{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LANA   K FRITZ","gend":1,"add":"3926 PURCHASE RIDGE ROAD","city":"DUFFIELD","state":"VA","zip":"24244-4060","dob":"1967-06-01","age":"","mstatus":"","insh":10058783,"cliId":"","pno":2767019704,"cno":2768706740,"email":"","ename":"","eno":"","pphy":"PARKER, DAVID G","ppno":2767837167,"pcpadd":"1020 Terrace Dr, Ste 100","pcpcity":"Marion","pcpstate":"VA","pcpzip":243544392,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"SOUTHWEST","aligned":"","ano":2768706740,"add2":"LOT 103","add3":"","madd1":"3926 PURCHASE RIDGE ROAD","madd2":"LOT 103","madd3":"","mcity":"DUFFIELD","mstate":"VA","mzip":"24244-4060","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I10","M51.26","M54.31","M50.13","K80.20","B95.62","J18.9","A41.02","R07.9","R10.9","K21.9","G47.9","F41.1","Z79.899","Z51.81","E87.6","M25.521","M25.522","M54.10","S40.211A","M43.02","R78.81","B96.89","R91.8","R10.11","D72.829","R06.02","R50.9","A41.9","R00.0","J96.91","I95.9","K80.80","Z01.818","Z20.828","M17.12","M25.562","S59.901A","S59.902A","M54.2","R53.81","K81.9","J15.212","F32.9","F41.9","G47.00","M54.5","E03.9","E78.5","Z45.2","Z79.2","R10.31","Z09","K81.1","J90","R10.84","H66.41","M25.461","E87.1","Z88.0","E78.00","I36.1","G47.01","M25.80","N17.9","G89.29","K80.70","Z86.14","Z79.891","Z79.1","M19.90","R05","R07.89","M25.561","M51.36","J30.9","M51.06","Z20.5","B99.8","M25.512"],"date":["2020-09-30","2021-05-10","2019-06-26","2021-04-09","2020-09-30","2020-05-18","2020-05-01","2020-05-12","2020-05-10","2020-10-21","2021-05-10","2020-10-21","2021-02-10","2020-09-30","2019-07-24","2020-05-05","2019-05-23","2019-05-23","2019-05-29","2019-09-17","2020-01-10","2020-05-18","2020-04-19","2020-04-19","2020-05-08","2020-04-19","2020-05-10","2020-05-09","2020-05-09","2020-05-09","2020-05-10","2020-05-10","2020-08-24","2020-09-26","2020-09-26","2019-03-06","2020-06-29","2019-05-01","2019-05-01","2020-04-02","2020-04-27","2020-04-18","2020-06-01","2020-06-01","2020-06-01","2020-06-01","2020-06-01","2020-06-01","2020-06-01","2020-06-01","2020-06-01","2020-04-27","2020-05-18","2020-09-30","2020-05-06","2020-05-06","2019-02-05","2019-02-05","2020-04-17","2020-05-05","2020-05-05","2020-04-21","2021-05-10","2021-01-12","2020-05-05","2020-05-05","2020-05-05","2020-05-05","2020-05-05","2020-05-05","2019-03-06","2020-04-27","2020-05-10","2020-06-29","2019-04-02","2019-04-02","2019-10-15","2019-12-13","2020-04-17","2020-11-18"],"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":[["","00904645760","DOK ","CAP 100MG","20","Select","Select",""],["","11822060597","RA ","LIE F 10 MG T","30","Select","Select",""],["","00406012305","HYDROCO\/APAP ","TAB 5-325MG","10","Select","Select",""],["","29300016915","TIZANIDINE ","TAB 4MG","90","Select","Select",""],["","60505083305","AZELASTINE ","SPR 0.001","30","Select","Select",""],["","68462012705","GABAPENTIN ","TAB 800MG","90","Select","Select",""],["","69097052444","DICLOFENAC ","GEL 0.01","100","Select","Select",""],["","60505006501","OMEPRAZOLE ","CAP 20MG","60","Select","Select",""],["","29300012410","MELOXICAM ","TAB 7.5MG","60","Select","Select",""],["","68180072103","AMLODIPINE ","TAB 10MG","30","Select","Select",""],["","70710122501","AMITRIPTYLIN ","TAB 10MG","30","Select","Select",""],["","00054327099","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","00113061246","ALLERGY ","TAB 10MG","30","Select","Select",""],["","43598081115","CETIRIZINE ","TAB 10MG","30","Select","Select",""],["","57237015630","MOXIFLOXACIN ","TAB 400MG","7","Select","Select",""],["","68462010530","ONDANSETRON ","TAB 4MG","20","Select","Select",""],["","00781808926","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","68462024805","RANITIDINE ","TAB 150MG","60","Select","Select",""],["","65862007701","CIPROFLOXACN ","TAB 500MG","20","Select","Select",""],["","65862001905","CEPHALEXIN ","CAP 500MG","20","Select","Select",""],["","13668000701","ZOLPIDEM ","TAB 5MG","30","Select","Select",""],["","65862057490","MONTELUKAST ","TAB 10MG","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","",""],["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":""}]}]}