{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MELISSA   J WORRELL","gend":1,"add":"3191 FOSTER FALL ROAD","city":"BARREN SPRINGS","state":"VA","zip":"24313-0242","dob":"1977-10-04","age":"","mstatus":"","insh":10058082,"cliId":"","pno":2767338106,"cno":2767338106,"email":"","ename":"","eno":"","pphy":"SIMPSON, MICHAEL R","ppno":7579552828,"pcpadd":"885 Kempsville Rd, Ste 320","pcpcity":"Norfolk","pcpstate":"VA","pcpzip":235023800,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"PO BOX 242","add3":"","madd1":"3191 FOSTER FALL ROAD","madd2":"PO BOX 242","madd3":"","mcity":"BARREN SPRINGS","mstate":"VA","mzip":"24313-0242","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11.40","G47.00","R53.82","E66.01","R07.89","M99.08","R30.0","R09.02","J44.9","E11.9","I10","E78.5","K21.9","D72.829","J44.1","R05","Z72.0","Z68.44","F41.9","F32.9","G43.909","K29.70","G47.33","K44.9","F17.200","Z79.4","R79.89","S93.401A","M54.2","M79.661","R16.1","R10.30","Z79.899","R60.1","B49","R10.9","J98.8","H60.90","M19.90","M54.9","M25.512","R74.8","D22.9","M79.673","R10.31","N10","R07.2","Z79.51","Z79.84","A41.9","R65.20","Z79.1","Z90.49","Z90.710","R06.03","R53.1","R11.0","R06.02","R09.81","L03.115","M62.838","R39.81","R60.9","F43.20","L03.90","G62.9","R26.81","R13.10","G47.30","R07.9","S93.401D","I11.0","I50.9","K58.9","C53.9","F41.1","R07.81","R00.2","J02.9","L03.311","Z71.6","M25.561","M79.604","R79.1","E87.70","K76.0","K59.00","K13.79","R21","R94.31","I51.7","R60.0","E11.65","J96.21","E66.2","E87.2","J06.9","B34.2","M25.571","B96.5","F17.290","R16.0","M17.11","I50.31","B37.0","L02.92","M25.579","E55.9","E53.8","M79.89","Z99.81","J96.11","E11.42","Z68.45","F17.210","Z85.41","Z80.49","M79.3","Z11.59","R63.4","R09.89","M35.1","Z91.19","Z79.52","R06.00","J45.901","E66.9","J20.9","J03.90","B96.89","E11.8","L53.9","Z99.89","E66.8","R41.82","T38.0X5A","Z79.891","R06.2","J96.90","R94.5","X50.1XXA","F39","R91.8","S93.409A","J45.909","B37.9"],"date":["2021-02-10","2021-04-26","2019-02-12","2021-04-26","2020-03-29","2019-03-25","2020-10-29","2020-12-02","2021-02-10","2021-04-26","2021-04-26","2020-11-02","2020-11-03","2020-03-01","2020-03-07","2020-03-03","2020-03-03","2021-02-10","2020-05-27","2020-11-02","2020-11-02","2020-06-27","2020-11-03","2020-06-27","2020-11-02","2020-06-27","2020-03-09","2020-03-09","2020-03-09","2020-03-09","2020-06-27","2020-06-27","2021-04-26","2021-04-26","2020-11-06","2021-02-10","2019-07-23","2019-02-14","2019-04-15","2019-10-07","2019-06-20","2020-07-24","2019-05-16","2019-10-07","2021-02-16","2019-08-28","2019-09-22","2020-06-27","2020-03-03","2020-03-08","2019-11-12","2020-03-03","2020-11-02","2019-11-25","2020-02-10","2020-02-10","2020-08-14","2020-12-14","2020-02-24","2020-11-02","2020-08-14","2021-04-26","2020-08-14","2019-01-03","2020-11-02","2020-11-02","2020-05-12","2020-04-13","2020-05-11","2021-04-26","2020-04-13","2020-11-02","2020-04-13","2020-04-13","2020-04-13","2020-11-02","2020-03-29","2020-04-13","2021-04-26","2020-06-27","2021-03-11","2020-08-14","2020-10-14","2020-10-14","2020-11-02","2020-11-02","2021-04-26","2021-04-01","2019-10-07","2019-12-19","2019-12-19","2020-10-29","2020-05-26","2020-03-08","2020-03-07","2020-03