{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" RONETTA K MOSLEY","gend":1,"add":"616 INSTITUTE STREET","city":"JONESVILLE","state":"VA","zip":"24263-7516","dob":"1966-04-11","age":"","mstatus":"","insh":10068314,"cliId":"","pno":"2763467561, 2763467561","cno":"","email":"","ename":"","eno":"","pphy":"ALMATARI, ABDULLATIEF","ppno":"               ","pcpadd":"127 Health Care Dr, Ste 12","pcpcity":"Pennington Gap","pcpstate":"VA","pcpzip":242772853,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP - VIRGINIA PREMIER","program":"MEDICAID","lob":"MLTSS","region":"SOUTHWEST","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"616 INSTITUTE STREET","madd2":"                                                            ","madd3":"","mcity":"JONESVILLE","mstate":"VA","mzip":"24263-7516","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E78.5","R74.8","R79.89","I50.9","R06.09","R09.02","J80","J18.9","R91.8","E87.0","E87.8","E87.2","D25.9","B96.89","R50.9","K70.31","F10.188","D69.6","R00.1","K70.30","F17.210","J44.1","K76.9","E87.6","F33.1","F11.20","F10.20","F60.3","K22.2","C55","R39.81","S52.501A","W19.XXXA","S52.551A","Z09","R53.82","K43.6","K70.11","A41.9","X58.XXXA","J96.01","J44.0","E87.1","K72.90","R65.20","M54.6","Z88.0","F10.10","S29.012A","J94.8","Z99.11","J96.90","R04.2","I87.2","K56.7","J44.9","G40.909","R53.1","M79.7","Z91.81","R26.81","H10.9","M54.5","Z87.891","Z79.51","Z99.81","K29.70","F17.200","E66.9","F10.21","F13.11","S22.42XA","D72.829","K74.60","M06.9","J18.1","W18.30XA","K21.9","F41.9","Z79.899","J40","R84.6","Z46.82","R18.8","I34.0","I36.1","Z23","Z88.5","R06.00","R10.9","S52.591A","K76.81","D69.59","Z83.3","F32.9","I25.2","E78.1","R14.0","J90","M54.9","J20.9","Z68.24","M25.511","I10","M25.531","I50.1","R05","T14.8XXA","S52.531D","Z01.818","S29.9XXA","K52.9","Z87.19","F41.8","R07.89","R16.2","W18.39XA","S52.531G","W19.XXXD","I11.0","I25.10","E07.9","I47.1","F11.90","N83.9","M79.601","R06.02","J18.0"],"date":["2020-03-03","2019-03-01","2019-03-01","2021-03-15","2020-12-27","2020-12-27","2020-03-04","2020-04-13","2020-03-03","2020-03-03","2020-03-03","2020-03-03","2020-03-03","2020-03-03","2020-03-03","2020-03-31","2020-03-03","2020-03-03","2020-03-03","2021-03-15","2021-03-04","2020-03-16","2021-03-25","2020-07-10","2021-03-18","2021-03-18","2021-03-18","2021-03-18","2021-01-27","2021-01-27","2021-05-20","2021-03-15","2021-03-15","2021-04-06","2021-04-06","2019-08-08","2019-08-08","2020-02-17","2020-02-22","2020-02-22","2020-03-02","2020-04-13","2020-02-22","2020-02-22","2020-02-22","2020-02-22","2020-02-22","2020-02-22","2020-02-22","2020-02-25","2020-03-01","2020-03-04","2020-02-25","2020-02-25","2020-03-01","2021-03-15","2021-03-15","2020-03-31","2021-03-15","2020-03-31","2020-03-31","2020-04-01","2020-04-01","2020-04-13","2020-04-13","2020-04-13","2020-08-27","2020-08-27","2020-08-27","2019-08-05","2019-08-05","2020-02-24","2020-02-24","2020-08-27","2020-02-25","2020-02-25","2021-03-15","2021-03-15","2021-03-15","2021-03-15","2020-02-26","2020-02-26","2020-02-28","2020-02-28","2020-02-28","2020-02-28","2020-03-05","2020-03-05","2020-03-05","2