{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SARAH   M BARNES","gend":1,"add":"PO BOX 8033","city":"HAMPTON","state":"VA","zip":"23666-8033","dob":"1957-05-07","age":"","mstatus":"","insh":10155744,"cliId":"","pno":7577597072,"cno":7577597072,"email":"","ename":"","eno":"","pphy":"PHILLIPS, CHARLES K","ppno":7575944111,"pcpadd":"12 Bruton Ave, ","pcpcity":"Newport News","pcpstate":"VA","pcpzip":236011602,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"TIDEWATER","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"PO BOX 8033","madd2":"                                                            ","madd3":"","mcity":"HAMPTON","mstate":"VA","mzip":"23666-8033","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["C50.412","Z17.0","C50.812","R07.9","R06.02","R79.89","M79.605","I89.0","Z74.09","I87.2","H16.223","R10.13","R11.2","Z12.11","R14.0","E11.9","Z79.811","I97.2","Z08","Z85.3","D55.9","D72.819","M85.89","N18.9","Z90.710","Z90.722","M75.80","M54.12","M25.561","M25.562","G89.29","M19.042","M65.4","M18.12","M50.30","M25.511","M25.512","M79.642","Z51.81","E55.9","R59.0","N28.89","N28.9","Z90.79","J01.01","H65.01","Z20.822","J45.20","R07.89","M79.662","I10","F41.9","Z79.899","Z79.51","Z88.5","Z88.1","Z92.3","I08.8","I83.899","Z79.4","E78.00","I83.11","T78.40XA","J45.21","M17.0","R22.31","H40.023","H65.412","H92.02","J42","L98.9","W57.XXXA","S40.862A","R29.898","I83.12","N18.3","M85.80","J00","H16.221","H16.222","K63.5","K64.8","Z88.0","J98.4","K21.9","J45.909","Z90.12","Z82.49","E66.09","G89.4","H90.3","H93.13","M26.623","H92.03","R26.89","J20.9","J01.11","H66.92","Z20.828","K59.01","E66.01","Z68.36","K21.0","M25.532","M79.622","Z12.31","H04.213","H40.033","R50.9","R52","Z01.419","N94.9","R30.9","N95.2","B35.6","L29.3","H90.5","R06.00","M75.82","Z23","Q82.0","H57.13","E66.9","Z68.37","Z88.8","Z79.82","J01.10","J06.9","R11.0","B37.2","D12.5"],"date":["2021-05-24","2021-05-24","2020-01-20","2019-04-11","2020-10-02","2019-04-10","2019-04-10","2019-06-12","2019-06-12","2020-12-21","2021-05-12","2019-07-29","2019-07-15","2020-02-11","2019-07-15","2021-04-21","2021-03-01","2020-12-07","2021-03-01","2021-03-01","2019-10-25","2021-03-01","2021-03-01","2019-10-25","2021-01-08","2021-01-08","2020-02-20","2020-07-30","2020-02-25","2020-02-25","2020-06-15","2020-06-10","2020-08-26","2020-08-26","2020-08-10","2020-06-15","2020-06-15","2020-08-10","2020-08-10","2021-03-01","2021-03-01","2020-07-17","2021-05-24","2021-01-08","2021-01-28","2021-02-10","2021-01-28","2021-01-28","2019-04-09","2019-04-11","2021-01-25","2020-02-07","2019-06-05","2019-04-09","2019-07-29","2020-02-07","2019-07-29","2019-04-10","2019-04-16","2020-02-26","2019-06-05","2019-06-11","2019-07-29","2020-10-02","2020-02-03","2020-10-09","2021-04-21","2021-01-25","2021-01-25","2021-01-25","2021-01-25","2021-01-25","2021-01-25","2019-05-07","2019-05-07","2019-08-02","2021-02-15","2019-08-10","2020-04-21","2020-04-21","2020-02-11","2020-02-07","2020-02-07","2020-02-07","2020-02-07","2020-02-07","2020-02-07","2020-02-07","2020-02-07","2020-08-10","2021-02-10","2021-02-10","2021-02-10","2021-02-10","2021-02-10","2020-10-02","2019-12-31","2020-12-30","2020-12-30","2019-06-05","2019-06-05","2019-06-05","2020-02-26","2020-07-23","2020-07-23","2020-12-23","2019-04-01","2019-04-01","2020-10-02","2020-10-02","2021-03-18","2021-03-18","2021-03-18","2021-03-18","2021-03-18","2021-03-18","2021-03-31","2019-04-09","2020-01-08","2020-02-26","2020-12-23","2019-04-01","2019-07-29","2019-07-29","2019-07-29","2019-07-29","2019-08-12","2019-08-12","2019-08-12","2019-08-12","2020-02-07"],"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":[["","68645055354","LISINOPRIL ","TAB 20MG","30","Select","Select",""],["","10702000709","CYCLOBENZAPR ","TAB 10MG","90","Select","Select",""],["","45802005911","NYSTATIN ","CRE 100000","60","Select","Select",""],["","08290320122","BD  PEN NEEDL","MIS 32GX4MM","100","Select","Select",""],["","00228202950","ALPRAZOLAM ","TAB 0.5MG","30","Select","Select",""],["","00093762056","LETROZOLE ","TAB 2.5MG","30","Select","Select",""],["","00088221905","LANTUS ","INJ 100\/ML","6","Select","Select",""],["","00093220401","METOCLOPRAM ","TAB 5MG","40","Select","Select",""],["","00781279010","OMEPRAZOLE ","CAP 20MG","30","Select","Select",""],["","50111078751","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","64380073706","VITAMIN ","CAP 50000UNT","4","Select","Select",""],["","45802014464","HC ","CRE 1-1%","30","Select","Select",""],["","49035030603","EQ ","POW ","510","Select","Select",""],["","23155022701","ACYCLOVIR ","TAB 400MG","25","Select","Select",""],["","65862044930","VALACYCLOVIR ","TAB 1GM","21","Select","Select",""],["","69452014430","BENZONATATE ","CAP 200MG","42","Select","Select",""],["","00186037020","SYMBICORT ","AER 160-4.5","10.2","Select","Select",""],["","00603254421","BUT\/APAP\/CAF ","TAB ","30","Select","Select",""],["","31722070730","FAMCICLOVIR ","TAB 250MG","14","Select","Select",""],["","00054418425","DEXAMETHASON ","TAB 4MG","6","Select","Select",""],["","66993001968","ALBUTEROL ","AER HFA","18","Select","Select",""],["","45802042578","FEXOFENADINE ","TAB 60MG","20","Select","Select",""],["","16729028415","ROSUVASTATIN ","TAB 5MG","30","Select","Select",""],["","68180071160","CEFDINIR ","CAP 300MG","20","Select","Select",""],["","51672126302","NYSTAT\/TRIAM ","CRE ","30","Select","Select",""],["","59746017509","PREDNISONE ","TAB 20MG","10","Select","Select",""],["","68382004001","PROMETHAZINE ","TAB 12.5MG","20","Select","Select",""],["","68382005105","MELOXICAM ","TAB 15MG","30","Select","Select",""],["","00168025846","CLOTRIM\/BETA ","CRE DIPROP","45","Select","Select",""],["","68382060010","POT  CHLORIDE","TAB 10MEQ ER","30","Select","Select",""],["","58160082311","SHINGRIX ","INJ 50\/0.5ML","1","Select","Select",""],["","65862039010","ONDANSETRON ","TAB 4MG ODT","10","Select","Select",""],["","67877022210","GABAPENTIN ","CAP 100MG","40","Select","Select",""],["","00536322210","PAIN ","TAB 325MG","30","Select","Select",""],["","31722072250","LEVOFLOXACIN ","TAB 500MG","7","Select","Select",""],["","69543025216","VIRTUSSIN ","SOL 100-10\/5","120","Select","Select",""],["","00005197102","PREVNAR ","INJ ","0.5","Select","Select",""],["","43598021055","SSD ","CRE 0.01","400","Select","Select",""],["","69097022316","ALENDRONATE ","TAB 35MG","12","Select","Select",""],["","45802013970","METRONIDAZOL ","GEL 0.75%VAG","70","Select","Select",""],["","60505257808","ATORVASTATIN ","TAB 10MG","60","Select","Select",""],["","59630058090","OSPHENA ","60MG","90","Select","Select",""],["","16714079801","SUMATRIPTAN ","100MG","9","Select","Select",""],["","00078091112","XIIDRA ","5%","180","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":""}]}]}