{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BEATRICE   R ISON","gend":1,"add":"202 HAYES AVENUE","city":"RICHLANDS","state":"VA","zip":"24641-3123","dob":"1965-06-07","age":"","mstatus":"","insh":10060696,"cliId":"","pno":2762103379,"cno":2762103379,"email":"","ename":"","eno":"","pphy":"CHAUDHRY, FAISAL W","ppno":2768736300,"pcpadd":"5705 Redbud Hwy, ","pcpcity":"Honaker","pcpstate":"VA","pcpzip":24260,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"SOUTHWEST","aligned":"","ano":"","add2":"APT 30","add3":"","madd1":"202 HAYES AVENUE","madd2":"APT 30","madd3":"","mcity":"RICHLANDS","mstate":"VA","mzip":"24641-3123","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F11.20","H16.223","J44.9","R09.02","I27.0","E11.9","L03.116","L97.522","E11.42","R23.4","L84","M65.871","M79.671","M79.672","R20.9","S92.301A","L29.9","F41.1","F29","D51.8","R20.3","L85.3","D48.5","K75.9","K12.2","M13.0","K76.9","J20.8","R06.00","I10","J18.9","T50.901A","J96.21","A41.9","R78.81","R68.89","J18.1","B37.0","L29.8","R05","R91.1","Z85.118","J90","G57.83","H25.813","H35.371","H53.453","J32.9","J20.9","F31.9","L97.511","I20.9","I25.10","L03.031","S92.324D","M19.072","I82.402","G56.03","M54.12","R20.8","D51.9","H10.223","L81.7","K56.41","J41.1","F17.209","J96.00","F15.10","R91.8","J44.0","J44.1","E11.621","M51.37","F41.9","L97.412","L97.512","F17.210","J30.9","J30.89","J30.1","Z01.82","F34.1","E11.65","E08.43","R07.9","I25.110","E78.2","I11.0","I50.31","K76.0","Z20.828","Z79.82","Z79.899","Z82.49","I50.9","F31.61","M79.674","R44.1","R44.0","L97.513","Z20.822","J02.9","Z03.89","M54.5","K59.03","R63.4","R19.5","B18.2","K74.0","L98.9","S00.85XA","J45.909","I27.20","E07.9","K72.90","Z79.1","Z79.890","L30.9","R42","D12.3","D12.8","H10.13","K21.9","K14.0","K08.89","H16.143","H01.021","H01.024","C34.90","F17.208","E78.49","R73.02","I11.9","M62.81","T15.01XA","L20.9","K64.0","E78.5","K14.8","F31.62","F20.89","B17.10","K76.89","I45.81","R94.31","R73.9","J06.9","Z79.4","H10.45","H01.111","H02.882","H02.885","J98.4","J34.2","M95.0","H01.8","F17.200","I95.9","H40.9","G47.30","L02.612","R10.9","K51.50","L98.1","E04.9","I24.9","J01.90","R06.02","F91.9","F22","L97.519","N39.0","F32.9","L20.89","J96.01","E87.0","R41.82","M51.9","M54.9","G89.29","E87.6","M51.17","B37.9","L03.115","I87.2","L23.9","G60.9","H01.115","R09.89","F28","F48.9","R01.1","R21","Z99.89","R11.2","R19.7","F41.8","Z85.850","R14.0","M19.071","B35.1","S39.012A","M79.5","X50.9XXA","Y93.E9","Y92.009","Y99.9","S50.312A","I51.7","W22.8XXA","Z71.6","F17.219","Z79.84","H25.13","M79.7","G57.93","T17.1XXA","T17.298A","N32.89","R10.10","R68.2","K13.79","M54.16","R26.0","F41.0","H16.011","M15.0","R16.0","R10.11","I49.8","R00.2","Z71.51","I20.0","G47.33","F34.9","T75.89XA","F23","M14.671"],"date":["2021-05-21","2020-06-25","2021-04-30","2021-03-27","2021-03-27","2021-03-27","2020-01-06","2020-11-03","2021-03-30","2019-03-26","2020-11-03","2019-03-26","2021-03-30","2020-11-03","2020-11-03","2019-03-04","2019-11-04","2021-01-28","2021-04-30","2019-07-09","2019-07-09","2021-04-06","2019-08-23","2019-09-03","2021-02-18","2019-09-10","2020-03-01","2020-03-23","2021-04-06","2021-03-26","2020-02-25","2020-02-12","2020-02-19","2020-03-01","2020-02-19","2021-03-05","2020-03-04","2021-03-01","2020-03-04","2021-03-07","2021-02-10","2021-03-20","2020-03-05","2020-05-11","2020-06-25","2020-06-25","2020-06-25","2021-02-02","2020-09-08","2021-03-09","2020-11-03","2020-11-30","2020-11-30","2021-01-26","2019-03-04","2019-03-18","2019-03-19","2019-03-27","2019-03-27","2019-03-27","2019-04-25","2019-05-07","2019-09-11","2019-10-31","2021-02-10","2021-02-10","2020-02-12","2020-02-12","2020-02