{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" MARGARET C LANE","gend":1,"add":"957 KIMBLERTOWN ROAD","city":"FORT BLACKMORE","state":"VA","zip":"24250-2925","dob":"1963-03-06","age":"","mstatus":"","insh":10101762,"cliId":"","pno":"2765946894, 2765946894","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":"957 KIMBLERTOWN ROAD","madd2":"                                                            ","madd3":"","mcity":"FORT BLACKMORE","mstate":"VA","mzip":"24250-2925","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M25.541","M25.542","E11.42","K21.9","E03.9","E78.2","M51.36","I10","I70.8","E06.3","I48.0","I50.813","Z79.899","L03.116","L03.115","R40.0","G47.33","Z87.891","I87.2","I83.019","I83.029","E11.40","L97.829","L97.819","R60.0","L97.919","L97.929","G25.81","I25.10","I25.2","K22.2","L03.119","I25.118","R10.2","N95.2","E11.65","Z12.11","Z12.2","R91.8","E01.0","I70.0","M41.84","J43.2","R06.02","I27.20","I50.42","M79.641","M79.642","M18.11","M18.12","Z23","M25.559","G56.01","F17.210","M62.838","E13.51","R25.2","R11.2","L02.91","M79.671","R30.0","B35.1","M25.562","W19.XXXA","Z01.419","R13.14","Z80.0","E11.9","I50.9","Z11.59","J42","R20.0","G56.03","I83.893","M15.9","G56.02","M65.332","Z01.818","L08.9","Z12.39","Z13.820","Z78.0","L89.321","R60.9","G47.19","E87.5","N28.9","Z99.89","G47.34","M72.0","J43.9","F32.2","I20.8","I89.0","Z11.51","N89.8","N89.0","R13.10","J01.40","R93.89","J84.10","R16.0","E04.9","J98.4","Z82.49","I48.91","J45.20","Z72.0","K57.30"],"date":["2019-02-25","2019-02-25","2021-01-06","2020-05-27","2021-01-06","2021-01-06","2020-09-29","2021-01-06","2019-08-12","2021-01-06","2019-04-26","2019-04-26","2021-01-06","2020-05-27","2020-05-27","2019-04-05","2021-02-24","2021-02-12","2021-01-28","2019-05-20","2019-05-20","2020-05-27","2019-04-15","2019-04-15","2019-05-20","2019-05-20","2019-05-20","2019-09-13","2020-09-01","2020-09-01","2020-01-28","2021-01-28","2021-04-07","2019-10-29","2019-11-18","2019-11-18","2020-02-04","2020-02-06","2021-02-24","2020-02-06","2020-02-06","2020-02-06","2021-02-24","2021-02-24","2021-02-24","2021-01-06","2020-08-21","2020-08-21","2020-08-21","2020-08-21","2021-01-06","2021-01-06","2021-02-04","2021-02-24","2019-02-05","2019-02-25","2019-02-25","2019-07-15","2019-08-02","2019-07-15","2019-07-15","2019-07-15","2019-09-13","2019-09-13","2019-09-30","2019-12-12","2019-12-12","2019-12-12","2019-12-12","2020-09-29","2020-09-29","2020-10-05","2020-10-20","2020-12-29","2021-01-20","2021-03-15","2021-03-15","2021-03-17","2019-01-02","2020-05-27","2020-06-30","2020-06-30","2020-05-27","2019-01-02","2019-03-05","2019-06-03","2019-07-12","2019-07-16","2019-09-05","2020-10-20","2019-08-13","2019-08-12","2019-08-12","2019-08-12","2019-09-30","2019-10-29","2019-10-29","2020-01-28","2020-02-18","2019-01-04","2019-01-04","2019-01-04","2019-01-04","2019-01-04","2019-01-07","2019-04-10","2021-02-02","2019-04-05","2020-02-04"],"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":[["","00006057761","JANUMET ","TAB 50-1000","30","Select","Select",""],["","16571020150","DICLOFENAC ","TAB 75MG DR","60","Select","Select",""],["","00378623201","CITALOPRAM ","TAB 20MG","30","Select","Select",""],["","68180051303","LISINOPRIL ","TAB 5MG","30","Select","Select",""],["","65162062711","TRAMADOL ","TAB 50MG","240","Select","Select",""],["","68462025501","ROPINIROLE ","TAB 1MG","30","Select","Select",""],["","59651000205","OMEPRAZOLE ","CAP 20MG","30","Select","Select",""],["","00093506105","HYDROXYZ ","TAB 25MG","90","Select","Select",""],["","65162010250","GABAPENTIN ","CAP 300MG","90","Select","Select",""],["","68382060001","POT  CHLORIDE","TAB 10MEQ ER","30","Select","Select",""],["","00054429731","FUROSEMIDE ","TAB 20MG","30","Select","Select",""],["","00093314705","CEPHALEXIN ","CAP 500MG","30","Select","Select",""],["","69238183901","LEVOTHYROXIN ","TAB 175MCG","30","Select","Select",""],["","00527133001","BACLOFEN ","TAB 10MG","90","Select","Select",""],["","00193658621","MICROLET ","MIS LANCETS","100","Select","Select",""],["","23155017801","ISOSORB ","TAB 60MG ER","30","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","16","Select","Select",""],["","50458058030","XARELTO ","TAB 10MG","5","Select","Select",""],["","00193731150","CONTOUR ","TES NEXT","50","Select","Select",""],["","62332014131","CELECOXIB ","CAP 100MG","60","Select","Select",""],["","55111012405","ATORVASTATIN ","TAB 80MG","30","Select","Select",""],["","52817033200","CYCLOBENZAPR ","TAB 10MG","90","Select","Select",""],["","00378932232","WIXELA ","AER 500\/50","60","Select","Select",""],["","70010077001","METHOCARBAM ","TAB 750MG","30","Select","Select",""],["","29300012410","MELOXICAM ","TAB 7.5MG","90","Select","Select",""],["","00713067115","KETOCONAZOLE ","CRE 0.02","15","Select","Select",""],["","11917003586","CLOTRIMAZOLE ","CRE 0.02","21","Select","Select",""],["","45802011222","MUPIROCIN ","OIN 0.02","22","Select","Select",""],["","66993001968","ALBUTEROL ","AER HFA","18","Select","Select",""],["","31604001718","MAGNESIUM ","TAB 250MG","30","Select","Select",""],["","33332031901","AFLURIA ","INJ 2019-20","0.5","Select","Select",""],["","43598043611","NITROGLYCERN ","SUB 0.4MG","25","Select","Select",""],["","00713031788","CICLOPIROX ","SOL 0.08","6.6","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":""}]}]}