{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JENNIFER   L PACK","gend":1,"add":"4560 COUNT PULASKI DRIVE","city":"PULASKI","state":"VA","zip":"24301-7611","dob":"1984-11-20","age":"","mstatus":"","insh":10056249,"cliId":"","pno":5405052749,"cno":5405536525,"email":"","ename":"","eno":"","pphy":"KAATZ, MATTHEW S","ppno":5409800550,"pcpadd":"101 1st St NW, ","pcpcity":"PULASKI","pcpstate":"VA","pcpzip":243015603,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":5405773605,"add2":"APT 406","add3":"","madd1":"4560 COUNT PULASKI DRIVE","madd2":"APT 406","madd3":"","mcity":"PULASKI","mstate":"VA","mzip":"24301-7611","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M26.602","H92.02","F31.9","F39","G25.81","J45.909","F17.200","B18.2","R11.2","R22.0","K21.9","F32.9","R30.0","L29.2","N13.30","R07.9","L08.9","R59.9","M54.9","T14.90XA","S44.92XA","M25.512","M79.602","V89.2XXA","Y92.410","M25.532","V49.9XXA","Y92.9","Z85.41","Z79.1","Z79.899","Z87.891","H10.31","H57.9","G43.909","M54.5","F31.4","S90.31XA","M79.671","W22.8XXA","R51","N91.2","R10.30","R51.9","W22.09XA","R10.9","J34.0","K12.0","K59.00","R20.0","R11.10","R10.13","R63.4","Z20.9","R07.81","F43.10","B19.20","Z87.448","M54.6","H00.011","H02.841","S63.502A","Z03.89","H00.026","H57.12","M62.838","R20.2","R55","J18.8","J18.9","R06.02","E87.6","C53.9","Z32.02","M62.830","S41.112A","N95.0","K29.00","R10.84","N93.9","D64.9","R78.81","N12","T78.40XA","X58.XXXA","M54.2","V69.50XA","M25.511","M25.531","G47.00","Z04.1","S39.012A","S40.012A","S60.212A","M75.82","M75.42","L03.211","N30.00","N89.8","B34.9","H69.82","H69.92","Z79.51","Z51.81","Z13.220","Z86.19","Z86.69","R10.2","N76.0","N39.0","R61","H10.9","H01.006","H01.009","N10","V49.50XA","L03.90","J34.89","Z48.00","J06.9","R05","Z72.0","J98.9","M79.18","S09.90XA","W19.XXXA","R19.7","I10","R11.0","H53.149","G44.209","Z20.828","B35.3","I87.8","S20.212A","J02.0","J02.9","D72.829","W18.2XXA","K05.10","K13.79","A69.1","Z11.59","Z91.5","A41.9","F41.9","E83.39","B96.20","R52","R50.9","M79.603","H00.019","H00.016","B00.2","H57.89","Z20.2","Z12.39","Z01.419","N63.10","N64.4","J30.9","N83.201","E73.9","S80.812A","M79.605","M79.604","W10.9XXA","Y93.01","S80.811A","V49.60XA","K58.9","G44.301","R10.12","W50.1XXA","R94.5","K76.0","K82.8","V48.6XXA","T36.95XA","R35.0","F31.30","R10.11","R10.33","K21.00"],"date":["2019-01-06","2020-01-27","2021-05-18","2019-04-22","2021-05-20","2021-05-20","2021-05-20","2020-02-11","2021-05-20","2019-02-03","2021-05-18","2020-10-25","2021-04-09","2019-02-13","2019-03-19","2020-02-25","2019-04-19","2020-06-09","2020-10-13","2019-07-04","2019-07-15","2019-07-24","2020-02-12","2019-07-24","2019-07-24","2019-08-01","2019-07-18","2020-02-21","2021-03-09","2019-07-18","2020-06-26","2021-03-09","2019-07-28","2020-11-15","2021-05-18","2021-04-09","2019-11-26","2020-03-17","2020-03-17","2020-03-17","2020-09-21","2020-11-17","2021-04-09","2021-05-18","2020-10-19","2021-05-18","2020-11-09","2020-12-04","2021-05-20","2020-12-01","2021-05-20","2021-05-22","2021-05-18","2021-05-18","2019-01-23","2020-12-01","2020-12-04","2019-03-23","2019-06-08","2019-07-29","2019-07-29","2019-08-30","2019