020-03-05","2021-03-15","2020-02-25","2020-02-25","2020-02-25","2021-02-21","2021-03-04","2020-02-25","2020-02-27","2020-03-04","2020-07-10","2020-07-10","2020-03-16","2020-03-16","2020-08-27","2021-03-08","2021-02-05","2021-02-05","2021-02-22","2021-03-04","2021-03-11","2020-02-22","2020-07-10","2020-02-28","2021-03-15","2020-02-25","2020-02-28","2021-02-21","2021-03-04","2021-03-04","2021-03-04","2021-03-15","2021-03-04","2021-03-04","2021-03-04","2021-03-25","2021-03-25","2021-03-25","2020-03-02"],"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":[["","13107003134","MIRTAZAPINE ","TAB 15MG","30","Select","Select",""],["","16714045401","QUETIAPINE ","TAB 100MG","30","Select","Select",""],["","65862019499","FLUOXETINE ","CAP 40MG","30","Select","Select",""],["","65862056099","PANTOPRAZOLE ","TAB 40MG","30","Select","Select",""],["","66993001968","ALBUTEROL ","AER HFA","18","Select","Select",""],["","68382009205","CARVEDILOL ","TAB 3.125MG","60","Select","Select",""],["","66993058597","FLUTIC\/SALME ","AER 250\/50","60","Select","Select",""],["","70954001910","PRAZOSIN ","CAP 1MG","30","Select","Select",""],["","16714070101","LAMOTRIGINE ","TAB 100MG","60","Select","Select",""],["","65862052405","GABAPENTIN ","TAB 800MG","120","Select","Select",""],["","65162083366","DICLOFENAC ","GEL 0.01","100","Select","Select",""],["","68382066005","SPIRONOLACT ","TAB 25MG","30","Select","Select",""],["","31722072250","LEVOFLOXACIN ","TAB 500MG","4","Select","Select",""],["","43547035211","LISINOPRIL ","TAB 5MG","30","Select","Select",""],["","16103040299","CALCIUM\/D ","TAB 600-400","30","Select","Select",""],["","00173069600","ADVAIR ","AER 250\/50","60","Select","Select",""],["","65862018830","ONDANSETRON ","TAB 8MG","60","Select","Select",""],["","00536105227","PEG3350 ","POW ","510","Select","Select",""],["","45963043965","CONSTULOSE ","SOL 10GM\/15","946","Select","Select",""],["","00173068220","VENTOLIN ","AER ","18","Select","Select",""],["","00406012305","HYDROCO\/APAP ","TAB 5-325MG","60","Select","Select",""],["","68180012202","CEPHALEXIN ","CAP 500MG","21","Select","Select",""],["","00121057716","LACTULOSE ","SOL 10GM\/15","473","Select","Select",""],["","11822770050","RA ","TAB 600-400","30","Select","Select",""],["","55111068305","IBU ","TAB 600MG","90","Select","Select",""],["","12496120803","SUBOXONE ","MIS 8-2MG","7","Select","Select",""],["","43386031214","GAVILAX ","POW ","510","Select","Select",""],["","42858010301","OXYCOD\/APAP ","TAB 7.5-325","40","Select","Select",""],["","59676058005","JANSSEN ","INJ COVID-19","0.5","Select","Select",""],["","00378020810","FUROSEMIDE ","TAB 20MG","30","Select","Select",""],["","68462019005","NAPROXEN ","TAB 500MG","30","Select","Select",""],["","70010075401","METHOCARBAM ","TAB 500MG","20","Select","Select",""],["","48582000330","BIOTENE ","LIQ DRY MTH","473","Select","Select",""],["","16714029904","AMOXICILLIN ","CAP 500MG","30","Select","Select",""],["","00574041205","POLYETH ","POW 3350 NF","527","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","",""],["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":""}]}]}