-18","2020-03-01","2021-03-07","2021-03-22","2020-11-30","2021-05-21","2021-03-30","2021-03-30","2021-03-26","2021-02-19","2021-04-02","2021-02-19","2021-03-29","2020-07-22","2021-03-22","2020-09-28","2020-12-01","2020-11-30","2020-11-30","2021-03-20","2020-11-30","2020-11-30","2021-02-18","2020-11-30","2020-11-30","2020-11-30","2021-03-20","2021-04-30","2021-01-26","2021-03-22","2021-03-22","2021-03-22","2021-03-07","2021-03-09","2019-02-20","2019-02-20","2019-06-14","2019-06-14","2019-06-14","2019-04-09","2019-04-09","2019-04-13","2019-04-13","2019-04-13","2021-03-07","2021-03-07","2019-08-17","2019-04-13","2019-04-13","2021-03-31","2019-06-12","2019-06-14","2019-06-14","2019-07-16","2020-08-31","2019-08-26","2019-08-22","2019-09-06","2019-08-26","2019-08-26","2019-01-03","2019-01-03","2019-01-03","2019-01-03","2019-01-25","2019-03-26","2019-04-23","2019-05-06","2019-06-14","2019-06-14","2019-08-22","2019-10-04","2019-08-19","2019-08-27","2019-08-26","2020-11-30","2020-02-12","2020-09-03","2020-09-21","2021-03-05","2021-01-27","2021-01-27","2021-03-12","2021-03-12","2021-02-09","2021-02-09","2021-02-09","2021-02-26","2021-03-01","2021-03-01","2021-03-01","2021-03-20","2021-03-23","2019-03-19","2019-03-19","2019-05-22","2019-08-27","2020-11-24","2021-02-05","2021-03-20","2021-03-07","2021-03-07","2021-03-22","2021-03-07","2021-03-07","2021-04-02","2020-02-12","2020-02-12","2020-02-12","2020-02-12","2020-02-12","2020-02-12","2020-02-12","2020-02-25","2020-06-10","2021-03-05","2021-03-22","2021-03-31","2019-04-18","2019-05-22","2019-08-17","2021-03-20","2019-08-22","2020-08-13","2021-03-05","2021-03-20","2021-03-20","2021-03-20","2021-03-20","2021-03-20","2021-03-20","2019-02-14","2019-02-14","2019-02-20","2019-02-20","2019-02-20","2019-02-20","2019-02-20","2019-02-20","2019-02-20","2019-02-20","2019-02-20","2019-03-12","2019-03-12","2019-03-14","2019-03-14","2019-04-03","2019-04-03","2019-08-17","2019-08-17","2019-09-16","2019-10-24","2021-02-02","2021-02-02","2019-03-26","2019-03-26","2019-05-20","2019-05-28","2019-09-03","2019-09-03","2019-10-31","2020-07-25","2020-07-25","2020-11-23","2020-11-30","2021-01-25","2021-01-25","2021-02-18","2021-03-20","2021-03-22"],"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":[["","00000000000",""," ","300","Select","Select",""],["","31722072250","LEVOFLOXACIN ","TAB 500MG","10","Select","Select",""],["","50383077504","LIDOCAINE ","SOL 2% VISC","100","Select","Select",""],["","00310009530","DALIRESP ","TAB 500MCG","30","Select","Select",""],["","00904598463","AMMONIUM ","LOT 0.12","396","Select","Select",""],["","68462024805","RANITIDINE ","TAB 150MG","60","Select","Select",""],["","00169750111","NOVOLOG ","INJ 100\/ML","10","Select","Select",""],["","59310057922","PROAIR ","AER ","8.5","Select","Select",""],["","67877019810","AMLODIPINE ","TAB 5MG","60","Select","Select",""],["","16714089802","LORATADINE ","TAB 10MG","90","Select","Select",""],["","99073070822","FREESTYLE    TES LITE","TES LITE","50","Select","Select",""],["","00904632951","LUBRICNT ","DRO 0.5% OP","60","Select","Select",""],["","00536117810","MECLIZINE ","TAB 12.5MG","60","Select","Select",""],["","00093738605","VENLAFAXINE ","CAP 150MG ER","21","Select","Select",""],["","50379000315","DRIPDROP ","POW HYDRATN","12","Select","Select",""],["","00228280111","PILOCARPINE ","TAB 5MG","90","Select","Select",""],["","12496120803","SUBOXONE ","MIS 8-2MG","28","Select","Select",""],["","00173068220","VENTOLIN ","AER ","18","Select","Select",""],["","08290328468","INSULIN ","MIS 0.5\/31G","100","Select","Select",""],["","16714068403","SIMVASTATIN ","TAB 40MG","30","Select","Select",""],["","43547040211","FUROSEMIDE ","TAB 40MG","30","Select","Select",""],["","16729000101","GLIMEPIRIDE ","TAB 1MG","30","Select","Select",""],["","16714075301","HYDROXYCHLOR ","TAB 200MG","60","Select","Select",""],["","68382080510","TRAZODONE ","TAB 50MG","30","Select","Select",""],["","00904530680","BANOPHEN ","CAP 25MG","30","Select","Select",""],["","53489014310","SPIRONOLACT ","TAB 25MG","30","Select","Select",""],["","71930005152","OXYBUTYNIN ","TAB 5MG","60","Select","Select",""],["","69680011225","CYANOCOBALAM ","INJ 1000MCG","4","Select","Select",""],["","00169368712","LEVEMIR ","INJ ","10","Select","Select",""],["","45802086803","POLYETH ","POW 3350 NF","510","Select","Select",""],["","63739047848","DOCUSATE ","CAP 100MG","120","Select","Select",""],["","00597015561","STIOLTO ","AER 2.5-2.5","4","Select","Select",""],["","62135098505","DOXYCYCL ","CAP 100MG","10","Select","Select",""],["","16714066202","GABAPENTIN ","CAP 300MG","45","Select","Select",""],["","00378510501","PROCHLORPER ","TAB 5MG","90","Select","Select",""],["","66993001968","ALBUTEROL ","AER HFA","54","Select","Select",""],["","00069047103","CHANTIX ","PAK 0.5& 1MG","53","Select","Select",""],["","62756018388","OXCARBAZEPIN ","TAB 150MG","60","Select","Select",""],["","16714008212","HYDROXYZ ","TAB 25MG","45","Select","Select",""],["","64764024060","AMITIZA ","CAP 24MCG","60","Select","Select",""],["","71930001730","ONDANSETRON ","TAB 4MG","28","Select","Select",""],["","00904645780","DOK ","CAP 100MG","120","Select","Select",""],["","29300022705","METRONIDAZOL ","TAB 500MG","30","Select","Select",""],["","00591079510","DICYCLOMINE ","TAB 20MG","60","Select","Select",""],["","16729013716","CLONAZEPAM ","TAB 1MG","60","Select","Select",""],["","59746017310","PREDNISONE ","TAB 10MG","15","Select","Select",""],["","16714010102","GEMFIBROZIL ","TAB 600MG","60","Select","Select",""],["","31722055190","LEVOCETIRIZI ","TAB 5MG","30","Select","Select",""],["","31722072610","MONTELUKAST ","TAB 10MG","30","Select","Select",""],["","00023530105","RESTASIS ","EMU 0.0005","5.5","Select","Select",""],["","47335090418","QUETIAPINE ","TAB 100MG","30","Select","Select",""],["","60505016907","PRAVASTATIN ","TAB 20MG","30","Select","Select",""],["","49348087277","MICONAZOLE ","CRE 0.02","45","Select","Select",""],["","50111078710","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","68462018022","MUPIROCIN ","OIN 0.02","22","Select","Select",""],["","60758011905","PREDNISOLONE ","SUS 1% OP","5","Select","Select",""],["","16714069101","FLUCONAZOLE ","TAB 100MG","3","Select","Select",""],["","62011025401","LUBRIC ","SOL 0.4-0.3%","15","Select","Select",""],["","61314063006","NEO\/POLY\/DEX ","SUS 0.1% OP","10","Select","Select",""],["","24208035805","ZYLET ","SUS 0.5-0.3%","5","Select","Select",""],["","00527512170","NYSTATIN ","SUS 100000","240","Select","Select",""],["","52565001059","TRIAMCINOLON ","LOT 0.00025","120","Select","Select",""],["","42192060716","BROM\/PSE\/DM ","SYP ","180","Select","Select",""],["","41167431006","ALLEGRA-D ","TAB 12 HOUR","30","Select","Select",""],["","16714047801","AMOX\/K ","TAB 875-125","20","Select","Select",""],["","16714078501","ARIPIPRAZOLE ","TAB 10MG","30","Select","Select",""],["","24208063110","NEO\/POLY\/HC ","SOL 1% OTIC","10","Select","Select",""],["","60505083305","AZELASTINE ","SPR 0.001","30","Select","Select",""],["","00023040370","REFRESH ","DRO 0.5% OP","70","Select","Select",""],["","62175013643","OMEPRAZOLE ","CAP 40MG","30","Select","Select",""],["","43547035411","LISINOPRIL ","TAB 20MG","30","Select","Select",""],["","63824002335","MUCINEX ","TAB 1200MG","60","Select","Select",""],["","57237009960","CEFDINIR ","CAP 300MG","20","Select","Select",""],["","51224000160","BENZONATATE ","CAP 200MG","30","Select","Select",""],["","00904052380","VITAMIN ","TAB 500MG","120","Select","Select",""],["","58160082152","ENGERIX-B ","INJ 20MCG\/ML","1","Select","Select",""],["","00574402235","BACITRACIN ","OIN OP","3.5","Select","Select",""],["","64380080707","IBUPROFEN ","TAB 800MG","90","Select","Select",""],["","00487980125","IPRATROPIUM ","SOL 0.02%INH","62.5","Select","Select",""],["","68682071310","ENALAPRIL ","TAB 20MG","60","Select","Select",""],["","00378312501","DOXEPIN ","CAP 25MG","18","Select","Select",""],["","00116200116","CHLORHEX ","SOL 0.0012","473","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","20","Select","Select",""],["","24208027715","MURO ","SOL 5% OP","15","Select","Select",""],["","00065924007","DUREZOL ","EMU 0.0005","5","Select","Select",""],["","49348014929","LUBRICATING ","SOL 0.4-0.3%","15","Select","Select",""],["","10572010001","PEG-3350 ","SOL ELECTROL","4,000.00","Select","Select",""],["","00316023075","SARNA ","LOT 0.01","1","Select","Select",""],["","00536108494","ARTIFI ","SOL 1.4% OP","15","Select","Select",""],["","29300011105","LAMOTRIGINE ","TAB 25MG","60","Select","Select",""],["","16714073801","FENOFIBRATE ","TAB 145MG","30","Select","Select",""],["","00065427325","PAZEO ","DRO 0.007","2.5","Select","Select",""],["","70069000801","EPINASTINE ","DRO 0.0005","5","Select","Select",""],["","17478007035","ERYTHROMYCIN ","OIN 5MG\/GM","3.5","Select","Select",""],["","50383026650","CLOBETASOL ","SOL 0.0005","50","Select","Select",""],["","00781572010","POT  CL MICRO","TAB 20MEQ ER","9","Select","Select",""],["","80681013500","ZINC ","CAP 220MG","30","Select","Select",""],["","00065045407","SYSTANE ","DRO 0.4-0.3%","10","Select","Select",""],["","50580089507","NIZORAL ","SHA 0.01","200","Select","Select",""],["","80777027399","MODERNA ","INJ COVID-19","0.5","Select","Select",""],["","70677005501","SM ","TAB 600MG ER","30","Select","Select",""],["","00054327099","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","55111017915","TIZANIDINE ","TAB 2MG","60","Select","Select",""],["","67877012450","SILVER ","CRE 0.01","50","Select","Select",""],["","61314062810","POLYMYXIN ","SOL TRIMETHP","10","Select","Select",""],["","60758088005","FLUOROMETHOL ","SUS 0.1% OP","5","Select","Select",""],["","13668010410","ISOSORB ","TAB 30MG ER","90","Select","Select",""],["","70010075405","METHOCARBAM ","TAB 500MG","30","Select","Select",""],["","61314064705","TOBRA\/DEXAME ","SUS 0.3-0.1%","5","Select","Select",""],["","00591555410","PROPRANOLOL ","TAB 10MG","90","Select","Select",""],["","70461031903","FLUCLVX ","INJ 2019-20","0.5","Select","Select",""],["","00173072020","FLOVENT ","AER 220MCG","12","Select","Select",""],["","00002821501","HUMULIN ","INJ U-100","10","Select","Select",""],["","63646001004","KETOCONAZOLE ","SHA 0.02","120","Select","Select",""],["","77333000415","ACIDOPHILUS ","CAP LACTOBA","30","Select","Select",""],["","60432060616","PROMETH\/COD ","SOL 6.25-10","300","Select","Select",""],["","48582000330","BIOTENE ","LIQ DRY MTH","473","Select","Select",""],["","65862018601","CLINDAMYCIN ","300MG","21","Select","Select",""],["","50383093093","BUPRENORPHIN ","8MG","28","Select","Select",""],["","80681006200","PROBIOTIC ","FORMULA","30","Select","Select",""],["","68180012202","CEPHALEXIN ","500MG","21","Select","Select",""],["","58160082311","SHINGRIX ","50\/0.5ML","0.5","Select","Select",""],["","23155019201","BUPROPION ","100MG","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","",""],["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":""}]}]}