{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" BETTY A LEFTWICH","gend":1,"add":"605 6TH AVE","city":"RADFORD","state":"VA","zip":"24141-2512","dob":"1958-02-01","age":"","mstatus":"","insh":10067463,"cliId":"","pno":"5407395623, 5405051829","cno":5402398430,"email":"","ename":"","eno":"","pphy":"UNKNOWN PROVIDER QNXT PCP","ppno":"               ","pcpadd":"UNKNOWN STREET, ","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":232190000,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP - VIRGINIA PREMIER","program":"MEDICAID","lob":"MLTSS","region":"ROANOKE","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"605 6TH AVE","madd2":"                                                            ","madd3":"","mcity":"RADFORD","mstate":"VA","mzip":"24141-2512","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R07.9","R09.89","J20.9","R07.89","R68.84","I63.9","M79.602","I10","Z87.891","I25.10","R01.1","E11.51","Z79.84","J44.9","E78.00","E78.5","I25.2","Z79.01","Z85.038","E11.9","K52.9","F41.8","G47.33","A41.9","R10.32","D72.823","I20.0","K21.9","F32.9","R94.31","M96.1","M50.30","M51.36","F33.9","M54.12","E11.65","R06.02","F17.210","R42","R11.0","M24.811","M75.111","M25.511","R00.0","E83.42","R79.89","E11.40","I25.9","Z79.02","A63.0","Z79.82","Z85.048","Z86.73","R30.0","N88.9","Z11.3","N90.89","Z11.4","Z11.59","M48.061","M47.896","M47.897","M43.26","R09.02","M79.604","M79.605","I73.9","G89.4","Z79.899","M54.2","I25.119","S14.129A","I95.9","I50.22","I63.231","J44.1","K51.90","F41.9","R29.701","M79.7","R40.2362","R40.2142","Z72.0","I65.21","I11.9","E66.9","F17.200","G89.29","Z79.891","Z71.6","I25.110","D69.6","E55.9","G25.81","I34.0","Z95.5","I51.89","G89.3","I65.29","K76.0","R16.2","M47.892","M48.02","Z98.1","R14.0","Z23","I95.2","R21","N39.0","B37.3","J43.9","D48.5","T88.7XXA","M47.26","M54.5","M54.16","M43.16","R87.612","N87.1","E66.01","S14.104A","W18.30XA","Y92.002","E11.22","E11.43","E53.8","S14.105A","N18.3","I12.9","R32","I63.89","R53.1","G45.9","K92.1","H26.492","R87.810","N90.0","G62.9","R23.8","T49.95XA","N95.2","Z01.818","Z96.1","H43.811","H02.61","H02.64","H52.03","H52.213","I21.3","M75.100","M47.23","Z79.4","H90.5","R29.91","W19.XXXA","M43.12","M50.31","M50.323","R05","R06.2","R20.2","I65.23","F33.1","R51","R29.898","R20.0","R10.84","R19.5","R07.2","S19.9XXA","I50.9","E04.2","M43.22","H26.491","B02.9","R10.9","I20.9","B97.7","M25.512","J45.909","I25.89","M25.78","S70.12XA","X58.XXXA","Y92.9","E11.69","T46.1X5A","E87.6","L02.92","Z87.42","I25.84","Z79.51","Z82.49","I45.81","M54.9","S14.109A","M99.71","Z89.111","R23.3","L30.8","N87.0","R00.2","L50.9","Z88.8","R94.39","R68.89","J06.9","I08.0","I27.20","I51.7","I63.239","A04.72","F39","M19.90","I05.2","H26.493","E08.65","L27.0","E78.2","M47.816"],"date":["2020-06-15","2020-07-01","2019-08-15","2020-11-23","2020-06-07","2019-12-13","2019-07-02","2021-03-18","2019-05-13","2021-04-16","2019-02-28","2020-07-01","2020-12-21","2020-12-16","2020-06-07","2021-03-18","2020-07-01","2020-03-02","2020-03-02","2021-03-18","2019-03-14","2019-03-14","2021-03-18","2019-03-14","2019-03-14","2019-03-14","2019-08-22","2020-06-07","2019-08-15","2020-06-07","2020-07-31","2019-12-11","2019-12-11","2020-01-31","2021-04-26","2021-04-26","2021-01-12","2020-07-22","2020-07-22","2020-01-21","2020-02-07","2020-02-07","2020-02-07","2020-02-08","2020-02-08","2020-02-08","2020-06-07","2020-02-25","2020-12-16","2020-06-11","2021-03-18","2020-02-25","2020-07-01","2020-03-11","2020-03-19","2020-03-31","2020-03-31","2020-03-31","2020-03-31","2020-05-03","2020-05-03","2020-05-03","2020-05-03","2020-05-03","2020-05-03","2020-05-03","2021-04-26","2020-07-31","2020-12-16","2020-07-31","2020-12-16","2019-01-12","2020-01-21","2019-01-13","2019-03-01","2019-03-01","2019-03-01","2019-03-01","2019-03-01","2020-06-07","2019-03-01","2019-03-01","2020-12-14","2019-03-08","2019-03-08","2019-05-11","2021-03-18","2020-01-21","2019-03-08","2019-04-30","2019-12-16","2019-05-13","2019-05-11","2019-12-16","2020-07-01","2020-12-16","2019-05-13","2019-05-13","2020-07-06","2019-06-19","2019-06-19","2019-07-02","2021-03-18","2021-03-18","2019-10-02","2019-12-13","2020-01-21","2020-03-02","2020-03-02","2020-03-02","2020-03-02","2020-03-03","2020-03-03","2020-05-07","2020-05-07","2020-05-07","2020-05-07","2020-06-11","2020-06-11","2021-04-26","2019-01-13","2019-01-13","2019-01-13","2019-01-13","2019-01-13","2019-