{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JOYCE HAMMONDS","gend":1,"add":"5273 CLINCH RIVER HIGHWAY","city":"GATE CITY","state":"VA","zip":"24251-4660","dob":"1962-11-14","age":"","mstatus":"","insh":10059904,"cliId":"","pno":2764522498,"cno":2764522498,"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":"                                                            ","add3":"","madd1":"5273 CLINCH RIVER HIGHWAY","madd2":"                                                            ","madd3":"","mcity":"GATE CITY","mstate":"VA","mzip":"24251-4660","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M53.9","R60.9","L89.302","E11.65","F41.9","G89.4","H02.055","H10.45","L03.119","I89.1","L97.421","L97.511","Z86.31","Z89.421","Z89.422","Z89.412","M79.672","M79.671","E11.42","E11.3313","Z79.4","H04.122","H43.822","Z01.419","Z12.72","R30.0","Z87.448","Z90.710","K22.9","L02.619","M72.0","M20.41","L84","J01.90","Z20.828","Z11.52","E11.39","H17.11","R07.9","M54.5","M54.9","M79.89","R23.8","R60.0","K21.9","E11.9","J30.89","L97.521","M20.42","I82.402","S89.91XA","W19.XXXA","S79.911A","S39.93XA","F32.9","Z23","N81.10","E11.3299","M94.0","E11.41","M79.675","D64.9","M79.674","M20.21","J01.00","L97.411","M65.341","M25.641","M25.541","M65.9","M62.81","R06.02","I34.0","I51.7","E11.3311","E11.3392","H25.813","M25.561","G89.29","S29.9XXA","L97.522","Z12.31","R59.0","E04.1","Z79.899","L97.512","M89.372","H02.052","H01.001","H01.004","H20.00","R10.10","H11.112","R10.9","R91.8","R19.8","M79.604","M79.605","M54.16","S90.822A","R29.898","M19.072","M79.662","R10.13","K22.70","R14.0","M65.331","M20.61","M89.371","R07.81","Z78.0","Z13.820","M81.0","H61.23","M51.26","M51.9","R26.2","M47.816","R07.1","M17.11","E11.621","M25.571","S20.211A","N64.4","G72.9","K30","R12","R74.8","I73.9","M51.16","J30.9","S83.91XA","I51.89","I05.9","F32.2","Z74.09","R29.6","I10","J32.9","L97.523","M75.121","M19.011","M75.41","Z11.59","Z12.11","N95.1","K62.89","E11.3312","E11.3391","H00.015","K59.00","M65.311"],"date":["2021-02-01","2019-02-01","2019-02-01","2021-04-05","2020-04-02","2019-02-22","2021-04-21","2019-05-22","2019-06-13","2019-05-28","2019-12-18","2020-07-27","2021-02-04","2020-06-09","2021-02-04","2021-02-04","2020-02-18","2020-07-27","2021-04-05","2021-05-17","2021-05-20","2019-09-16","2019-12-16","2021-04-12","2020-02-10","2020-04-16","2020-02-10","2020-02-10","2020-03-10","2020-04-16","2020-04-16","2021-02-04","2020-12-01","2021-01-19","2021-01-19","2021-01-19","2021-04-21","2021-04-21","2021-05-20","2019-04-02","2019-02-07","2019-02-07","2019-02-07","2019-02-07","2019-10-01","2021-05-20","2021-01-14","2020-05-21","2021-02-04","2020-01-02","2019-07-13","2019-07-13","2019-07-13","2019-07-13","2020-05-21","2021-04-05","2019-10-01","2021-04-05","2019-10-01","2020-12-01","2020-01-16","2019-12-02","2020-01-16","2021-02-04","2020-02-28","2020-05-26","2021-01-20","2021-01-26","2021-01-26","2021-01-26","2021-01-26","2019-02-20","2019-01-17","2019-01-17","2019-04-03","2019-04-03","2020-03-20","2019-08-06","2019-07-13","2019-08-15","2019-08-15","2019-12-30","2020-01-16","2020-01-16","2021-04-05","2020-06-04","2020-06-17","2021-02-03","2021-02-03","2021-02-03","2021-02-11","2021-02-11","2021-04-29","2021-05-20","2021-05-20","2019-01-09","2019-07-15","2019-02-07","2019-04-02","2019-02-22","2019-07-15","2019-08-15","2019-08-15","2021-05-20","2020-03-10","2020-02-13","2020-06-11","2020-06-17","2020-06