{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"HEATHER   M UNDERWOOD","gend":1,"add":"PO BOX 3107","city":"WISE","state":"VA","zip":"24293-3107","dob":"1976-12-14","age":"","mstatus":"","insh":10061827,"cliId":"","pno":2769714937,"cno":2764550623,"email":"","ename":"","eno":"","pphy":"YOUSUF, SAMINA","ppno":2768890433,"pcpadd":"142 Highland Dr, ","pcpcity":"Lebanon","pcpstate":"VA","pcpzip":242664636,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"SOUTHWEST","aligned":"","ano":2762987145,"add2":"                                                            ","add3":"","madd1":"11416 Riverview Rd","madd2":"                                                            ","madd3":"","mcity":"Coeburn","mstate":"VA","mzip":"24230-6530","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I10","F17.210","E66.3","F41.9","S40.921A","R06.03","R56.9","G40.909","F10.231","G93.40","J44.0","J96.01","J18.9","J15.7","E87.2","N39.0","Z79.01","F10.10","E78.2","S06.5X9A","I62.00","R41.0","G81.91","R47.01","G93.89","F19.11","Z86.79","J44.9","Z86.73","F10.21","K74.60","I62.02","R47.1","R13.10","B19.20","D50.0","G62.9","K70.0","I27.21","G47.00","M19.90","Z82.49","Z95.2","E87.6","R41.82","F19.10","Z72.89","B95.2","G25.3","H10.31","Z98.890","G93.49","R53.81","Z87.440","Z87.891","G25.81","A41.9","Z87.898","G97.51","F33.9","K73.9","F10.99","R26.81","Z72.0","I63.9","R10.31","R10.11","M54.5","Z79.82","Z79.899","R52","B37.3","M79.621","S42.334D","Z00.00","Z91.14","R10.9","R11.2","Z51.81","I08.3","I27.20","I08.8","B18.2","F51.01","R60.9","R00.0","I61.9","S06.5X0A","R06.89","R07.9","I62.01","I63.89","F15.11","F17.200","R07.89","R65.20","I36.1","R44.3","R39.9","K76.0","D25.9","G92","R16.0","R05","R68.89","M25.531","M79.10","W01.0XXA","D68.9","G40.89","R10.84","R25.1","K72.90","F10.20","F19.20","G89.21","F10.19","M79.2","I06.0","J96.90","I62.9","S06.329A","I33.0","I63.512","R11.10","K21.9","F32.9","G45.9","B85.0","Z76.0","J69.0","J44.1","D69.6","D64.9","J98.11","F10.239","Z76.89","B00.1","N95.1","I62.03","Z95.4","R29.810","Z71.81","J45.909","I25.10","R53.1","F80.1","R20.2","Z53.29","M25.551","K92.2","K62.5","Z95.1","J90","G31.9","R06.02","J95.821","G93.41","T45.515A","R45.1","R27.0","R29.818","Z45.2","J43.9","Z13.220","E61.9","R74.0","E80.6","E83.42","M79.601","M79.604","S06.5X7A","Z86.19","Z46.82","R25.9","I69.320","Z86.59","R10.2","M25.561","I65.22","S06.5X0S","R06.09","W19.XXXA","D61.818","I69.328","R14.0","I69.351","R40.2233","R40.2353","R40.2133","H10.9","M62.421","A41.89","R50.9","E44.0","J18.1","I51.7","S90.851A","I34.1","J15.9","R21","J81.1","X58.XXXA","Z48.811","R42"],"date":["2021-05-07","2021-05-07","2019-01-15","2021-03-30","2019-02-02","2019-02-02","2021-03-25","2021-03-30","2019-02-05","2019-12-01","2020-01-13","2019-09-22","2020-01-13","2019-11-24","2019-02-05","2020-06-30","2021-05-07","2020-04-29","2019-07-15","2019-10-20","2019-09-28","2020-06-30","2019-10-20","2019-12-26","2020-06-30","2019-12-26","2019-11-22","2021-05-07","2021-05-07","2019-09-28","2020-02-03","2019-10-04","2019-10-01","2019-10-21","2020-02-03","2019-10-03","2021-03-30","2019-12-25","2019-11-21","2021-03-30","2019-10-01","2019-10-01","2021-03-30","2019-10-03","2020-06-30","2019-11-21","2019-10-12","2019-10-20","2019-10-20","2019-10-20","2019-11-22","2019-10-20","2019-10-20","2020-01-22","2019-11-21","2019-10-20","2019-11-23","2019-11-22","2019-11-22","2019-11-21","2019-12-01","2019-12-01","2019-12-01","2020-05-27","2020-01-13","2020-02-03","2020-02-03","2020-02-03","2021-05-07","2021-05-07","2020-02-03","2020-04-01","2020-04-29","2020-05-27","2020-08-12","2020-10-28","2021-05-07","2021-05-07","2019-04-24","2019-02-04","2019-11-21","2019-02-04","2019-09-08","2019-02-18","2019-07-11","2021-02-05","2019-10-27","2020-04-01","2019-09-19","2019-09-21","2019-09-25","2019-09-25","2019-09-25","2019-12-26","2019-11-21