01-13","2019-01-13","2019-01-13","2019-01-13","2019-01-13","2019-02-28","2019-02-28","2019-03-01","2019-03-12","2019-08-06","2020-03-19","2020-04-01","2020-05-03","2020-05-28","2020-05-28","2020-05-28","2020-06-29","2020-12-21","2020-12-21","2020-12-21","2020-12-21","2020-12-21","2020-12-21","2021-03-18","2021-03-18","2021-03-18","2021-03-18","2021-04-27","2019-01-12","2019-01-12","2019-02-26","2019-02-26","2019-02-26","2019-06-28","2019-06-28","2019-07-02","2020-07-02","2021-01-27","2019-03-13","2019-02-28","2019-02-28","2019-03-12","2019-03-12","2019-01-04","2019-01-13","2019-01-13","2019-07-01","2019-07-01","2019-07-29","2019-08-15","2019-08-15","2020-12-16","2020-03-16","2020-06-07","2020-06-07","2020-06-07","2019-07-01","2019-11-13","2019-11-13","2020-01-21","2019-12-13","2020-01-21","2020-01-21","2020-04-24","2020-04-24","2020-07-01","2020-07-01","2020-07-01","2019-01-12","2019-01-12","2019-01-13","2019-02-28","2019-06-19","2019-11-13","2020-03-03","2020-03-23","2020-07-22","2020-10-02","2020-12-16","2019-01-04","2019-02-25","2019-02-25","2019-03-01","2019-03-01","2019-03-01","2019-03-05","2019-03-13","2019-03-13","2019-03-13","2019-05-13","2019-07-17","2020-02-08","2020-03-17","2020-03-17","2020-05-07"],"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":[["","23155000301","HYDRALAZINE ","TAB 50MG","60","Select","Select",""],["","76385011350","CARVEDILOL ","TAB 25MG","60","Select","Select",""],["","68180059101","RAMIPRIL ","CAP 10MG","30","Select","Select",""],["","50428027684","MELATONIN ","TAB 5MG","30","Select","Select",""],["","65862052890","VENLAFAXINE ","CAP 75MG ER","30","Select","Select",""],["","31722091701","OXYCODONE ","TAB 15MG","28","Select","Select",""],["","08290320122","BD  PEN NEEDL","MIS 32GX4MM","200","Select","Select",""],["","45802091987","CETIRIZINE ","TAB 10MG","90","Select","Select",""],["","00069046956","CHANTIX ","TAB 1MG","60","Select","Select",""],["","00378395377","ATORVASTATIN ","TAB 80MG","30","Select","Select",""],["","43598043611","NITROGLYCERN ","SUB 0.4MG","25","Select","Select",""],["","00169406013","VICTOZA ","INJ 18MG\/3ML","6","Select","Select",""],["","00093317431","ALBUTEROL ","FAT E HFA INH","8.5","Select","Select",""],["","00597015230","JARDIANCE ","TAB 10MG","30","Select","Select",""],["","68462010530","ONDANSETRON ","TAB 4MG","12","Select","Select",""],["","60505025203","TIZANIDINE ","TAB 4MG","90","Select","Select",""],["","65862035790","CLOPIDOGREL ","TAB 75MG","30","Select","Select",""],["","00193731150","CONTOUR ","TES NEXT","100","Select","Select",""],["","69842000003","FLUTICASONE ","SPR 50MCG","9.9","Select","Select",""],["","00299392116","CETAPHIL ","LIQ CLEANSER","473","Select","Select",""],["","10006073038","MAG ","TAB 400MG","14","Select","Select",""],["","69842093108","ACETAMINOPHN ","TAB 500MG","30","Select","Select",""],["","00536589688","NICOTINE ","DIS 21MG\/24H","84","Select","Select",""],["","65862020290","LOSARTAN ","TAB 50MG","30","Select","Select",""],["","00000000000",""," ","60","Select","Select",""],["","68382065005","ISOSORB ","TAB 30MG ER","30","Select","Select",""],["","17478020910","KETOROLAC ","SOL 0.005","5","Select","Select",""],["","59746028390","PANTOPRAZOLE ","TAB 20MG","30","Select","Select",""],["","47781073050","VANCOMYCIN ","CAP 250MG","48","Select","Select",""],["","68180035407","RANOLAZINE ","TAB 500MG ER","60","Select","Select",""],["","50428147651","MOISTURIZING ","LOT ","473","Select","Select",""],["","69097083512","SERTRALINE ","TAB 100MG","30","Select","Select",""],["","53746054201","POT  CHLORIDE","CAP 10MEQ ER","30","Select","Select",""],["","00781185220","AMOX\/K ","TAB 875-125","20","Select","Select",""],["","70710113908","FLUCONAZOLE ","TAB 150MG","2","Select","Select",""],["","00378021610","FUROSEMIDE ","TAB 40MG","30","Select","Select",""],["","61958100401","RANEXA ","TAB 1000MG","60","Select","Select",""],["","66758016005","KLOR-CON ","TAB 10MEQ ER","30","Select","Select",""],["","00496074804","PRAX ","LOT 0.01","118","Select","Select",""],["","67877057305","BENZONATATE ","CAP 100MG","30","Select","Select",""],["","59779030603","CVS ","POW ","510","Select","Select",""],["","64380080438","RANITIDINE ","TAB 300MG","30","Select","Select",""],["","68382076010","METFORMIN ","TAB 1000MG","60","Select","Select",""],["","68180016013","AZITHROMYCIN ","TAB 250MG","6","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":""}]}]}