{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"NANCY   A HALL","gend":1,"add":"260 SHEEP DRIVE","city":"NICKELSVILLE","state":"VA","zip":"24271-3415","dob":"1952-06-11","age":"","mstatus":"","insh":10059500,"cliId":"","pno":2763867724,"cno":2763867724,"email":"","ename":"","eno":"","pphy":"CASSEL, TODD A","ppno":2764672201,"pcpadd":"17285 Veterans Memorial Hwy, ","pcpcity":"Dungannon","pcpstate":"VA","pcpzip":242453937,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"SOUTHWEST","aligned":"","ano":"","add2":"APT 212","add3":"","madd1":"260 SHEEP DRIVE","madd2":"APT 212","madd3":"","mcity":"NICKELSVILLE","mstate":"VA","mzip":"24271-3415","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J44.1","E87.1","Z99.81","R07.89","R41.82","R68.89","J44.9","R06.02","R91.8","J96.92","R53.81","I95.9","R05","R19.7","R09.81","J45.998","I10","E03.9","F17.210","J96.11","J96.12","J84.10","L89.892","I11.0","I50.9","D75.1","I95.1","R07.9","J96.21","J96.22","R63.6","K21.9","F41.9","R51","Z48.00","N39.0","Z20.828","J18.1","F25.9","F41.8","E78.5","E55.9","G47.00","K58.9","N31.9","M85.80","J96.01","J44.0","J18.9","R30.0","Z03.818","E78.2","L72.0","R19.5","Z91.89","R73.9","R42","Z79.899","R13.10","J96.00","J96.91","I11.9","Z09","M15.9","A41.9","E83.42","F03.90","F20.9","H54.7","J43.9","Z79.51","J06.9","Z72.0","M54.5","K59.00","G45.9","E22.2","I50.32","E46","G47.30","H91.90","J32.9","D72.829","Z74.1","R26.9","J96.90","R06.2","J42","R94.31","R65.20","K52.9","R53.1","K52.89","R33.9","R94.6","R79.89","M19.90","Z87.01","R09.02","R78.81","N17.9","E86.0","R07.81","H66.90","K59.04","R04.0","Z11.59","E16.2","R07.2","R11.0","R00.1","Z90.5","I51.7","Z78.0","F25.0","R41.3","I69.354","K44.9","R13.14","T38.0X5A","F32.9","R41.0","J01.40","G89.29","Z86.73","R06.03","R25.2","L21.9","Z87.442","N32.81","N32.89","M62.81","R35.0","J15.9","R65.10","Z80.49","Z82.49","Z83.3","Z60.2","Z71.6","Z68.1","Z12.11","Z12.39","R11.11","T45.0X1A","Z87.11","Z90.710","Z98.51","R31.9","I50.30","E87.6","M12.9","M81.0","Z91.14","Z13.1","H65.03","Z12.31","K22.2","R22.1","M25.511","M25.512","R64","I27.20","J01.00","J80","Z80.0","Z23","R53.83","I95.89","N17.8","T46.5X5D","D63.8","J98.11","G93.40","M54.9","R06.00","J84.9","R10.32","R07.1","Y95","Z99.11","R21","B37.0","R47.1","I20.0","H65.192","B37.3","T36.95XA","Z87.891","H65.02","R68.84","G47.9","I25.10","D64.9","Z20.822","T46.5X5A","R00.0"],"date":["2021-03-24","2020-09-01","2021-04-16","2021-01-18","2019-04-29","2020-04-03","2021-04-22","2021-01-26","2021-01-17","2019-09-11","2021-01-31","2021-02-08","2020-01-02","2019-10-16","2020-01-02","2019-12-04","2021-03-24","2021-04-16","2020-08-21","2021-04-16","2020-09-16","2020-05-18","2020-03-28","2021-04-16","2021-01-16","2020-03-28","2021-01-26","2021-01-18","2021-04-01","2020-09-09","2020-03-03","2020-09-09","2020-09-14","2020-03-11","2020-03-28","2020-09-16","2020-11-11","2020-08-21","2021-04-16","2020-09-16","2021-04-16","2021-04-16","2020-09-16","2020-09-16","2021-04-16","2020-09-16","2020-09-06","2020-11-16","2020-11-16","2020-11-16","2020-12-29","2021-03-24","2020-12-29","2020-12-29","2020-12-29","2020-12-29","2021-01-26","2021-03-24","2020-05-18","2019-04