{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CHERYL   G HARRISS","gend":1,"add":"PO BOX 3731","city":"CHESTER","state":"VA","zip":"23831-9998","dob":"1972-08-03","age":"","mstatus":"","insh":10119375,"cliId":"","pno":8042439127,"cno":8042931364,"email":"","ename":"","eno":"","pphy":"VILLANUEVA, JOHN G","ppno":8044525800,"pcpadd":"8380 BOYDTON PLANK ROAD, ","pcpcity":"PRINCE GEORGE","pcpstate":"VA","pcpzip":238751400,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"CENTRAL","aligned":"","ano":8042931364,"add2":"PO BOX 430","add3":"","madd1":"PO BOX 3731","madd2":"PO BOX 430","madd3":"","mcity":"CHESTER","mstate":"VA","mzip":"23831-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R68.89","S70.02XA","M25.552","W00.0XXA","M54.32","F17.210","Z88.8","R07.89","W18.30XA","I10","J44.9","E66.9","F32.9","F17.200","Z68.39","K57.30","R16.1","F33.1","R51","R07.2","W19.XXXA","F41.9","R94.31","N39.3","N39.41","N39.0","R35.1","Z87.442","R07.9","K57.92","R10.9","J45.909","F39","F31.9","Z88.5","Z79.899","G89.29","K76.0","F11.90","R45.851","F33.2","W06.XXXA","Y92.89","M54.9","J43.9","S90.121A","E11.9","R05","K29.00","Z88.6","S09.90XA","W01.0XXA","M54.2","M19.90","K57.90","R16.2","Z90.710","M94.0","Z76.5","Z79.84","F11.11","F31.30","D69.6","F41.1","F43.10","F60.0","G89.4","E78.5","Z68.33","R09.02","K70.30","E11.65","Z79.4","Z79.51","Z79.82","Z91.11","R06.02","F31.0","M54.6","M54.5","Z04.3","C44.619","K52.9","K75.81","F41.8","F10.20","Z98.51","S90.122A","E87.6","Z12.31","N64.89","R92.2","R00.0","R52","I49.9","Y92.007","R29.6","M79.605","S99.921A","M25.579","F32.3","Z71.89","Z71.3","M79.7","R73.9","Z91.041","I20.0","J44.1","R11.0","R04.0","R14.0","R61","I36.1","I27.20","K74.60","F31.32","F60.9","S39.82XA","I51.7","I35.1","I11.0","I50.32","W06.XXXD","R10.84","K64.9","N32.89","E78.2","R73.09","J20.9","S30.0XXA","Z68.34","M54.16","M89.38","K57.32","F20.9","M79.671","R93.6","M25.562","M79.89","R10.32","M54.40","Z72.89","R11.2","W01.198A","F34.9","A41.9","J96.01","Z20.828","E11.10","J18.9","J44.0","F10.96","D72.819","J45.901","Z72.0","R91.8","R65.20","F10.10","K76.9","R10.30","S10.93XA","Y93.89","R68.83","R07.81","M25.521","B37.2","R30.0","W10.8XXA","I48.91","I25.10","M54.42","R53.1","K21.9","S41.002A","R10.12","X58.XXXA","D61.818","R19.7","K62.5","R10.31","R10.11","L98.9","B37.3","G89.18","M25.512","R35.0","R31.9","W22.8XXA","Z68.35","S06.9X1A","W18.39XA","M54.17","L98.499","L65.9","T14.90XA","K76.89","K82.8","R06.89","R10.13","Z53.29","S13.4XXA","S23.3XXA","S33.5XXA","Z79.01","R51.9","R00.2","E83.51","Z91.14","K92.1","S53.401A","S20.211A","J98.11","Q79.1","M48.8X6","M48.8X7","M46.06","R16.0","M79.674","M25.40","S90.31XA","R30.9","R93.2","S19.9XXA","S80.12XA","S13.4XXD","I78.1","D48.5","D12.2","R93.5","Z88.9","R42","M48.00","Z87.891","S99.919A","T30.0","F29","Z91.81","K29.70","F41.0","R32","Y92.009","S20.20XA","R06.2","K42.9","R93.421","S39.92XA","G44.309","S41.002D","E66.01","Z71.6","E78.00"],"date":["2021-02-17","2019-01-14","2020-02-10","2019-01-14","2019-01-14","2021-05-18","2020-10-01","2021-05-11","2020-08-18","2021-02-17","2021-05-11","2021-02-17","2020-11-15","2021-05-11","2019-03-07","2021-02-17","2020-10-19","2020-11-30","2020-09-12","2021-04-09","2021-01-01","2021-05-11","2021-05-11","2019-05-21","2020-12-18","2021-05-18","2019-05-21","2021-05-18","2021-05-11","2019-07-08","