-08","2020-03-07","2020-03-07","2020-04-28","2020-03-07","2020-03-07","2020-07-24","2020-09-08","2020-11-02","2021-04-26","2021-04-26","2021-04-26","2021-04-26","2021-04-26","2020-04-28","2020-05-25","2020-05-25","2020-05-25","2021-04-26","2020-05-25","2020-05-25","2020-05-25","2020-05-27","2020-05-26","2020-11-02","2021-03-08","2019-12-17","2019-12-02","2019-12-02","2019-12-17","2020-03-01","2019-12-17","2020-03-03","2020-03-08","2020-05-21","2020-05-21","2020-05-21","2020-05-25","2020-10-29","2019-05-13","2019-11-25","2019-11-25","2019-12-14","2020-02-10","2020-03-09","2020-03-29","2019-03-25","2020-03-01","2020-04-16","2020-11-02","2021-04-26"],"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":[["","99073070822","FREESTYLE    TES LITE","TES LITE","50","Select","Select",""],["","00228203150","ALPRAZOLAM ","TAB 1MG","12","Select","Select",""],["","76204060030","IPRATROPIUM\/ ","SOL ALBUTER","90","Select","Select",""],["","08290320119","BD  PEN NEEDL","MIS 31GX5MM","100","Select","Select",""],["","00591544305","PREDNISONE ","TAB 20MG","10","Select","Select",""],["","65862053750","LEVOFLOXACIN ","TAB 500MG","7","Select","Select",""],["","31722072690","MONTELUKAST ","TAB 10MG","30","Select","Select",""],["","00555032302","HYDROXYZ ","CAP 25MG","60","Select","Select",""],["","51991077290","LANSOPRAZOLE ","CAP 30MG DR","30","Select","Select",""],["","00169280015","SAXENDA ","INJ 18MG\/3ML","15","Select","Select",""],["","57237007710","ONDANSETRON ","TAB 4MG ODT","42","Select","Select",""],["","68180098003","LISINOPRIL ","TAB 10MG","30","Select","Select",""],["","65862007701","CIPROFLOXACN ","TAB 500MG","14","Select","Select",""],["","00169633910","NOVOLOG ","INJ FLEXPEN","3","Select","Select",""],["","68462012605","GABAPENTIN ","TAB 600MG","112","Select","Select",""],["","00093770198","LEVOCETIRIZI ","TAB 5MG","30","Select","Select",""],["","00185013001","BUMETANIDE ","TAB 2MG","30","Select","Select",""],["","41167580003","NASACORT ","SPR 55MCG\/AC","10.8","Select","Select",""],["","00088221905","LANTUS ","INJ 100\/ML","3","Select","Select",""],["","65862056090","PANTOPRAZOLE ","TAB 40MG","30","Select","Select",""],["","00093226301","AMOXICILLIN ","TAB 500MG","14","Select","Select",""],["","66993066430","DULOXETINE ","CAP 60MG","30","Select","Select",""],["","11917016995","PROBIOTIC ","CAP ","30","Select","Select",""],["","43547040011","CYCLOBENZAPR ","TAB 10MG","60","Select","Select",""],["","62542030117","HYD ","SUS 10-8\/5ML","50","Select","Select",""],["","70377002811","ATORVASTATIN ","TAB 20MG","30","Select","Select",""],["","57599000200","FREESTYLE    MIS READER","MIS READER","1","Select","Select",""],["","10702000350","PROMETHAZINE ","TAB 25MG","20","Select","Select",""],["","57599000101","FREESTYLE    KIT SENSOR","KIT SENSOR","1","Select","Select",""],["","00904698640","MUCUS ","TAB 600MG ER","68","Select","Select",""],["","65862050220","AMOX\/K ","TAB 500-125","14","Select","Select",""],["","66993058597","FLUTIC\/SALME ","AER 250\/50","60","Select","Select",""],["","00904615760","VITAMIN ","TAB 2000UNIT","30","Select","Select",""],["","66689000816","NYSTATIN ","SUS 100000","20","Select","Select",""],["","64380080807","IBUPROFEN ","TAB 