{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KAREN   Y BLEVINS","gend":1,"add":"11037 HIGHLANDS PARKWAY","city":"MOUTH OF WILSON","state":"VA","zip":"24363-3530","dob":"1966-11-29","age":"","mstatus":"","insh":10059332,"cliId":"","pno":2763883626,"cno":2763883626,"email":"","ename":"","eno":"","pphy":"TRIPLETT, LARAMIE C","ppno":2766761133,"pcpadd":"613 Campus Dr Ste 200, ","pcpcity":"Abingdon","pcpstate":"VA","pcpzip":242109703,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"SOUTHWEST","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"11037 HIGHLANDS PARKWAY","madd2":"                                                            ","madd3":"","mcity":"MOUTH OF WILSON","mstate":"VA","mzip":"24363-3530","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R00.0","Z51.11","C50.911","C40.02","C79.31","C79.51","C77.0","D63.0","D64.9","D70.1","D70.2","G62.0","J06.9","J34.89","I10","N89.8","C50.919","C71.9","K21.9","Z08","R13.10","R13.13","K22.2","Z01.89","N39.0","R68.89","R39.9","Z85.3","Z92.21","R30.0","Z76.89","G89.3","Z51.12","H53.8","M25.50","R22.1","E83.52","M81.0","Z45.2","Z90.13","Z90.49","M54.9","L30.9","J01.90","E86.0","R11.0","Z51.81","Z78.0","R23.8","G47.9","R73.09","I51.9","R01.1","E78.00","B96.89","E87.6","C79.9","R59.9","Z87.440","Z17.1","B37.3","Z71.89","R51","R00.2","R53.83","B15.9","H60.313","I05.8","N30.00","L27.0","R10.13","C78.7","M48.54XA","R64","Z68.1","M79.7","Z88.1","E78.5","M41.9","C79.49","Z12.4","I11.9","H61.21","M54.5","Z53.9","K44.9","Z79.899","N93.9","R41.3","R20.0","R20.2","D49.2","H53.2","C79.52","R10.9","Z16.24","K92.1","E11.9","M06.9","K57.30","R53.81","Z17.0","M79.602","M25.512","M19.012","M87.021","Z95.828","R50.81","G31.9","D70.9","R59.0","M48.56XA","R10.813","R10.2","Z87.448","M87.022","R93.7","R79.89","D89.9","Z80.3","M79.603"],"date":["2020-09-29","2021-05-11","2021-05-12","2020-09-29","2021-05-04","2021-05-12","2021-04-13","2020-09-08","2021-02-17","2020-09-08","2020-09-08","2020-09-08","2019-06-18","2020-09-29","2020-09-12","2021-03-01","2021-01-27","2020-07-23","2020-11-20","2019-04-25","2020-01-20","2020-07-23","2019-11-01","2020-07-27","2021-05-03","2021-02-17","2020-11-17","2020-09-12","2021-05-17","2021-02-11","2020-12-11","2021-05-04","2021-05-04","2019-11-01","2019-08-27","2019-08-27","2020-07-23","2019-11-01","2019-08-22","2020-09-12","2019-08-22","2020-09-29","2020-09-29","2020-09-29","2020-09-29","2020-09-29","2020-01-28","2020-03-04","2020-07-23","2020-07-23","2020-07-23","2020-07-23","2020-07-23","2020-07-23","2020-09-15","2020-09-15","2021-01-27","2020-09-29","2020-11-10","2020-12-08","2021-04-13","2021-05-04","2019-11-12","2019-03-20","2020-07-28","2020-09-12","2019-09-19","2019-10-09","2020-11-20","2019-11-01","2019-11-01","2020-09-12","2020-09-12","2020-09-12","2020-09-12","2020-11-20","2020-09-12","2020-09-12","2020-09-12","2020-10-14","2021-02-11","2019-06-17","2019-06-27","2020-05-05","2019-08-29","2019-11-01","2021-01-27","2019-11-12","2020-01-22","2020-01-22","2020-01-22","2020-02-25","2020-03-04","2020-10-14","2020-11-20","2020-11-20","2021-05-25","2019-08-29","2019-08-29","2020-07-30","2020-09-11","2020-11-10","2021-01-28","2021-01-27","2021-01-27","2021-01-27","2021-05-04","2019-03-05","2019-07-10","2020-01-30","2019-09-27","2020-04-03","2020-09-22","2020-09-22","2020-11-05","2021-01-28","2021-01-28","2020-01-30","2020-09-15","2020-10-20","2021-01-27"],"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":[["","53746011001","HYDROCO\/APAP ","TAB 10-325MG","50","Select","Select",""],["","00904773445","MICONAZOLE ","CRE 0.02","45","Select","Select",""],["","51672302002","LIDOCAINE ","OIN 0.05","30","Select","Select",""],["","65862017760","CEFDINIR ","CAP 300MG","20","Select","Select",""],["","68682045570","METRONIDAZOL ","GEL 0.75%VAG","70","Select","Select",""],["","51672130406","TERCONAZOLE ","CRE 0.004","45","Select","Select",""],["","43386033001","TRIMETHOPRIM ","TAB 100MG","14","Select","Select",""],["","24208063562","NEO\/POLY\/HC ","SUS 1% OTIC","10","Select","Select",""],["","37205027810","ANTI-ITCH ","CRE 2-0.1%","28","Select","Select",""],["","70700026894","FOSFOMYCIN ","POW 3GM","1","Select","Select",""],["","00781577626","AZITHROMYCIN ","TAB 250MG","6","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":""}]}]}