-09-03","2019-11-20","2020-01-17","2020-05-08","2020-02-12","2020-02-21","2020-02-25","2020-02-26","2020-02-25","2020-02-25","2020-02-25","2020-02-25","2020-05-08","2020-10-26","2021-03-23","2019-01-15","2020-11-15","2020-12-28","2019-03-20","2019-03-20","2019-03-22","2019-05-30","2020-03-17","2021-04-06","2019-07-03","2019-07-03","2019-07-03","2020-09-12","2019-07-03","2019-10-12","2019-07-24","2019-07-24","2019-08-01","2019-08-01","2019-09-03","2019-10-12","2020-02-18","2020-01-27","2020-01-27","2020-01-27","2020-03-17","2021-04-19","2020-06-26","2020-06-26","2020-09-12","2021-02-18","2020-12-13","2020-12-13","2021-03-09","2021-05-11","2021-05-11","2021-05-11","2019-03-19","2019-07-03","2019-09-04","2019-09-04","2019-09-04","2019-11-02","2019-11-02","2020-06-25","2019-11-02","2019-11-02","2020-02-21","2020-02-21","2020-09-14","2020-09-14","2021-05-22","2020-10-11","2020-10-25","2020-10-25","2021-04-06","2021-05-18","2019-01-23","2019-04-22","2019-04-22","2020-12-28","2020-02-21","2020-07-08","2020-07-08","2020-07-08","2020-10-25","2020-10-26","2019-03-19","2019-03-19","2019-03-19","2019-03-19","2019-04-10","2019-04-10","2019-07-03","2019-11-20","2019-11-20","2020-07-09","2020-11-15","2020-12-04","2020-12-04","2020-12-04","2020-12-04","2020-12-04","2020-12-28","2020-12-28","2021-05-18","2019-04-19","2019-04-19","2019-04-19","2019-04-19","2019-04-19","2019-04-19","2019-07-04","2020-02-11","2020-02-21","2021-05-18","2019-01-23","2019-02-06","2019-02-06","2019-02-06","2019-07-15","2019-10-13","2020-10-13","2020-10-13","2021-04-16","2021-04-06","2021-05-18"],"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":[["","10702000310","PROMETHAZINE ","TAB 25MG","30","Select","Select",""],["","65162019050","NAPROXEN ","TAB 500MG","10","Select","Select",""],["","43547040010","CYCLOBENZAPR ","TAB 10MG","9","Select","Select",""],["","59310057922","PROAIR ","AER ","8.5","Select","Select",""],["","65862014636","SUMATRIPTAN ","TAB 25MG","9","Select","Select",""],["","00173068220","VENTOLIN ","AER ","18","Select","Select",""],["","71093011105","GABAPENTIN ","TAB 600MG","90","Select","Select",""],["","00378668910","PANTOPRAZOLE ","TAB 40MG","30","Select","Select",""],["","65862039010","ONDANSETRON ","TAB 4MG ODT","30","Select","Select",""],["","00093317431","ALBUTEROL ","FAT E","8.5","Select","Select",""],["","59746017310","PREDNISONE ","TAB 10MG","21","Select","Select",""],["","45802091987","CETIRIZINE ","TAB 10MG","30","Select","Select",""],["","00143122701","DICYCLOMINE ","TAB 20MG","60","Select","Select",""],["","00378427693","VALACYCLOVIR ","TAB 1GM","14","Select","Select",""],["","27241009990","DULOXETINE ","CAP 60MG","30","Select","Select",""],["","43598044674","NICOTINE ","DIS 7MG\/24HR","14","Select","Select",""],["","29300011610","TOPIRAMATE ","TAB 50MG","120","Select","Select",""],["","00085113204","PROVENTIL ","AER HFA","6.7","Select","Select",""],["","65862018601","CLINDAMYCIN ","CAP 300MG","30","Select","Select",""],["","50383077504","LIDOCAINE ","SOL 2% VISC","100","Select","Select",""],["","65862059501","DIVALPROEX ","TAB 500MG ER","30","Select","Select",""],["","64980032005","TRIAMCINOLON ","PST DEN 