{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"AMANDA   J COLLINS","gend":1,"add":"191B NORTH ANGLE  AVENUE                                    ","city":"LEBANON                       ","state":"VA","zip":"24266-4335","dob":"1983-01-08","age":"","mstatus":"","insh":10156021,"cliId":"","pno":2766778137,"cno":2766778137,"email":"","ename":"","eno":"","pphy":"EASTON, BRIAN T                                             ","ppno":"","pcpadd":"60 Town and Country Dr,Ste 14","pcpcity":"Lebanon                       ","pcpstate":"VA","pcpzip":242665409,"pcpcounty":"","pcpid":"P9058505","pcpname":"C HEALTH LEBANON","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"SOUTHWEST","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"193 NORTH ANGLE  AVENUE                                     ","madd2":"                                                            ","madd3":"","mcity":"LEBANON                       ","mstate":"VA","mzip":"24266-4335","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F32.2","E66.01","Z00.8","Z12.4","K21.9","G47.33","K29.60","Z68.43","F32.9","K29.30","K29.50","K31.89","A04.8","R10.11","R53.83","R10.9","K28.1","K80.20","K28.5","E66.9","Z11.59","F17.210","D64.9","R00.1","E87.6","Z68.31","K65.1","K28.9","K80.10","Z48.815","R68.89","K63.2","R50.9","R10.31","Z98.84","Z79.899","R00.0","G89.18","R51","R69","R63.4","R11.0","R93.3","T81.89XA","Z88.8","Z90.49","Z98.0","T81.43XA","Z97.8","Z20.828","Z03.818","N30.00","R25.2","Z33.1","Z87.19","B37.3","R68.84","Z34.91","N91.2","O09.521","Z32.00","N96","Z01.419","Z11.51","Z11.3","Z34.80","Z3A.10","O09.522","O09.292","Z3A.19","Z3A.23","Z34.82","E55.9","O99.810","Z3A.25","O26.892","O23.42","R11.2","O99.332","Z72.0","Z3A.27","Z3A.28","O26.893","Z67.91","O09.523","Z34.93","Z36.9","Z3A.32","F41.9","O09.513","O36.0110","Z3A.33","Z3A.34","O99.343","O99.333","F17.200","O99.013","D50.9","Z3A.35","R35.0","Z36.83","O36.8131","O09.293","Z3A.37","Z23","Z3A.31","O09.93","Z3A.00","O32.8XX0","O76","F43.10","O99.02","O77.0","O99.334","O32.6XX0","Z37.0","O32.1XX0","O64.1XX0","Z37.9","O99.019","Z11.52","Z20.822"],"date":["2019-02-25","2019-04-23","2019-03-12","2021-03-30","2021-02-11","2020-08-01","2019-03-20","2019-03-20","2021-09-16","2019-03-20","2019-03-20","2019-03-20","2019-03-20","2021-09-16","2019-03-26","2021-07-10","2020-08-01","2020-08-01","2020-08-01","2020-08-04","2020-08-01","2021-02-06","2021-09-27","2020-08-01","2020-08-01","2020-08-01","2020-08-04","2020-08-03","2020-08-03","2020-08-03","2020-08-18","2020-08-19","2020-08-22","2020-08-19","2021-09-16","2021-09-16","2020-08-19","2020-08-19","2020-08-19","2020-08-19","2020-08-19","2021-09-16","2020-08-19","2020-08-19","2020-08-19","2021-09-27","2020-08-19","2020-08-22","2020-08-22","2020-08-22","2021-01-04","2021-02-06","2021-02-06","2021-02-11","2021-02-11","2021-02-11","2021-03-03","2021-03-15","2021-03-15","2021-03-30","2021-03-15","2021-03-15","2021-03-30","2021-03-30","2021-03-30","2021-03-30","2021-03-30","2021-07-23","2021-06-25","2021-05-26","2021-06-25","2021-06-25","2021-07-07","2021-08-19","2021-07-10","2021-07-10","2021-07-10","2021-07-10","2021-07-23","2021-07-23","2021-07-23","2021-08-04","2021-09-16","2021-08-04","2021-10-01","2021-09-27","2021-08-26","2021-08-26","2021-09-27","2021-09-02","2021-09-03","2021-09-03","2021-09-09","2021-09-27","2021-09-16","2021-09-16","2021-09-16","2021-09-16","2021-09-27","2021-10-18","2021-09-16","2021-09-23","2021-10-01","2021-10-03","2021-08-19","2021-08-19","2021-08-26","2021-09-23","2021-09-27","2021-10-03","2021-09-27","2021-09-27","2021-10-03","2021-09-27","2021-09-27","2021-10-03","2021-10-03","2021-10-03","2021-10-03","2021-10-18","2021-10-06","2021-10-06"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",null,null]}},{"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":[["","10702001850","OXYCODONE","5MG","20","Select","Select",""],["","68180031909","BUPROPN","150MG