{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" KRISTINA TAYLOR","gend":1,"add":"928 ALLISON GAP ROAD","city":"SALTVILLE","state":"VA","zip":"24370-3567","dob":"1967-06-02","age":"","mstatus":"","insh":10070536,"cliId":"","pno":"2768804632, 2768804632","cno":"","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":"SOUTHWEST","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"928 ALLISON GAP ROAD","madd2":"                                                            ","madd3":"","mcity":"SALTVILLE","mstate":"VA","mzip":"24370-3567","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R59.0","D49.89","D49.1","J98.09","J98.8","Z51.0","C77.1","C34.12","D70.1","D63.0","E87.6","E83.42","N17.9","R11.2","R74.0","H93.12","R63.0","G89.3","R53.83","D47.3","Z51.11","R05","E87.1","R07.9","R06.00","K20.8","B37.0","R93.89","I51.3","J98.11","K57.30","D25.9","C34.90","Z45.2","Z79.01","I10","R79.89","J44.9","C34.92","R30.0","M54.42","M54.41","M54.9","F17.210","G47.34","F32.9","F41.9","Z85.840","R06.02","D77","D72.829","R06.2","Z51.81","M54.6","R19.7","R91.8","J18.9","J44.0","Z85.118","E78.5","Z79.899","J02.9","C34.32","J44.1","E03.9","R59.9","R51","D69.59","R69","H52.4","H52.222","G89.29","J06.9","H04.123","H10.45","Z95.828","K57.90","J84.10","R13.10","H93.19","D72.828","E83.52","C34.82","Z08","J15.6","I34.0","J45.909","J40","I77.89","Z92.21","D64.9"],"date":["2019-04-20","2019-04-19","2019-04-20","2019-04-19","2019-04-19","2019-09-04","2020-06-03","2020-08-03","2020-05-12","2020-05-12","2020-05-12","2020-05-12","2020-05-12","2019-11-11","2020-01-29","2020-01-29","2019-09-04","2020-05-12","2019-12-04","2019-11-11","2019-08-21","2019-07-22","2020-05-12","2019-06-11","2019-06-11","2020-05-12","2020-01-29","2019-07-22","2019-11-13","2019-07-22","2019-10-16","2020-02-13","2020-02-13","2020-12-04","2019-11-13","2020-10-07","2019-09-16","2019-11-14","2020-04-14","2019-10-15","2020-04-14","2020-04-14","2020-06-03","2019-04-20","2019-04-20","2019-04-19","2019-08-16","2019-04-20","2019-07-30","2020-01-29","2020-01-29","2020-01-29","2019-09-16","2020-01-13","2019-11-12","2019-04-23","2019-04-20","2019-04-20","2020-05-12","2019-06-11","2019-06-16","2019-02-05","2019-04-19","2019-08-16","2019-09-16","2019-04-19","2019-04-20","2020-05-12","2019-06-16","2019-11-19","2019-11-19","2020-01-13","2020-01-13","2020-10-07","2020-10-07","2019-10-14","2020-02-13","2020-02-13","2019-12-16","2019-06-16","2019-04-18","2019-04-18","2019-04-19","2019-11-07","2019-04-20","2019-08-13","2019-04-20","2019-04-10","2019-04-18","2020-05-12","2020-05-12"],"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":[["","69315012710","FOLIC ","TAB 1000MCG","30","Select","Select",""],["","43547035611","LISINOPRIL ","TAB 40MG","30","Select","Select",""],["","67253090111","ALPRAZOLAM ","TAB 0.5MG","60","Select","Select",""],["","55111068305","IBU ","TAB 600MG","120","Select","Select",""],["","00591079410","DICYCLOMINE ","CAP 10MG","240","Select","Select",""],["","47781065110","LEVOTHYROXIN ","TAB 100MCG","30","Select","Select",""],["","16729018317","HYDROCHLOROT ","TAB 25MG","30","Select","Select",""],["","45802057178","FEXOFENADINE ","TAB 180MG","30","Select","Select",""],["","55111015905","OMEPRAZOLE ","CAP 40MG","30","Select","Select",""],["","47335090588","QUETIAPINE ","TAB 200MG","30","Select","Select",""],["","65862001305","SERTRALINE ","TAB 100MG","45","Select","Select",""],["","42571025201","CLINDAMYCIN ","CAP 300MG","40","Select","Select",""],["","00054418425","DEXAMETHASON ","TAB 4MG","20","Select","Select",""],["","27808003503","HYDROCO\/APAP ","TAB 5-325MG","90","Select","Select",""],["","00093220305","METOCLOPRAM ","TAB 10MG","20","Select","Select",""],["","69315090410","LORAZEPAM ","TAB 0.5MG","30","Select","Select",""],["","00536110688","NICOTINE ","DIS 7MG\/24HR","28","Select","Select",""],["","00781152610","POT  CHLORIDE","TAB 10MEQ CR","60","Select","Select",""],["","59310057922","PROAIR ","AER ","8.5","Select","Select",""],["","00054023525","MORPHINE ","TAB 15MG","30","Select","Select",""],["","00591352530","LIDOCAINE ","PAD 0.05","30","Select","Select",""],["","69547035302","NARCAN ","SPR ","2","Select","Select",""],["","00000000000",""," ","400","Select","Select",""],["","65862064163","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","67877057305","BENZONATATE ","CAP 100MG","15","Select","Select",""],["","60432053716","NYSTATIN ","SUS 100000","473","Select","Select",""],["","00003089421","ELIQUIS ","TAB 5MG","60","Select","Select",""],["","00173068220","VENTOLIN ","AER ","18","Select","Select",""],["","67877032001","IBUPROFEN ","TAB 600MG","120","Select","Select",""],["","00172572880","FAMOTIDINE ","TAB 20MG","60","Select","Select",""],["","00487950125","ALBUTEROL ","NEB 0.00083","375","Select","Select",""],["","00603107558","CHERATUSSIN ","SYP AC","120","Select","Select",""],["","59267100001","PFIZER ","INJ COVID-19","0.3","Select","Select",""],["","00143973801","PREDNISONE ","TAB 20MG","10","Select","Select",""],["","00904667840","OXYCODONE ","SOL 5MG\/5ML","240","Select","Select",""],["","67877019810","AMLODIPINE ","TAB 5MG","30","Select","Select",""],["","55111028130","LEVOFLOXACIN ","TAB 750MG","9","Select","Select",""],["","00781572005","POT  CL MICRO","TAB 20MEQ ER","30","Select","Select",""],["","63824000832","MUCINEX ","TAB 600MG ER","20","Select","Select",""],["","65862039110","ONDANSETRON ","TAB 8MG ODT","40","Select","Select",""],["","00069047103","CHANTIX ","PAK 0.5& 1MG","53","Select","Select",""],["","67405055055","DOXYCYCL ","TAB 100MG","20","Select","Select",""],["","68382077277","LANSOPRAZOLE ","TAB 30MG ODT","60","Select","Select",""],["","58914017014","CARAFATE ","SUS 1GM\/10ML","420","Select","Select",""],["","50383077916","LACTULOSE ","SOL 10GM\/15","473","Select","Select",""],["","00186037020","SYMBICORT ","AER 160-4.5","10.2","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":""}]}]}