{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" VIRGINIA K GREGORY","gend":1,"add":"759 SAND CAVE ROAD","city":"EWING","state":"VA","zip":"24248-8398","dob":"1979-09-25","age":"","mstatus":"","insh":10233369,"cliId":"","pno":"2762065777, 2762065777","cno":"","email":"","ename":"","eno":"","pphy":"YEARY, JOSHUA ADAM","ppno":"               ","pcpadd":"1446 Dr Thomas Walker Rd, ","pcpcity":"Ewing","pcpstate":"VA","pcpzip":242488307,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP - VIRGINIA PREMIER","program":"MEDICAID","lob":"MLTSS","region":"SOUTHWEST","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"759 SAND CAVE ROAD","madd2":"                                                            ","madd3":"","mcity":"EWING","mstate":"VA","mzip":"24248-8398","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R68.89","A41.9","N39.0","E11.42","F43.10","F33.2","J18.9","R06.02","M54.5","I48.91","I10","E66.01","F41.1","E11.65","J96.00","R53.2","J90","I48.19","Z68.43","J91.8","Z79.4","Z71.3","Z20.822","I11.0","I50.9","I50.31","J96.01","E66.9","G40.909","E78.5","Z79.01","F41.9","J45.909","E11.40","R65.20","Y95","E11.621","L97.509","J81.1","Z13.9","Z13.89","Z71.89","Z09","E11.9","E87.1","Z51.81","Z79.899","K52.9","L03.115","R91.8","Z29.9","R51","R79.89","J20.9","J42","Z79.84","R56.9","J44.1","Z20.828","E11.8","R07.2","K04.7","M79.651","B37.2","Z23","Z00.8","M79.605","R06.00","R73.9","R53.83","K05.319","K08.89","G43.009","K02.9","I48.20","Z03.89","R07.9","R00.0","L03.311","R39.9","D73.5","Z86.718","R21","L23.7","R09.89","M25.562","M25.561","M54.2","A40.1","Z11.59","E87.70","L97.519","Z99.81","J18.1","Z45.2","I51.7","K57.30"],"date":["2020-08-05","2021-05-11","2020-06-12","2021-05-07","2020-10-30","2021-01-25","2021-05-11","2021-05-03","2021-01-25","2021-05-11","2021-04-26","2021-05-11","2021-04-21","2021-04-26","2021-04-21","2021-05-03","2021-05-03","2021-04-21","2021-05-03","2021-04-16","2021-04-21","2021-04-16","2021-04-26","2021-05-03","2021-05-04","2021-05-11","2021-05-11","2021-05-03","2021-05-03","2021-05-03","2021-05-03","2021-05-03","2021-05-03","2021-05-03","2021-05-11","2021-05-11","2021-05-11","2021-05-11","2020-05-25","2021-01-25","2021-01-25","2021-01-25","2020-05-26","2021-04-21","2021-04-12","2021-04-26","2021-04-26","2020-05-24","2020-05-24","2021-05-03","2020-05-24","2020-05-24","2020-05-24","2020-06-03","2020-06-03","2020-06-02","2021-04-07","2020-06-02","2020-06-02","2020-06-03","2020-06-11","2020-12-22","2020-06-19","2020-09-16","2020-09-16","2020-09-16","2021-04-21","2020-05-24","2020-06-02","2020-07-16","2020-12-22","2020-12-22","2021-01-25","2021-01-25","2021-04-07","2020-05-24","2020-06-11","2020-06-11","2020-12-07","2020-12-07","2020-06-22","2020-06-22","2020-09-19","2020-09-19","2021-05-03","2020-03-02","2020-03-02","2020-03-02","2020-06-04","2020-06-04","2020-06-04","2020-06-04","2020-06-04","2020-06-10","2020-06-10","2020-06-10","2020-06-10"],"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":[["","98302014059","COMFORT ","MIS 32GX4MM","30","Select","Select",""],["","65862039010","ONDANSETRON ","TAB 4MG ODT","15","Select","Select",""],["","52817018100","CLONIDINE ","TAB 0.2MG","60","Select","Select",""],["","64980028105","GLIPIZIDE ","TAB 10MG","30","Select","Select",""],["","00003089421","ELIQUIS ","TAB 5MG","60","Select","Select",""],["","00456141030","BYSTOLIC ","TAB 10MG","30","Select","Select",""],["","51224022070","METFORMIN ","TAB 1000MG","60","Select","Select",""],["","31722052110","HYDRALAZINE ","TAB 50MG","90","Select","Select",""],["","69315030630","NYSTATIN ","POW 100000","30","Select","Select",""],["","59746033790","LOSARTAN\/HCT ","TAB 50-12.5","60","Select","Select",""],["","00169413212","OZEMPIC ","INJ 2\/1.5ML","1.5","Select","Select",""],["","67877022310","GABAPENTIN ","CAP 300MG","90","Select","Select",""],["","55111018010","TIZANIDINE ","TAB 4MG","60","Select","Select",""],["","00603389032","HYDROCO\/APAP ","TAB 5-325MG","6","Select","Select",""],["","69097012215","TOPIRAMATE ","TAB 25MG","60","Select","Select",""],["","16729000517","SIMVASTATIN ","TAB 20MG","30","Select","Select",""],["","51672208002","TERBINAFINE ","CRE 0.01","30","Select","Select",""],["","51991074710","DULOXETINE ","CAP 30MG","30","Select","Select",""],["","00591352530","LIDOCAINE ","PAD 0.05","30","Select","Select",""],["","49483060350","IBUPROFEN ","TAB 600MG","90","Select","Select",""],["","57237004105","PENICILLN ","TAB 500MG","30","Select","Select",""],["","57599080300","FREESTY ","MIS 2 READER","1","Select","Select",""],["","00002751001","HUMALOG ","INJ 100\/ML","10","Select","Select",""],["","00193731150","CONTOUR ","TES NEXT","100","Select","Select",""],["","00548560400","ENOXAPARIN ","INJ 80\/0.8ML","12.8","Select","Select",""],["","86227030105","SURE ","MIS LANCETS","100","Select","Select",""],["","00088222033","LANTUS ","INJ 100\/ML","10","Select","Select",""],["","00093031401","KETOROLAC ","TAB 10MG","20","Select","Select",""],["","00006027731","JANUVIA ","TAB 100MG","30","Select","Select",""],["","70710114003","FLUCONAZOLE ","TAB 200MG","5","Select","Select",""],["","00169255013","TRESIBA ","INJ 200UNIT","18","Select","Select",""],["","67877021905","CEPHALEXIN ","CAP 500MG","28","Select","Select",""],["","23155000910","HYDROCHLOROT ","TAB 50MG","60","Select","Select",""],["","53489014605","SMZ\/TMP ","TAB 800-160","20","Select","Select",""],["","42799012102","BUMETANIDE ","TAB 2MG","60","Select","Select",""],["","52817036200","METOPROL ","TAB 100MG","90","Select","Select",""],["","08290324912","INSULIN ","MIS 1ML\/31G","100","Select","Select",""],["","00172392670","DIAZEPAM ","TAB 5MG","90","Select","Select",""],["","43547040111","FUROSEMIDE ","TAB 20MG","30","Select","Select",""],["","60505001508","DILT-XR ","CAP 180MG","60","Select","Select",""],["","99073070827","FREESTYLE    TES LITE","TES LITE","100","Select","Select",""],["","16729013716","CLONAZEPAM ","TAB 1MG","28","Select","Select",""],["","00185505001","METOLAZONE ","TAB 2.5MG","30","Select","Select",""],["","00024586903","TOUJEO ","INJ 300IU\/ML","4.5","Select","Select",""],["","00093005405","BUSPIRONE ","TAB 10MG","60","Select","Select",""],["","99073013001","FREESTYLE    MIS LANCETS","MIS LANCETS","100","Select","Select",""],["","23155050105","HYDROXYZ ","TAB 25MG","90","Select","Select",""],["","67877024910","QUETIAPINE ","TAB 50MG","30","Select","Select",""],["","00832532510","POT  CL MICRO","TAB 20MEQ ER","30","Select","Select",""],["","43547028111","ESCITALOPRAM ","TAB 10MG","30","Select","Select",""],["","00245014760","PACERONE ","TAB 200MG","60","Select","Select",""],["","16252051501","CIPROFLOXACN ","TAB 500MG","20","Select","Select",""],["","63402030430","LATUDA ","TAB 40MG","30","Select","Select",""],["","59762501002","CLINDAMYCIN ","CAP 300MG","21","Select","Select",""],["","50742024990","DILTIAZEM ","CAP 180MG ER","60","Select","Select",""],["","69543013611","TRAMADOL ","TAB 50MG","20","Select","Select",""],["","67877021660","CEFUROXIME ","TAB 500MG","10","Select","Select",""],["","16714059101","DIGOXIN ","TAB 0.25MG","30","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":""}]}]}