{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"HEATHER   S CARTER","gend":1,"add":"217 STICKLEY DRIVE","city":"STEPHENS CITY","state":"VA","zip":"22655-2954","dob":"1989-05-30","age":"","mstatus":"","insh":10065040,"cliId":"","pno":5403279085,"cno":5403279085,"email":"","ename":"","eno":"","pphy":"HOLTHUS, THOMAS E","ppno":5404653751,"pcpadd":"33674 Old Valley Pike, ","pcpcity":"Strasburg","pcpstate":"VA","pcpzip":226573704,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"NORTHERN\/ WINCHESTER","aligned":"","ano":"","add2":"TRLR 142","add3":"","madd1":"217 STICKLEY DRIVE","madd2":"TRLR 142","madd3":"","mcity":"STEPHENS CITY","mstate":"VA","mzip":"22655-2954","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["D50.9","M25.50","M79.18","Z80.3","N93.9","M25.571","R61","F41.9","R91.8","R09.02","J02.0","M54.16","R20.2","H90.5","G47.00","F33.1","G47.61","F39","K43.2","N92.1","N94.6","K66.0","R00.2","M54.2","M54.9","R25.2","Z79.891","M41.83","M54.12","M54.5","J36","J02.9","R05","M41.9","M41.84","M62.838","N94.10","R45.84","N92.0","J69.0","R00.0","Z09","M54.17","M54.6","M89.29","R26.9","R26.81","M41.115","R10.2","H81.10","J30.9","G89.29","R53.83","G25.81","J45.20","D25.1","J18.9","R06.09","M41.20","J45.909","K62.89","K21.9","H61.22","Z03.818","Z20.828","J01.90","K13.70","Z72.51","E61.1","M62.08","K46.9","Q33.6","Q25.0","I34.1","R11.2","Z88.8","Z87.790","Z87.76","Z80.0","J90","R21","K59.00","J35.01","Z01.818","R79.0","G43.909","R23.2"],"date":["2019-01-11","2019-01-11","2019-03-04","2019-03-15","2019-04-11","2019-04-02","2019-04-02","2021-02-19","2019-04-29","2019-04-29","2019-08-02","2020-08-11","2020-08-11","2020-04-30","2020-07-07","2021-02-19","2019-10-17","2019-01-30","2019-04-24","2019-04-24","2019-04-24","2019-04-24","2019-05-14","2019-07-02","2019-07-12","2019-07-18","2019-07-12","2020-04-28","2020-04-28","2019-10-14","2019-11-11","2020-01-19","2020-01-19","2020-05-21","2020-04-28","2020-04-28","2020-02-14","2019-03-05","2019-04-24","2019-04-30","2019-06-07","2019-06-07","2019-09-10","2020-01-31","2019-07-15","2019-10-17","2020-01-31","2020-05-21","2020-02-14","2020-05-04","2020-05-04","2020-08-11","2021-05-19","2019-01-22","2019-01-29","2019-04-24","2019-05-14","2019-06-07","2019-12-23","2020-01-14","2020-04-20","2020-04-20","2020-04-20","2020-09-29","2020-09-29","2020-09-29","2021-01-21","2021-01-22","2019-01-11","2019-04-10","2019-04-10","2019-04-24","2019-04-24","2019-04-24","2019-04-24","2019-04-24","2019-04-24","2019-04-24","2019-04-24","2019-04-27","2019-09-09","2020-02-14","2020-03-06","2019-04-11","2019-01-03","2019-01-03","2019-06-07"],"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":[["","00363030602","SMOOTH ","POW ","476","Select","Select",""],["","00172392570","DIAZEPAM ","TAB 2MG","10","Select","Select",""],["","65862069790","VENLAFAXINE ","CAP 150MG ER","30","Select","Select",""],["","59651000205","OMEPRAZOLE ","CAP 20MG","30","Select","Select",""],["","23155050105","HYDROXYZ ","TAB 25MG","30","Select","Select",""],["","13668034130","LAMOTRIGINE ","TAB 100MG ER","30","Select","Select",""],["","00054001829","PREDNISONE ","TAB 20MG","10","Select","Select",""],["","64380071206","BENZONATATE ","CAP 100MG","30","Select","Select",""],["","65162010250","GABAPENTIN ","CAP 300MG","90","Select","Select",""],["","69315090405","LORAZEPAM ","TAB 0.5MG","5","Select","Select",""],["","62542030117","HYD ","SUS 10-8\/5ML","100","Select","Select",""],["","55111018015","TIZANIDINE ","TAB 4MG","90","Select","Select",""],["","00555021110","NORETHIN ","TAB 5MG","60","Select","Select",""],["","76204090025","LEVALBUTEROL ","NEB 1.25MG","75","Select","Select",""],["","00173068220","VENTOLIN ","AER ","18","Select","Select",""],["","33342008750","RIZATRIPTAN ","TAB 5MG","4","Select","Select",""],["","65862050320","AMOX\/K ","TAB 875-125","14","Select","Select",""],["","53191036201","VITAMIN ","CAP 50000UNT","8","Select","Select",""],["","00904198260","MAPAP ","TAB 325MG","60","Select","Select",""],["","65862001705","AMOXICILLIN ","CAP 500MG","20","Select","Select",""],["","00406055201","OXYCODONE ","TAB 5MG","30","Select","Select",""],["","68462033090","PRAMIPEXOLE ","TAB 0.125MG","60","Select","Select",""],["","13107000130","MIRTAZAPINE ","TAB 7.5MG","30","Select","Select",""],["","00054327099","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","00093762398","PREGABALIN ","CAP 50MG","90","Select","Select",""],["","00378247401","DICLOFEN ","TAB 50MG","15","Select","Select",""],["","00116200116","CHLORHEX ","0.12%","473","Select","Select",""],["","64380080807","IBUPROFEN ","600MG","28","Select","Select",""],["","00363017508","PAIN ","500MG","28","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":""}]}]}