2021-05-18","2021-05-18","2019-06-16","2021-02-17","2020-10-01","2021-05-18","2021-04-09","2021-05-18","2019-07-01","2020-09-18","2020-09-22","2021-01-01","2020-10-01","2020-10-19","2019-10-03","2021-01-01","2021-02-17","2020-05-23","2020-01-24","2020-09-18","2020-02-27","2020-02-10","2020-09-03","2020-10-20","2021-02-03","2021-05-18","2020-10-19","2020-02-16","2021-05-11","2020-04-22","2020-03-13","2020-10-19","2021-05-18","2020-09-18","2020-05-21","2020-03-17","2020-05-23","2021-05-11","2020-05-20","2020-05-07","2020-05-15","2021-05-18","2021-04-09","2021-05-11","2021-05-11","2020-05-15","2021-05-11","2020-09-03","2020-09-03","2020-10-01","2020-08-18","2020-11-16","2020-10-20","2020-10-19","2021-02-17","2020-10-19","2020-10-19","2021-01-01","2021-05-11","2019-04-05","2019-04-19","2019-04-19","2021-05-11","2021-02-03","2019-07-27","2019-08-17","2019-08-17","2020-08-18","2019-09-29","2019-10-04","2019-10-04","2020-07-29","2020-07-29","2019-12-30","2019-12-30","2019-12-30","2021-04-09","2020-05-08","2021-04-09","2020-04-22","2020-07-14","2020-04-22","2020-05-06","2020-05-06","2020-05-15","2020-05-21","2020-05-21","2020-08-18","2020-09-14","2021-02-17","2021-01-01","2021-01-01","2021-01-01","2021-05-18","2021-02-03","2019-01-24","2020-07-29","2019-11-15","2019-03-18","2020-08-18","2019-06-11","2020-09-03","2019-04-27","2019-06-11","2019-09-13","2019-10-04","2019-10-04","2019-10-04","2019-10-04","2020-08-13","2019-11-15","2019-12-30","2020-01-14","2020-02-27","2020-03-17","2020-05-08","2020-05-08","2020-05-05","2020-05-06","2020-06-04","2020-05-05","2020-05-05","2020-05-05","2020-05-07","2020-05-07","2020-05-06","2020-05-08","2021-02-17","2020-06-10","2020-08-13","2020-08-18","2020-10-01","2019-01-24","2019-03-02","2019-03-02","2019-03-12","2020-08-13","2019-03-23","2019-09-13","2019-09-13","2019-11-15","2019-12-12","2020-09-18","2020-01-07","2020-01-07","2020-01-07","2020-04-15","2020-10-19","2020-10-19","2020-07-14","2021-05-18","2020-07-29","2020-08-13","2020-11-06","2020-11-06","2019-02-21","2019-02-21","2019-07-27","2019-07-27","2019-08-17","2019-08-17","2020-01-14","2020-01-24","2020-01-24","2020-02-27","2021-05-18","2021-05-18","2020-05-05","2021-02-17","2020-08-08","2020-08-28","2020-08-28","2020-08-28","2020-09-12","2020-10-19","2021-05-11","2021-05-11","2021-05-11","2021-05-18","2019-03-02","2019-03-02","2019-03-18","2019-03-18","2019-04-27","2019-04-27","2019-04-27","2019-05-12","2019-09-29","2019-09-29","2019-09-29","2019-10-16","2019-10-16","2020-02-27","2020-08-18","2020-09-07","2020-09-23","2020-09-23","2020-10-19","2020-10-19","2020-11-15","2021-04-09","2020-10-01","2019-09-24","2019-09-29","2020-03-17","2020-05-21","2020-10-01","2021-02-17","2021-02-17","2019-02-21","2019-02-26","2019-03-02","2019-03-02","2019-06-11","2019-06-11","2019-08-17","2019-12-30","2020-01-07","2020-03-04","2020-03-04","2020-09-18"],"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":[["","70377002811","ATORVASTATIN ","TAB 20MG","30","Select","Select",""],["","70436001102","BUPROPN ","TAB 300MG XL","30","Select","Select",""],["","00006011231","JANUVIA ","TAB 50MG","30","Select","Select",""],["","68180098003","LISINOPRIL ","TAB 10MG","30","Select","Select",""],["","00093816201","QUETIAPINE ","TAB 100MG","30","Select","Select",""],["","67877032005","IBUPROFEN ","TAB 