{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BETTY   J STRAWDERMAN","gend":1,"add":"119 BATTLECREEK DRIVE","city":"STANLEY","state":"VA","zip":"22851-2612","dob":"1974-03-14","age":"","mstatus":"","insh":10062722,"cliId":"","pno":5402444959,"cno":5402444959,"email":"","ename":"","eno":"","pphy":"TIMMONS, JOHN","ppno":5406529100,"pcpadd":"505 Williams Ave, ","pcpcity":"Shenandoah","pcpstate":"VA","pcpzip":228491263,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"NORTHERN\/ WINCHESTER","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"119 BATTLECREEK DRIVE","madd2":"                                                            ","madd3":"","mcity":"STANLEY","mstate":"VA","mzip":"22851-2612","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M48.04","M51.24","B20","Z51.81","Z79.01","Z95.2","N32.9","N39.490","Z98.890","R09.89","Z48.812","I77.71","E11.9","I11.0","I50.9","J44.9","M15.0","F32.9","F41.9","F17.210","I10","Z72.0","I71.01","E78.2","E66.9","K21.9","Z86.73","F43.10","T82.330A","M54.6","I71.03","Y83.8","Y92.239","J95.821","D62","E87.2","K56.7","J94.2","I71.2","I95.81","E78.5","F33.41","I71.1","J95.89","R74.8","G89.18","I51.7","R91.8","J90","K59.9","T82.330D","S31.104D","R53.81","E11.40","Z21","I71.6","H91.8X1","G25.81","E28.2","J43.1","R00.2","R35.0","R09.02","G47.33","M79.604","M79.605","R31.0","R30.0","G25.9","F41.1","R56.9","R51","E83.19","M54.81","R06.83","G93.89","G40.909","G25.0","G25.3","N39.0","R41.82","Z00.00","R39.9","E88.01","M47.26","M54.16","M51.16","M48.061","I71.02","G95.11","M51.34","M53.84","S91.201A","L60.0","X58.XXXA","Z01.818","Y83.2","E11.42","Z68.30","R32","Z86.19","Z90.710","Z83.3","G96.0","J98.11","M25.552","R29.6","Z23","R82.998","R39.15","N39.41","N30.01","R73.09","R53.83","Z88.0","Z88.8","Z91.018","Z91.048","N31.9","M51.26","M51.36","M79.2","T82.898A","Z46.82","I95.1","S70.02XA","W18.30XA","I72.4","M79.606","G40.89","I73.9","G47.34","L08.82","I65.23","Z95.9","Z95.828","K59.09","M54.5","R10.84","G89.29","G50.0","J96.01","D69.6","R06.89","S61.401A","S61.402A","E87.6","R13.10","K22.2","R07.2","R06.02","F44.5","F41.8","B37.2","K76.0","D35.02","H40.013","R25.9","M62.81","M47.896","R26.2","M54.2","Z68.32","Z79.82","Z99.81","Z79.51","I20.9","D64.9","M79.18","I65.21","Z01.810","E86.1","S22.42XA","Z45.2","M25.572","M16.12","R68.89","I77.72","I77.79","J34.2","H52.4","R25.1","M54.9","J96.90","R10.2","R10.32","J94.8","S22.32XA","S93.402A","W18.49XA","M79.661","M79.662","R07.89","H00.012","R53.1","J69.0","M25.512","I70.201","K59.8","R93.3","R11.2","R10.9","R42","R21","M51.17","Z79.899","Z79.84","G47.30","E78.00","L93.0","R41.0","J81.1","J18.1","R50.9","I65.22","J98.4","L60.2","Z74.3","R26.9","K59.00","R31.9","R29.898"],"date":["2019-01-10","2019-01-10","2020-08-13","2020-12-03","2020-12-03","2020-12-03","2020-10-09","2020-10-09","2020-10-05","2019-06-20","2019-06-19","2020-06-05","2020-08-19","2019-06-19","2020-05-15","2020-08-19","2019-05-03","2019-05-03","2019-06-24","2020-11-10","2020-05-15","2020-06-30","2020-06-03","2020-05-12","2020-05-15","2019-04-26","2020-05-15","2019-09-16","2020-06-05","2019-06-18","2020-06-17","2019-06-19","2019-06-19","2019