600MG","40","Select","Select",""],["","64380071206","BENZONATATE ","CAP 100MG","12","Select","Select",""],["","00054429731","FUROSEMIDE ","TAB 20MG","30","Select","Select",""],["","43598043611","NITROGLYCERN ","SUB 0.4MG","25","Select","Select",""],["","55111018015","TIZANIDINE ","TAB 4MG","90","Select","Select",""],["","16729013616","CLONAZEPAM ","TAB 0.5MG","45","Select","Select",""],["","31604002678","D3 ","CAP 2000UNIT","30","Select","Select",""],["","59762134401","PREGABALIN ","CAP 50MG","60","Select","Select",""],["","43598044874","NICOTINE ","DIS 21MG\/24H","28","Select","Select",""],["","74312027800","FISH ","CAP 1000MG","30","Select","Select",""],["","65162019050","NAPROXEN ","TAB 500MG","15","Select","Select",""],["","00406012305","HYDROCO\/APAP ","TAB 5-325MG","6","Select","Select",""],["","73070010315","INSULIN ","INJ FLEXPEN","3","Select","Select",""],["","68180030360","CEFUROXIME ","TAB 500MG","10","Select","Select",""],["","75826011510","PHENAZOPYRID ","TAB 200MG","6","Select","Select",""],["","00093314705","CEPHALEXIN ","CAP 500MG","21","Select","Select",""],["","99073070914","FREESTYLE    KIT FREEDOM","KIT FREEDOM","1","Select","Select",""],["","00904645760","DOK ","CAP 100MG","90","Select","Select",""],["","00597007541","SPIRIVA ","CAP HANDIHLR","30","Select","Select",""],["","00054350049","LIDOCAINE ","SOL 2% VISC","100","Select","Select",""],["","29300012810","HYDROCHLOROT ","TAB 25MG","30","Select","Select",""],["","00536113428","MICONAZOLE ","CRE 0.02","28","Select","Select",""],["","68180071160","CEFDINIR ","CAP 300MG","10","Select","Select",""],["","00406055201","OXYCODONE ","TAB 5MG","14","Select","Select",""],["","00193654621","BAYER ","MIS LANCETS","100","Select","Select",""],["","63824000832","MUCINEX ","TAB 600MG ER","10","Select","Select",""],["","58914017014","CARAFATE ","SUS 1GM\/10ML","1,200.00","Select","Select",""],["","69543025216","VIRTUSSIN ","SOL 100-10\/5","40","Select","Select",""],["","60505265401","TRAZODONE ","TAB 100MG","30","Select","Select",""],["","65862018601","CLINDAMYCIN ","CAP 300MG","30","Select","Select",""],["","53489011905","DOXYCYCL ","CAP 100MG","10","Select","Select",""],["","00135014502","NICODERM ","DIS 21MG\/24H","28","Select","Select",""],["","00378827052","ALBUTEROL ","NEB 0.00083","375","Select","Select",""],["","00186037220","SYMBICORT ","AER 80-4.5","10.2","Select","Select",""],["","99073070805","FREESTYLE    MIS LITE","MIS LITE","1","Select","Select",""],["","99073013001","FREESTYLE    MIS LANCETS","MIS LANCETS","100","Select","Select",""],["","62037099901","POT  CL MICRO","TAB 20MEQ ER","14","Select","Select",""],["","00378161001","DICYCLOMINE ","CAP 10MG","120","Select","Select",""],["","68382075810","METFORMIN ","TAB 500MG","20","Select","Select",""],["","68462035701","POT  CHLORIDE","CAP 10MEQ ER","30","Select","Select",""],["","00169643810","LEVEMIR ","INJ FLEXTOUC","24","Select","Select",""],["","68180016106","AZITHROMYCIN ","TAB 500MG","5","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","14","Select","Select",""],["","00603020922","MAG ","TAB 400MG","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","",""],["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":""}]}]}