08-26","2021-01-13","2021-02-04","2021-02-22","2021-02-22","2021-02-22","2021-02-22","2021-02-22","2021-02-22","2021-02-22","2021-04-11","2021-07-11","2021-05-09","2021-05-09","2021-05-09","2021-05-09","2021-09-07","2021-05-25","2021-05-09","2021-05-10","2021-05-09","2021-05-09","2021-05-09","2021-05-10","2021-05-10","2021-05-13","2021-05-18","2021-05-11","2021-05-12","2021-05-12","2021-05-25","2021-05-10","2021-10-07","2021-05-10","2021-05-11","2021-05-25","2021-05-15","2021-10-07","2021-05-19","2021-05-18","2021-05-25","2021-08-03","2021-05-18","2021-05-18","2021-05-18","2021-08-03","2021-05-19","2021-05-25","2021-05-19","2021-07-08","2021-08-03","2021-06-14","2021-06-14","2021-07-08","2021-07-12","2021-07-11","2021-10-07","2021-07-11","2021-07-12","2021-07-12","2021-08-04","2021-09-07","2021-10-07","2021-09-07","2021-09-07","2021-09-07","2021-09-28","2021-09-28","2021-09-30","2021-09-30","2021-11-29","2021-09-09","2021-10-07","2021-10-07","2021-10-07","2021-10-07","2021-10-07","2021-10-07"],"priorHcc":["","","",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":[["","00088221905","LANTUS","100\/ML","60","Select","Select",""],["","00002821501","HUMULIN","U-100","20","Select","Select",""],["","31722094305","HYDROCO\/APAP","10-325MG","120","Select","Select",""],["","47781067190","LEVOTHYROXIN","300MCG","90","Select","Select",""],["","50228017705","GABAPENTIN","600MG","90","Select","Select",""],["","69547035302","NARCAN","","2","Select","Select",""],["","00193731221","CONTOUR","NEXT","100","Select","Select",""],["","00378214601","SPIRONOLACT","25MG","90","Select","Select",""],["","08290324909","INSULIN","0.3\/31G","100","Select","Select",""],["","43547035311","LISINOPRIL","10MG","30","Select","Select",""],["","29300012510","MELOXICAM","15MG","30","Select","Select",""],["","16729029917","TRAZODONE","50MG","30","Select","Select",""],["","60258017101","MAG","400MG","30","Select","Select",""],["","00054418625","DEXAMETHASON","6MG","4","Select","Select",""],["","00597007541","SPIRIVA","HANDIHLR","30","Select","Select",""],["","63868035203","QC","325MG","30","Select","Select",""],["","50228011505","FLUOXETINE","40MG","30","Select","Select",""],["","00006027731","JANUVIA","100MG","30","Select","Select",""],["","43547040011","CYCLOBENZAPR","10MG","90","Select","Select",""],["","70436001002","BUPROPN","150MG XL","30","Select","Select",""],["","00904759180","FEROSUL","325MG","30","Select","Select",""],["","69097012415","TOPIRAMATE","100MG","60","Select","Select",""],["","62175012837","ISOSORB","30MG ER","30","Select","Select",""],["","00173069600","ADVAIR","250\/50","60","Select","Select",""],["","55111018010","TIZANIDINE","4MG","30","Select","Select",""],["","00603188016","LIDOCAINE","5%","30","Select","Select",""],["","08290320119","BD PEN NEEDL","31GX5MM","100","Select","Select",""],["","49035019502","EQ","14MG\/24H","28","Select","Select",""],["","90166063132","PEN NEEDLES","31GX5MM","100","Select","Select",""],["","55111014512","FLUCONAZOLE","150MG","3","Select","Select",""],["","00169210125","NOVOLOG","FLEXPEN","15","Select","Select",""],["","67877041301","METFORMIN","500MG ER","120","Select","Select",""],["","00904759180","FERROUS","325MG","30","Select","Select",""],["","31722088530","ROSUVASTATIN","40MG","30","Select","Select",""],["","66993058597","FLUTIC\/SALME","250\/50","60","Select","Select",""],["","00169406013","VICTOZA","18MG\/3ML","9","Select","Select",""],["","00310621030","FARXIGA","10MG","30","Select","Select",""],["","31722071390","PANTOPRAZOLE","40MG","180","Select","Select",""],["","81131074933","IRON","325MG","90","Select","Select",""],["","75834020501","NATEGLINIDE","60MG","90","Select","Select",""],["","57896092101","ASPIRIN","325MG