600MG","15","Select","Select",""],["","00603497528","OXYBUTYNIN ","TAB 5MG","20","Select","Select",""],["","16729013716","CLONAZEPAM ","TAB 1MG","60","Select","Select",""],["","53746010901","HYDROCO\/APAP ","TAB 5-325MG","15","Select","Select",""],["","00591352530","LIDOCAINE ","PAD 0.05","30","Select","Select",""],["","42858010201","OXYCOD\/APAP ","TAB 5-325MG","10","Select","Select",""],["","65162083366","DICLOFENAC ","GEL 0.01","100","Select","Select",""],["","10702001801","OXYCODONE ","TAB 5MG","10","Select","Select",""],["","63824000832","MUCINEX ","TAB 600MG ER","20","Select","Select",""],["","65162062711","TRAMADOL ","TAB 50MG","5","Select","Select",""],["","70010077005","METHOCARBAM ","TAB 750MG","18","Select","Select",""],["","00597007541","SPIRIVA ","CAP HANDIHLR","30","Select","Select",""],["","50111043301","TRAZODONE ","TAB 50MG","30","Select","Select",""],["","68180016006","AZITHROMYCIN ","TAB 250MG","5","Select","Select",""],["","00085720601","DULERA ","AER 100-5MCG","13","Select","Select",""],["","00193731221","CONTOUR ","TES NEXT","100","Select","Select",""],["","00093317431","ALBUTEROL ","FAT E","8.5","Select","Select",""],["","00088221905","LANTUS ","INJ 100\/ML","30","Select","Select",""],["","70710113803","FLUCONAZOLE ","TAB 100MG","1","Select","Select",""],["","29300012510","MELOXICAM ","TAB 15MG","30","Select","Select",""],["","50428085942","PREP ","PAD ","100","Select","Select",""],["","68382075810","METFORMIN ","TAB 500MG","60","Select","Select",""],["","65862050220","AMOX\/K ","TAB 500-125","20","Select","Select",""],["","68462010530","ONDANSETRON ","TAB 4MG","10","Select","Select",""],["","50111033401","METRONIDAZOL ","TAB 500MG","28","Select","Select",""],["","45802088830","OMEPRAZOLE ","TAB 20MG","56","Select","Select",""],["","00536123441","ASPIRIN ","TAB 81MG EC","30","Select","Select",""],["","65862007701","CIPROFLOXACN ","TAB 500MG","14","Select","Select",""],["","08290320109","BD  PEN NEEDL","MIS 31GX8MM","100","Select","Select",""],["","00143312601","DICYCLOMINE ","CAP 10MG","20","Select","Select",""],["","00193654621","BAYER ","MIS LANCETS","100","Select","Select",""],["","43598043611","NITROGLYCERN ","SUB 0.4MG","100","Select","Select",""],["","50428028552","ACETAMINOPHN ","TAB 500MG","20","Select","Select",""],["","50428026496","CVS ","TAB 8.6MG","15","Select","Select",""],["","69547035302","NARCAN ","SPR ","2","Select","Select",""],["","00832105410","BACLOFEN ","TAB 10MG","90","Select","Select",""],["","00093101042","MUPIROCIN ","OIN 0.02","22","Select","Select",""],["","68180012202","CEPHALEXIN ","CAP 500MG","21","Select","Select",""],["","70710122701","AMITRIPTYLIN ","TAB 50MG","90","Select","Select",""],["","50428030894","MELATONIN ","CAP 10MG","30","Select","Select",""],["","43598075201","BUPROPION ","TAB 150MG SR","60","Select","Select",""],["","00316022115","NYSTATIN ","CRE 100000","15","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","10","Select","Select",""],["","00536589688","NICOTINE ","DIS 21MG\/24H","28","Select","Select",""],["","62175061743","PANTOPRAZOLE ","TAB 40MG","60","Select","Select",""],["","10572030201","PEG-3350\/KCL ","SOL \/SODIUM","4,000.00","Select","Select",""],["","43386031208","GAVILAX ","","238","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","",""],["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":""}]}]}