0.1%","5","Select","Select",""],["","13668021830","ARIPIPRAZOLE ","TAB 10MG","30","Select","Select",""],["","67877024901","QUETIAPINE ","TAB 50MG","30","Select","Select",""],["","65862064163","AZITHROMYCIN ","TAB 250MG","4","Select","Select",""],["","51293081001","PHENAZOPYRID ","TAB 100MG","20","Select","Select",""],["","00406012305","HYDROCO\/APAP ","TAB 5-325MG","15","Select","Select",""],["","65862060012","RIZATRIPTAN ","TAB 10MG","12","Select","Select",""],["","00093314705","CEPHALEXIN ","CAP 500MG","30","Select","Select",""],["","63824000832","MUCINEX ","TAB 600MG ER","20","Select","Select",""],["","00143992801","CIPROFLOXACN ","TAB 500MG","20","Select","Select",""],["","55111018015","TIZANIDINE ","TAB 4MG","30","Select","Select",""],["","55111068405","IBU ","TAB 800MG","90","Select","Select",""],["","11917002642","SALINE ","SPR 0.0065","44","Select","Select",""],["","68382031910","TRAMADOL ","TAB 50MG","10","Select","Select",""],["","33332032001","AFLURIA ","INJ 2020-21","0.5","Select","Select",""],["","45802011222","MUPIROCIN ","OIN 0.02","22","Select","Select",""],["","51991096257","POLYETH ","POW 3350 NF","510","Select","Select",""],["","70010075401","METHOCARBAM ","TAB 500MG","12","Select","Select",""],["","57237023305","SMZ-TMP ","TAB 800-160","10","Select","Select",""],["","10702025350","BUT\/APAP\/CAF ","TAB ","15","Select","Select",""],["","00135061502","FLONASE ","SUS 27.5MCG","5.9","Select","Select",""],["","00000000000",""," ","480","Select","Select",""],["","70069013101","TOBRAMYCIN ","SOL 0.3% OP","5","Select","Select",""],["","00574722612","COMPRO ","SUP 25MG","10","Select","Select",""],["","00245532630","KLOR-CON\/EF ","TAB 25MEQ FR","30","Select","Select",""],["","16714036004","MONO-LINYAH ","TAB 0.25-35","28","Select","Select",""],["","59746000106","METHYLPRED ","TAB 4MG","21","Select","Select",""],["","16571020150","DICLOFENAC ","TAB 75MG DR","30","Select","Select",""],["","00143980350","DOXYCYCL ","CAP 100MG","20","Select","Select",""],["","67618012012","SENOKOT ","TAB 17.2MG","40","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","20","Select","Select",""],["","00781708035","METRONIDAZOL ","GEL 0.01","60","Select","Select",""],["","31722072250","LEVOFLOXACIN ","TAB 500MG","10","Select","Select",""],["","67405060301","FLUCONAZOLE ","TAB 150MG","1","Select","Select",""],["","57237004105","PENICILLN ","TAB 500MG","40","Select","Select",""],["","00574402435","ERYTHROMYCIN ","OIN 5MG\/GM","3.5","Select","Select",""],["","49281042050","FLUZONE ","INJ 2020-21","0.5","Select","Select",""],["","69543038810","KETOROLAC ","TAB 10MG","15","Select","Select",""],["","45802005935","NYSTATIN ","CRE 100000","15","Select","Select",""],["","59676058015","JANSSEN ","INJ COVID-19","0.5","Select","Select",""],["","59746011506","PROCHLORPER ","TAB 10MG","15","Select","Select",""],["","00185012201","NITROFURANTN ","CAP 100MG","20","Select","Select",""],["","00074262528","MAVYRET ","TAB 100-40MG","84","Select","Select",""],["","00904640761","BISACODYL ","5MG EC","4","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","",""],["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":""}]}]}