EC","90","Select","Select",""],["","43547040111","FUROSEMIDE","20MG","3","Select","Select",""],["","50111078751","AZITHROMYCIN","250MG","6","Select","Select",""],["","51672129803","KETOCONAZOLE","2%","30","Select","Select",""],["","45802013970","METRONIDAZOL","0.75%VAG","70","Select","Select",""],["","00088221905","LANTUS ","INJ 100\/ML","60","Select","Select",""],["","00002821501","HUMULIN ","INJ U-100","20","Select","Select",""],["","31722094305","HYDROCO\/APAP ","TAB 10-325MG","120","Select","Select",""],["","47781067190","LEVOTHYROXIN ","TAB 300MCG","90","Select","Select",""],["","50228017705","GABAPENTIN ","TAB 600MG","90","Select","Select",""],["","69547035302","NARCAN ","SPR ","2","Select","Select",""],["","00193731221","CONTOUR ","TES NEXT","100","Select","Select",""],["","00378214601","SPIRONOLACT ","TAB 25MG","90","Select","Select",""],["","08290324909","INSULIN ","MIS 0.3\/31G","100","Select","Select",""],["","43547035311","LISINOPRIL ","TAB 10MG","30","Select","Select",""],["","29300012510","MELOXICAM ","TAB 15MG","30","Select","Select",""],["","16729029917","TRAZODONE ","TAB 50MG","30","Select","Select",""],["","60258017101","MAG ","TAB 400MG","30","Select","Select",""],["","00054418625","DEXAMETHASON ","TAB 6MG","4","Select","Select",""],["","00597007541","SPIRIVA ","CAP HANDIHLR","30","Select","Select",""],["","63868035203","QC ","TAB 325MG","30","Select","Select",""],["","50228011505","FLUOXETINE ","CAP 40MG","30","Select","Select",""],["","00006027731","JANUVIA ","TAB 100MG","30","Select","Select",""],["","43547040011","CYCLOBENZAPR ","TAB 10MG","90","Select","Select",""],["","70436001002","BUPROPN ","TAB 150MG XL","30","Select","Select",""],["","00904759180","FEROSUL ","TAB 325MG","30","Select","Select",""],["","69097012415","TOPIRAMATE ","TAB 100MG","60","Select","Select",""],["","62175012837","ISOSORB ","TAB 30MG ER","30","Select","Select",""],["","00173069600","ADVAIR ","AER 250\/50","60","Select","Select",""],["","55111018010","TIZANIDINE ","TAB 4MG","30","Select","Select",""],["","00603188016","LIDOCAINE ","PAD 0.05","30","Select","Select",""],["","08290320119","BD  PEN NEEDL","MIS 31GX5MM","100","Select","Select",""],["","49035019502","EQ ","DIS 14MG\/24H","28","Select","Select",""],["","90166063132","PEN  NEEDLES  ","MIS 31GX5MM","100","Select","Select",""],["","55111014512","FLUCONAZOLE ","TAB 150MG","3","Select","Select",""],["","00169210125","NOVOLOG ","INJ FLEXPEN","15","Select","Select",""],["","67877041301","METFORMIN ","TAB 500MG ER","120","Select","Select",""],["","00904759180","FERROUS ","TAB 325MG","30","Select","Select",""],["","31722088530","ROSUVASTATIN ","TAB 40MG","30","Select","Select",""],["","66993058597","FLUTIC\/SALME ","AER 250\/50","60","Select","Select",""],["","00169406013","VICTOZA ","INJ 18MG\/3ML","9","Select","Select",""],["","00310621030","FARXIGA ","TAB 10MG","30","Select","Select",""],["","31722071390","PANTOPRAZOLE ","TAB 40MG","180","Select","Select",""],["","81131074933","IRON ","TAB 325MG","90","Select","Select",""],["","75834020501","NATEGLINIDE ","TAB 60MG","90","Select","Select",""],["","57896092101","ASPIRIN ","TAB 325MG EC","90","Select","Select",""],["","43547040111","FUROSEMIDE ","TAB 20MG","3","Select","Select",""],["","50111078751","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","51672129803","KETOCONAZOLE ","CRE 0.02","30","Select","Select",""],["","45802013970","METRONIDAZOL ","GEL 0.75%VAG","70","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":""}]}]}