","2019-11-21","2019-11-22","2019-11-24","2020-01-22","2020-02-03","2020-06-30","2020-06-30","2020-06-30","2020-06-30","2020-10-28","2021-02-05","2021-02-05","2021-02-05","2021-05-07","2020-06-30","2019-02-02","2019-02-03","2019-02-03","2021-03-30","2019-02-04","2019-05-07","2019-04-02","2019-04-02","2019-09-23","2019-09-25","2019-09-25","2019-09-25","2019-10-14","2019-10-09","2019-10-09","2019-10-09","2019-10-09","2020-01-07","2020-09-09","2021-03-25","2019-02-02","2019-02-05","2019-11-22","2019-11-22","2019-02-05","2019-10-10","2019-07-11","2019-07-11","2019-07-11","2019-09-13","2019-09-13","2019-09-23","2019-09-23","2019-10-10","2021-05-07","2019-12-25","2019-12-27","2020-01-13","2021-02-05","2021-02-05","2021-05-07","2021-05-07","2021-05-07","2019-02-05","2019-02-05","2019-11-24","2019-09-17","2019-10-10","2019-09-17","2019-09-17","2019-09-17","2019-12-25","2019-09-23","2020-06-30","2021-03-30","2021-03-30","2019-02-04","2019-02-04","2019-09-17","2019-09-17","2019-09-17","2019-09-17","2019-12-25","2019-09-23","2019-10-09","2019-10-14","2019-10-14","2019-12-25","2019-12-25","2019-12-26","2020-04-01","2019-01-31","2019-09-08","2019-09-08","2019-09-08","2019-09-18","2019-10-10","2019-10-10","2019-10-10","2019-10-10","2019-10-10","2019-10-10","2019-11-21","2019-11-21","2019-11-21","2019-11-21","2019-11-21","2019-12-25","2020-01-13","2019-02-01","2019-04-24","2019-09-17","2019-09-17","2019-11-24","2020-06-30"],"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":[["","62037083110","METOPROL ","TAB 50MG ER","30","Select","Select",""],["","00093171501","WARFARIN ","TAB 3MG","30","Select","Select",""],["","50111043301","TRAZODONE ","TAB 50MG","30","Select","Select",""],["","51672411103","PHENYTOIN ","CAP 100MG","90","Select","Select",""],["","65162010350","GABAPENTIN ","CAP 400MG","90","Select","Select",""],["","00254100752","ALBUTEROL ","AER HFA","6.7","Select","Select",""],["","31722053960","LEVETIRACETA ","TAB 1000MG","60","Select","Select",""],["","00536110788","NICOTINE ","DIS 14MG\/24H","28","Select","Select",""],["","69584009210","BUSPIRONE ","TAB 10MG","60","Select","Select",""],["","00378700193","PAROXETINE ","TAB 10MG","30","Select","Select",""],["","00781350069","ENOXAPARIN ","INJ 100MG\/ML","10","Select","Select",""],["","00781217660","CEFDINIR ","CAP 300MG","8","Select","Select",""],["","00093811956","FAMCICLOVIR ","TAB 500MG","21","Select","Select",""],["","54629005701","VITAMIN ","TAB 100MG","45","Select","Select",""],["","68001033408","LISINOPRIL ","TAB 10MG","90","Select","Select",""],["","13668021630","ARIPIPRAZOLE ","TAB 2MG","30","Select","Select",""],["","51862006205","DIAZEPAM ","TAB 2MG","120","Select","Select",""],["","49781002802","LICE ","LIQ 0.01","59","Select","Select",""],["","51672130005","AMMONIUM ","LOT 0.12","400","Select","Select",""],["","65862064230","AZITHROMYCIN ","TAB 500MG","3","Select","Select",""],["","45802005935","NYSTATIN ","CRE 100000","15","Select","Select",""],["","68462010230","FLUCONAZOLE ","TAB 100MG","8","Select","Select",""],["","66685100100","AMOX\/K ","TAB 875-125","21","Select","Select",""],["","00406012305","HYDROCO\/APAP ","TAB 5-325MG","60","Select","Select",""],["","69547035302","NARCAN ","SPR ","2","Select","Select",""],["","60258017101","MAG ","TAB 400MG","60","Select","Select",""],["","62103033304","BOUDREAUXS ","OIN 0.16","113","Select","Select",""],["","52565005630","TRIAMCINOLON ","CRE 0.001","60","Select","Select",""],["","00115521116","COLESTIPOL ","TAB 1GM","60","Select","Select",""],["","00555003305","CHLORDIAZEP ","CAP 10MG","120","Select","Select",""],["","00093314705","CEPHALEXIN ","CAP 500MG","20","Select","Select",""],["","68382004101","PROMETHAZINE ","TAB 25MG","12","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","",""],["No","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":""}]}]}