XL","30","Select","Select",""],["","00172572860","FAMOTIDINE","20MG","90","Select","Select",""],["","54838001150","FERROUS","15MG\/ML","100","Select","Select",""],["","70700016201","PROGESTERONE","100MG","60","Select","Select",""],["","65862056090","PANTOPRAZOLE","40MG","90","Select","Select",""],["","65862018730","ONDANSETRON","4MG","20","Select","Select",""],["","65862050320","AMOX\/K","875-125","20","Select","Select",""],["","65862001605","AMOXICILLIN","250MG","21","Select","Select",""],["","65862042005","SMZ\/TMP","800-160","14","Select","Select",""],["","00069046956","CHANTIX","1MG","60","Select","Select",""],["","13668001001","CITALOPRAM","20MG","90","Select","Select",""],["","70069000510","CYANOCOBALAM","1000MCG","3","Select","Select",""],["","00135014502","NICODERM","21MG\/24H","28","Select","Select",""],["","00093314705","CEPHALEXIN","500MG","40","Select","Select",""],["","16571020210","DICLOFENAC","50MG DR","60","Select","Select",""],["","00116200116","CHLORHEX","0.12%","473","Select","Select",""],["","49022008444","MICONAZOLE","2%","45","Select","Select",""],["","00193731150","CONTOUR","NEXT","50","Select","Select",""],["","00193730850","BAYER","XT 50CT","50","Select","Select",""],["","00193658621","MICROLET","LANCETS","100","Select","Select",""],["","10702001850","OXYCODONE ","TAB 5MG","20","Select","Select",""],["","68180031909","BUPROPN ","TAB 150MG XL","30","Select","Select",""],["","54838000650","VITAMIN ","DRO 10MCG\/ML","50","Select","Select",""],["","00143962125","CYANOCOBALAM ","INJ 1000MCG","2","Select","Select",""],["","00172572860","FAMOTIDINE ","TAB 20MG","90","Select","Select",""],["","54838001150","FERROUS ","DRO 15MG\/ML","100","Select","Select",""],["","70700016201","PROGESTERONE ","CAP 100MG","60","Select","Select",""],["","65862056090","PANTOPRAZOLE ","TAB 40MG","90","Select","Select",""],["","65862018730","ONDANSETRON ","TAB 4MG","20","Select","Select",""],["","65862050320","AMOX\/K ","TAB 875-125","20","Select","Select",""],["","65862001605","AMOXICILLIN ","CAP 250MG","21","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","14","Select","Select",""],["","00069046956","CHANTIX ","TAB 1MG","60","Select","Select",""],["","13668001001","CITALOPRAM ","TAB 20MG","90","Select","Select",""],["","00135014502","NICODERM ","DIS 21MG\/24H","28","Select","Select",""],["","00093314705","CEPHALEXIN ","CAP 500MG","40","Select","Select",""],["","16571020210","DICLOFENAC ","TAB 50MG DR","60","Select","Select",""],["","00116200116","CHLORHEX ","SOL 0.0012","473","Select","Select",""],["","49022008444","MICONAZOLE ","CRE 0.02","45","Select","Select",""],["","00193731150","CONTOUR ","TES NEXT","50","Select","Select",""],["","00193730850","BAYER ","NE XT 50CT","50","Select","Select",""],["","00193658621","MICROLET ","MIS LANCETS","100","Select","Select",""],["","00363023820","STOOL ","CAP 100MG","20","Select","Select",""],["","00406051205","OXYCOD\/APAP ","TAB 5-325MG","20","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":""}]}]}