-17","2020-11-24","2020-10-07","2020-10-07","2020-10-07","2021-01-14","2019-02-25","2019-02-25","2019-02-25","2019-04-22","2019-06-13","2019-08-06","2020-06-15","2020-06-11","2020-11-24","2021-02-02","2021-04-05","2021-05-20","2021-05-20","2021-05-20","2019-02-20","2019-03-14","2019-05-16","2019-07-09","2019-01-17","2019-01-17","2019-04-04","2019-07-13","2019-07-13","2020-08-04","2020-04-02","2020-06-15","2020-06-15","2020-06-15","2020-06-15","2020-08-04","2020-08-04","2019-08-08","2019-08-08","2020-03-20","2019-10-07","2020-07-06","2020-10-05","2021-02-10"],"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":[["","65162010150","GABAPENTIN ","CAP 100MG","90","Select","Select",""],["","57599000101","FREESTYLE    KIT SENSOR","KIT SENSOR","1","Select","Select",""],["","00406853001","OXYCODONE ","TAB 30MG","120","Select","Select",""],["","00472016315","NYSTATIN ","CRE 100000","30","Select","Select",""],["","00573245042","NEXIUM ","CAP 20MG","126","Select","Select",""],["","68180098003","LISINOPRIL ","TAB 10MG","30","Select","Select",""],["","00054429731","FUROSEMIDE ","TAB 20MG","30","Select","Select",""],["","00088221905","LANTUS ","INJ 100\/ML","9","Select","Select",""],["","45802065087","LORATADINE ","TAB 10MG","30","Select","Select",""],["","65862067899","ALPRAZOLAM ","TAB 1MG","60","Select","Select",""],["","00799000103","CALMOSEPTINE ","OIN ","113","Select","Select",""],["","24208039915","IPRATROPIUM ","SPR 0.0006","15","Select","Select",""],["","00193731221","CONTOUR ","TES NEXT","100","Select","Select",""],["","11917017094","VITAMIN ","CAP 2000UNIT","30","Select","Select",""],["","65862019201","FLUOXETINE ","CAP 10MG","30","Select","Select",""],["","00574402435","ERYTHROMYCIN ","OIN 5MG\/GM","3.5","Select","Select",""],["","67877024201","QUETIAPINE ","TAB 25MG","60","Select","Select",""],["","57599000200","FREESTYLE    MIS READER","MIS READER","1","Select","Select",""],["","45802086803","POLYETH ","POW 3350 NF","510","Select","Select",""],["","65862086001","FAMOTIDINE ","TAB 40MG","60","Select","Select",""],["","60505082901","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","65862032904","ALENDRONATE ","TAB 70MG","4","Select","Select",""],["","65862001905","CEPHALEXIN ","CAP 500MG","20","Select","Select",""],["","31722072250","LEVOFLOXACIN ","TAB 500MG","10","Select","Select",""],["","11917005024","CALCIUM ","","60","Select","Select",""],["","69315030805","CIPROFLOXACN ","SOL 0.3% OP","5","Select","Select",""],["","00555089902","ESTRADIOL ","TAB 0.5MG","30","Select","Select",""],["","55111012205","ATORVASTATIN ","TAB 20MG","30","Select","Select",""],["","57237007710","ONDANSETRON ","TAB 4MG ODT","15","Select","Select",""],["","00143211250","DOXYCYCL ","TAB 100MG","20","Select","Select",""],["","57237000511","FLUCONAZOLE ","TAB 150MG","2","Select","Select",""],["","11917016081","EYE ","DRO 0.025%OP","5","Select","Select",""],["","61314063705","PREDNISOLONE ","SUS 1% OP","5","Select","Select",""],["","59762040101","SUCRALFATE ","TAB 1GM","120","Select","Select",""],["","65862017760","CEFDINIR ","CAP 300MG","20","Select","Select",""],["","00093101042","MUPIROCIN ","OIN 0.02","22","Select","Select",""],["","24208083060","NEO\/POLY\/DEX ","SUS 0.1% OP","5","Select","Select",""],["","60758088005","FLUOROMETHOL ","SUS 0.1% OP","5","Select","Select",""],["","00054350049","LIDOCAINE ","2% VISC","200","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":""}]}]}