-06-21","2019-06-22","2019-06-19","2019-06-29","2019-06-24","2020-05-12","2019-06-22","2019-06-19","2019-09-16","2019-06-21","2019-06-22","2019-06-22","2019-06-24","2019-12-09","2019-07-01","2019-07-01","2019-06-30","2019-08-06","2019-08-06","2019-08-06","2019-08-06","2019-07-11","2019-07-29","2019-09-16","2020-11-10","2019-09-16","2019-09-16","2019-09-16","2020-04-24","2020-08-01","2020-08-01","2019-12-09","2019-12-09","2019-12-26","2020-08-18","2020-01-06","2020-01-06","2020-11-25","2020-06-11","2020-12-23","2021-01-28","2020-05-15","2020-12-23","2020-12-23","2020-04-02","2020-04-02","2020-04-03","2020-11-25","2020-05-14","2020-08-18","2020-08-19","2020-10-05","2020-10-27","2020-11-10","2020-10-05","2019-06-20","2019-01-10","2019-01-10","2019-01-10","2019-03-14","2019-03-14","2019-03-14","2019-04-02","2019-06-19","2019-06-19","2019-06-19","2019-06-19","2019-06-19","2019-06-19","2019-06-19","2019-06-21","2019-09-01","2019-10-24","2019-07-25","2019-11-12","2019-12-05","2020-04-24","2020-04-24","2019-12-27","2020-05-14","2020-05-15","2020-11-10","2020-11-10","2020-11-10","2020-11-10","2020-10-09","2020-10-07","2020-10-07","2020-10-23","2019-06-19","2019-06-28","2019-07-11","2019-07-25","2019-07-25","2020-06-17","2020-10-27","2020-04-02","2020-06-30","2020-05-27","2020-05-30","2020-06-03","2020-06-03","2020-06-03","2020-06-17","2020-10-27","2020-06-17","2020-06-17","2020-09-23","2019-04-07","2019-04-07","2019-06-28","2019-05-11","2019-05-11","2019-06-24","2019-06-24","2019-09-01","2019-09-01","2019-09-01","2019-12-03","2019-12-03","2020-05-25","2020-06-17","2020-06-17","2020-09-15","2019-01-23","2019-02-04","2019-02-04","2020-10-27","2019-02-04","2019-02-28","2020-11-10","2019-02-28","2020-11-10","2019-04-02","2019-04-25","2019-05-13","2020-06-03","2019-06-19","2019-06-21","2019-06-24","2019-06-24","2019-10-24","2019-10-24","2019-11-20","2020-02-03","2020-02-03","2020-08-01","2020-07-31","2019-01-23","2019-03-23","2019-04-05","2019-05-02","2019-07-11","2019-09-01","2019-09-01","2019-10-24","2019-10-24","2019-11-22","2019-11-22","2019-11-22","2020-06-22","2020-10-27","2019-04-06","2019-06-18","2019-06-20","2019-06-27","2019-06-27","2019-06-27","2019-07-11","2019-07-11","2020-05-25","2020-11-10","2020-11-10","2020-11-10","2020-11-10","2019-04-01","2019-04-01","2019-04-02","2019-04-02","2019-04-02","2019-04-02","2019-04-03","2019-04-05","2019-04-25","2019-06-19","2019-06-28","2019-06-28","2019-12-26","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":[["","68645055554","LISINOPRIL ","TAB 40MG","30","Select","Select",""],["","00904675180","ASPIRIN ","TAB 81MG EC","30","Select","Select",""],["","57237011999","WARFARIN ","TAB 1MG","30","Select","Select",""],["","59762004801","TOLTERODINE ","CAP 4MG ER","30","Select","Select",""],["","16714089902","FEXOFENADINE ","TAB 180MG","30","Select","Select",""],["","62175089143","ATORVASTATIN ","TAB 20MG","30","Select","Select",""],["","00186037020","SYMBICORT ","AER 160-4.5","10.2","Select","Select",""],["","68462039610","OMEPRAZOLE ","CAP 20MG","30","Select","Select",""],["","27241009990","DULOXETINE ","CAP 60MG","30","Select","Select",""],["","61958250101","BIKTARVY ","TAB ","30","Select","Select",""],["","00093005405","BUSPIRONE ","TAB 10MG","30","Select","Select",""],["","52817036100","METOPROL ","TAB 50MG","30","Select","Select",""],["","16714043901","NITROFURANTN ","CAP 100MG","20","Select","Select",""],["","51248015101","VESICARE ","TAB 10MG","30","Select","Select",""],["","49483060650","GABAPENTIN ","CAP 300MG","90","Select","Select",""],["","62332003231","ROPINIROLE ","TAB 1MG","60","Select","Select",""],["","43547040111","FUROSEMIDE ","TAB 20MG","30","Select","Select",""],["","50111056001","TRAZODONE ","TAB 50MG","60","Select","Select",""],["","00469260130","MYRBETRIQ ","TAB 25MG","30","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","20","Select","Select",""],["","37000045504","PRILOSEC ","TAB 20MG","30","Select","Select",""],["","00781569031","EZETIMIBE ","TAB 10MG","30","Select","Select",""],["","55111018015","TIZANIDINE ","TAB 4MG","90","Select","Select",""],["","69097081603","TOPIRAMATE ","TAB 25MG","120","Select","Select",""],["","49035057139","ALLERGY ","TAB 180MG","30","Select","Select",""],["","23155010210","METFORMIN ","TAB 500MG","60","Select","Select",""],["","49702022813","TIVICAY ","TAB 50MG","60","Select","Select",""],["","49281042050","FLUZONE ","INJ 2020-21","0.5","Select","Select",""],["","00006483703","PNEUMOVAX ","INJ 25\/0.5","0.5","Select","Select",""],["","42858000101","OXYCODONE ","TAB 5MG","15","Select","Select",""],["","00193731221","CONTOUR ","TES NEXT","100","Select","Select",""],["","00093526456","SOLIFENACIN ","TAB 10MG","30","Select","Select",""],["","68462012801","ZONISAMIDE ","CAP 25MG","120","Select","Select",""],["","51293081101","PHENAZOPYRID ","TAB 200MG","6","Select","Select",""],["","61958200201","DESCOVY ","TAB 200\/25","30","Select","Select",""],["","65862001905","CEPHALEXIN ","CAP 500MG","14","Select","Select",""],["","10702000709","CYCLOBENZAPR ","TAB 10MG","30","Select","Select",""],["","00832105415","BACLOFEN ","TAB 10MG","90","Select","Select",""],["","61314063136","NEO\/POLY\/DEX ","OIN 0.1% OP","3.5","Select","Select",""],["","63304069301","CLINDAMYCIN ","CAP 300MG","21","Select","Select",""],["","08470104801","UNISTIK ","MIS COMFORT","75","Select","Select",""],["","55111053301","DIVALPROEX ","TAB 250MG ER","90","Select","Select",""],["","00574200802","NYSTOP ","POW 100000","60","Select","Select",""],["","68462018022","MUPIROCIN ","OIN 0.02","22","Select","Select",""],["","68180071160","CEFDINIR ","CAP 300MG","14","Select","Select",""],["","57896048914","POLYETH ","POW 3350 NF","238","Select","Select",""],["","00904645780","DOK ","CAP 100MG","8","Select","Select",""],["","65162062710","TRAMADOL ","TAB 50MG","9","Select","Select",""],["","00536338601","NICOTINE ","GUM 2MGFRUIT","100","Select","Select",""],["","00591352530","LIDOCAINE ","PAD 0.05","30","Select","Select",""],["","69547035302","NARCAN ","SPR ","2","Select","Select",""],["","00054001825","PREDNISONE ","TAB 20MG","5","Select","Select",""],["","00904671980","ACETAMINOPHEN ","TA B 325","36","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","",""],["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":""}]}]}