-09","2019-06-17","2019-08-09","2021-02-08","2019-08-26","2019-10-12","2019-08-31","2021-01-26","2021-01-18","2020-09-01","2021-01-26","2019-08-31","2020-11-11","2020-01-02","2020-05-18","2019-12-08","2019-04-18","2019-04-18","2021-04-16","2020-09-01","2019-07-26","2020-05-18","2021-01-26","2020-03-24","2019-04-25","2019-04-30","2019-04-30","2020-09-01","2019-07-29","2019-09-06","2019-10-12","2019-10-12","2020-09-09","2019-10-16","2020-01-19","2020-04-03","2020-04-03","2020-05-18","2021-01-16","2020-10-14","2021-01-27","2021-02-08","2021-03-16","2020-02-28","2020-02-28","2020-02-28","2020-08-03","2020-08-03","2020-08-21","2021-01-17","2021-01-17","2021-01-18","2021-01-18","2021-01-19","2019-04-01","2019-07-19","2019-07-19","2019-04-09","2019-04-09","2020-08-19","2020-03-11","2021-01-17","2019-04-22","2019-06-11","2019-07-12","2021-01-26","2020-09-09","2019-12-08","2019-12-08","2021-01-26","2019-12-16","2019-12-16","2020-01-03","2020-01-13","2020-03-02","2020-03-02","2020-03-02","2020-03-02","2020-03-02","2021-01-16","2019-05-28","2019-07-21","2020-12-16","2019-09-30","2019-09-30","2019-10-08","2019-10-10","2019-10-10","2019-10-10","2020-01-13","2020-03-11","2020-03-11","2020-03-11","2020-03-24","2020-03-24","2020-06-09","2020-06-09","2020-06-09","2020-08-03","2020-08-03","2020-08-03","2020-08-03","2020-09-01","2020-09-01","2020-09-01","2020-09-01","2020-12-16","2020-12-16","2021-01-17","2021-03-16","2021-03-16","2021-03-16","2021-04-16","2019-04-21","2019-04-23","2019-07-21","2020-09-01","2019-09-06","2019-12-08","2020-01-02","2020-09-22","2021-04-16","2021-05-18","2019-04-21","2019-04-21","2019-04-22","2019-05-13","2019-07-19","2019-10-08","2020-09-09","2021-03-15","2019-11-27","2019-11-27","2021-01-26","2021-01-26","2021-01-26","2021-01-26","2021-02-08"],"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":[["","00536589688","NICOTINE ","DIS 21MG\/24H","28","Select","Select",""],["","00591544210","PREDNISONE ","TAB 10MG","5","Select","Select",""],["","49884072703","DOXYCYC ","CAP 100MG","9","Select","Select",""],["","16729013616","CLONAZEPAM ","TAB 0.5MG","30","Select","Select",""],["","00054350049","LIDOCAINE ","SOL 2% VISC","100","Select","Select",""],["","69238183107","LEVOTHYROXIN ","TAB 50MCG","30","Select","Select",""],["","10006070166","MELATONIN ","TAB 5MG","30","Select","Select",""],["","31722072320","LEVOFLOXACIN ","TAB 750MG","1","Select","Select",""],["","43547034150","RISPERIDONE ","TAB 1MG","30","Select","Select",""],["","68180072003","AMLODIPINE ","TAB 5MG","30","Select","Select",""],["","60432053716","NYSTATIN ","SUS 100000","280","Select","Select",""],["","00781730431","RIVASTIGMINE ","DIS 4.6MG\/24","30","Select","Select",""],["","00597003134","CATAPRES-TTS ","DIS 0.1\/24HR","4","Select","Select",""],["","76204020060","ALBUTEROL ","NEB 0.00083","360","Select","Select",""],["","65862032904","ALENDRONATE ","TAB 70MG","4","Select","Select",""],["","31722072690","MONTELUKAST ","TAB 10MG","30","Select","Select",""],["","29300017216","MEMANTINE ","TAB HCL 10MG","60","Select","Select",""],["","31722071390","PANTOPRAZOLE ","TAB 40MG","30","Select","Select",""],["","00378623301","CITALOPRAM ","TAB 40MG","30","Select","Select",""],["","69097084905","ESCITALOPRAM ","TAB 20MG","30","Select","Select",""],["","00186037020","SYMBICORT ","AER 160-4.5","10.2","Select","Select",""],["","29300012510","MELOXICAM ","TAB 15MG","30","Select","Select",""],["","65862001705","AMOXICILLIN ","CAP 500MG","21","Select","Select",""],["","66685100100","AMOX\/K ","TAB 875-125","20","Select","Select",""],["","00781577626","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","11917011819","D3 ","CAP 2000UNIT","30","Select","Select",""],["","00054429731","FUROSEMIDE ","TAB 20MG","30","Select","Select",""],["","68382050010","OMEPRAZOLE ","CAP 40MG","30","Select","Select",""],["","65862006299","METOPROL ","TAB 25MG","32","Select","Select",""],["","60505083001","MOMETASONE ","SPR 50MCG","17","Select","Select",""],["","00093314705","CEPHALEXIN ","CAP 500MG","20","Select","Select",""],["","00536430611","FIBER-LAX ","TAB 625MG","60","Select","Select",""],["","68180098003","LISINOPRIL ","TAB 10MG","30","Select","Select",""],["","58487003711","VITAMIN ","TAB 2000UNIT","30","Select","Select",""],["","00363049860","MUCUS ","TAB 600MG ER","20","Select","Select",""],["","00597007541","SPIRIVA ","CAP HANDIHLR","30","Select","Select",""],["","57896098110","ASPIRIN ","TAB 81MG EC","30","Select","Select",""],["","50383002510","OFLOXACIN ","DRO 0.3%OTIC","10","Select","Select",""],["","59310057922","PROAIR ","AER ","8.5","Select","Select",""],["","87701040770","CALCIUM\/D3 ","TAB ","60","Select","Select",""],["","00223176001","SOD ","TAB 1GM","30","Select","Select",""],["","47469000928","OMEGA-3 ","CAP 1000MG","30","Select","Select",""],["","00225052547","AYR ","GEL NASAL","14.1","Select","Select",""],["","35046000334","OMEGA ","CAP EPA+DHA","30","Select","Select",""],["","00536105907","PROBIOTIC ","CAP FORMULA","30","Select","Select",""],["","57237000430","FLUCONAZOLE ","TAB 100MG","5","Select","Select",""],["","00143980305","DOXYCYCL ","CAP 100MG","20","Select","Select",""],["","16714087603","ATORVASTATIN ","TAB 40MG","30","Select","Select",""],["","00065853302","CIPRODEX ","SUS 0.3-0.1%","7.5","Select","Select",""],["","00005550924","CALTRATE ","TAB 600-800","60","Select","Select",""],["","59746000103","METHYLPRED ","TAB 4MG","21","Select","Select",""],["","04142000024","FLORASTOR ","CAP 250MG","20","Select","Select",""],["","00093321930","KETOCONAZOLE ","CRE 0.02","30","Select","Select",""],["","00781320885","CEFTRIAXONE ","INJ 1GM","7","Select","Select",""],["","68180071160","CEFDINIR ","CAP 300MG","14","Select","Select",""],["","63824000834","MUCINEX ","TAB 600MG ER","40","Select","Select",""],["","00054418625","DEXAMETHASON ","TAB 6MG","4","Select","Select",""],["","45802086802","POLYETH ","POW 3350 NF","238","Select","Select",""],["","50111033402","METRONIDAZOL ","TAB 500MG","18","Select","Select",""],["","47469016108","ACIDOPHILUS ","CAP 100MG","12","Select","Select",""],["","51293081001","PHENAZOPYRID ","TAB 100MG","6","Select","Select",""],["","00781618667","CIPRO\/DEXA ","SUS 0.3-0.1%","7.5","Select","Select",""],["","70010075401","METHOCARBAM ","TAB 500MG","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":""}]}]}