{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"HANNAH AMER","gend":1,"add":"361   TRIGG STREET                                          ","city":"ABINGDON                      ","state":"VA","zip":"24210-3447","dob":"1990-05-28","age":"","mstatus":"","insh":10127946,"cliId":"","pno":2766987592,"cno":2766987592,"email":"","ename":"","eno":"","pphy":"HIGINBOTHOM, BRUCE C                                        ","ppno":"","pcpadd":"445 Porterfield Hwy Sw Ste A","pcpcity":"Abingdon                      ","pcpstate":"VA","pcpzip":242102583,"pcpcounty":"","pcpid":"P9058309","pcpname":"ABINGDON FAMILY HEALTHCARE","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"SOUTHWEST","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"361   TRIGG STREET                                          ","madd2":"                                                            ","madd3":"","mcity":"ABINGDON                      ","mstate":"VA","mzip":"24210-3447","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z01.810","Z01.818","Z01.812","Z30.2","R45.0","F41.9","E66.9","Z68.31","Z79.899","R11.10","K59.00","M79.671","S90.30XA","S92.344A","S92.344D","B34.9","J02.9","R05","N92.6","R53.1","R73.01","R53.83","D64.9","N92.1","E28.2","H66.92","N93.8","N80.0","N85.8","K44.9","Z98.51","Z68.32","R30.0","N76.0","B96.89","I74.3","I80.9","I80.8","R10.30","R10.2","I74.8","Z90.710","N20.0","R10.32","N83.202","R79.89","K58.1","K21.9","Z20.828","Z87.442","Z87.09","J45.909","R06.02","R10.84","R91.8","R10.9","K29.50","K31.89","R11.2","K76.0","R31.9","R82.90","R39.9","R31.0","G54.9","G56.00","M54.10","N83.201","M54.5","Z79.01","R69","R31.29","R82.998","T78.40XA","M25.50","N20.2","Z79.02","M79.641","N28.1","N39.0","R19.7","R11.0","R35.0","Z86.718","K11.7","R63.1","R45.86","M19.90","Z82.61","Z80.41","Z80.3","M06.9","M35.9","M54.9","M79.672","M25.541","M25.542","M25.571","M25.572","M60.89","G47.00","E83.118","I82.90","R19.8","E83.119","R07.89","R07.9","R00.0","R07.2","G62.9"],"date":["2019-01-02","2020-09-15","2019-01-02","2019-01-08","2021-04-19","2020-06-09","2020-06-23","2019-07-31","2020-11-03","2019-11-11","2021-08-02","2020-11-20","2020-01-10","2020-01-13","2020-02-03","2020-03-03","2020-03-03","2020-03-03","2020-03-09","2020-07-29","2020-03-09","2021-07-26","2020-09-21","2020-06-23","2020-08-04","2020-04-30","2020-12-09","2020-06-23","2020-06-23","2020-06-23","2020-06-23","2020-06-23","2020-10-28","2020-07-14","2020-07-14","2020-07-28","2020-10-05","2020-07-29","2020-10-28","2020-07-28","2020-07-28","2020-10-28","2021-04-21","2020-10-28","2020-07-28","2020-07-29","2020-07-29","2021-08-02","2020-09-15","2020-07-29","2020-07-29","2020-08-04","2020-07-29","2020-10-28","2020-07-29","2020-10-28","2020-08-01","2020-08-01","2020-08-01","2020-08-02","2020-10-28","2020-08-19","2020-08-19","2020-11-05","2020-08-21","2020-08-21","2020-08-21","2020-08-28","2020-11-20","2020-10-28","2020-08-28","2021-05-04","2020-09-10","2020-09-11","2020-11-20","2020-09-23","2020-09-23","2020-10-01","2020-10-28","2020-10-28","2020-10-28","2020-10-28","2020-10-28","2020-10-28","2020-11-03","2020-11-03","2020-11-03","2020-11-20","2020-12-04","2020-11-17","2020-11-17","2020-11-20","2020-11-20","2020-11-20","2020-11-20","2020-12-04","2020-12-04","2020-12-04","2020-12-04","2021-04-27","2021-07-26","2020-12-09","2020-12-09","2021-02-01","2021-08-02","2021-08-20","2021-06-17","2021-04-19","2021-06-17","2021-07-26"],"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":[["","59267100001","PFIZER","COVID-19","0.3","Select","Select",""],["","69238116609","DOXEPIN","10MG","90","Select","Select",""],["","27241009706","DULOXETINE","20MG","90","Select","Select",""],["","00185012201","NITROFURANTN","100MG","10","Select","Select",""],["","68462010530","ONDANSETRON","4MG","12","Select","Select",""],["","00003376474","ELIQUIS","5MG","74","Select","Select",""],["","64764008060","AMITIZA","8MCG","60","Select","Select",""],["","00378668999","PANTOPRAZOLE","40MG","60","Select","Select",""],["","58160082152","ENGERIX-B","20MCG\/ML","1","Select","Select",""],["","68382013201","TAMSULOSIN","0.4MG","90","Select","Select",""],["","65862001105","SERTRALINE","25MG","30","Select","Select",""],["","58160082652","HAVRIX","1440UNIT","1","Select","Select",""],["","65862042005","SMZ\/TMP","800-160","6","Select","Select",""],["","50111033402","METRONIDAZOL","500MG","14","Select","Select",""],["","00406012305","HYDROCO\/APAP","5-325MG","10","Select","Select",""],["","65862007701","CIPROFLOXACN","500MG","6","Select","Select",""],["","59762005601","MEDROXYPR","10MG","10","Select","Select",""],["","00456120230","LINZESS","290MCG","90","Select","Select",""],["","00406051205","OXYCOD\/APAP","5-325MG","12","Select","Select",""],["","64380080907","IBUPROFEN","400MG","30","Select","Select",""],["","00555901858","TRI-SPRINTEC","","84","Select","Select",""],["","00093005301","BUSPIRONE","5MG","60","Select","Select",""],["","67877056105","METFORMIN","500MG","180","Select","Select",""],["","00591352530","LIDOCAINE","5%","15","Select","Select",""],["","00093314705","CEPHALEXIN","500MG","20","Select","Select",""],["","00172572860","FAMOTIDINE","20MG","180","Select","Select",""],["","68180071160","CEFDINIR","300MG","20","Select","Select",""],["","49281042150","FLUZONE","2021-22","0.5","Select","Select",""],["","59267100001","PFIZER ","INJ COVID-19","0.3","Select","Select",""],["","69238116609","DOXEPIN ","CAP 10MG","90","Select","Select",""],["","27241009706","DULOXETINE ","CAP 20MG","90","Select","Select",""],["","00185012201","NITROFURANTN ","CAP 100MG","10","Select","Select",""],["","68462010530","ONDANSETRON ","TAB 4MG","12","Select","Select",""],["","00003376474","ELIQUIS ","TAB 5MG","74","Select","Select",""],["","64764008060","AMITIZA ","CAP 8MCG","60","Select","Select",""],["","00378668999","PANTOPRAZOLE ","TAB 40MG","60","Select","Select",""],["","58160082152","ENGERIX-B ","INJ 20MCG\/ML","1","Select","Select",""],["","68382013201","TAMSULOSIN ","CAP 0.4MG","90","Select","Select",""],["","65862001105","SERTRALINE ","TAB 25MG","30","Select","Select",""],["","58160082652","HAVRIX ","INJ 1440UNIT","1","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","6","Select","Select",""],["","50111033402","METRONIDAZOL ","TAB 500MG","14","Select","Select",""],["","00406012305","HYDROCO\/APAP ","TAB 5-325MG","10","Select","Select",""],["","65862007701","CIPROFLOXACN ","TAB 500MG","6","Select","Select",""],["","59762005601","MEDROXYPR ","TAB 10MG","10","Select","Select",""],["","00456120230","LINZESS ","CAP 290MCG","90","Select","Select",""],["","00406051205","OXYCOD\/APAP ","TAB 5-325MG","12","Select","Select",""],["","64380080907","IBUPROFEN ","TAB 400MG","30","Select","Select",""],["","00555901858","TRI-SPRINTEC ","TAB ","84","Select","Select",""],["","00093005301","BUSPIRONE ","TAB 5MG","60","Select","Select",""],["","67877056105","METFORMIN ","TAB 500MG","180","Select","Select",""],["","00591352530","LIDOCAINE ","PAD 0.05","15","Select","Select",""],["","00093314705","CEPHALEXIN ","CAP 500MG","20","Select","Select",""],["","00172572860","FAMOTIDINE ","TAB 20MG","180","Select","Select",""],["","68180071160","CEFDINIR ","CAP 300MG","20","Select","Select",""],["","49281042150","FLUZONE ","INJ 2021-22","0.5","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","",""],["N\/A","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":""}]}]}