{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KIMBERLY   S HILL","gend":1,"add":"607 THOMAS BRIDGE ROAD","city":"MARION","state":"VA","zip":"24354-6972","dob":"1992-03-25","age":"","mstatus":"","insh":3244322,"cliId":"","pno":2767810742,"cno":2767810742,"email":"","ename":"","eno":"","pphy":"THOMAS, KARI","ppno":2762288686,"pcpadd":"1375 W Ridge Rd, ","pcpcity":"Wytheville","pcpstate":"VA","pcpzip":243825011,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"SOUTHWEST","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"607 THOMAS BRIDGE ROAD","madd2":"                                                            ","madd3":"","mcity":"MARION","mstate":"VA","mzip":"24354-6972","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["A41.9","J69.0","I95.9","R13.10","R06.03","Z93.1","L98.429","B37.7","N39.0","Q07.02","R53.81","Q07.00","Z91.89","Q05.4","F41.9","R11.0","L30.9","G91.9","J38.02","R13.12","M79.2","Z86.69","G95.0","H53.2","H53.10","H55.00","G50.8","I69.891","M62.81","S33.6XXA","M53.3","W01.0XXA","Z79.899","Z72.0","Q27.30","T17.908D","R49.0","R13.13","Z87.09","K94.23","Z98.2","Z79.891","J38.00","F32.9","Z01.812","Z88.8","Z01.419","Z98.51","N93.9","R10.2","Z12.4","Q07.03","G51.0","R26.81","E46","D72.829","J96.00","Z93.0","R27.0","H51.0","G91.0","R53.1","H51.8","E83.51","R07.9","R50.9","R07.89","R05","R79.89","E86.0","R00.0","R51.9","N30.00","E87.6","J18.9","R06.02","I50.9","R65.21","J96.01","K20.9","F41.8","G44.321","B35.1","E44.0","M20.5X2","Z46.59","T85.518A","R63.3","Z90.49","R11.10","Z97.8","J38.7","J02.9","A60.09","Z43.0","R49.1","Z90.02","R13.11","J06.9","R11.2","R30.0","R09.1","Z87.440","R63.6","R10.31","J40","R09.89","L03.032","L60.0","G93.5","Z43.1","H50.00","R63.4","K52.9","N83.202","N83.201","Q05.9","J96.21","H50.05","H50.21","Z01.818","R10.9","R53.83","Z74.01","R09.3","J98.09","Q28.2","R09.02","K20.8","E43","R19.7","R57.9","L89.151","Z45.41","R49.9","W01.198A","I20.9","R68.89","K59.00","R10.11","R10.12","Z83.49","R42","Z99.81","E88.09","Q07.01","G89.29","E10.9","E78.6","E66.09","E55.9","J04.10","K22.2","Z71.1","E87.5","H57.12","H50.40","R10.84","R06.00","M54.5","M54.40","Z68.1","K21.9","J01.80","G44.329","H50.021","S14.109A","S14.109S","R26.9","R25.2","M79.18","G89.0","R27.8","K21.0","K94.29","A60.00","G47.00","R91.8","Z20.822","T17.990A","R07.0","R51","Z86.79","H05.222","E10.65","E78.5","I15.2","Z96.3","U07.1"],"date":["2019-01-10","2019-02-12","2019-03-14","2021-02-01","2019-01-15","2019-11-25","2019-01-15","2019-02-12","2019-02-12","2019-12-17","2019-03-14","2021-03-05","2019-03-14","2020-11-09","2021-03-05","2021-03-10","2019-03-22","2020-03-04","2019-11-08","2020-01-02","2019-07-08","2019-05-03","2020-11-09","2020-10-23","2019-05-07","2019-05-07","2019-05-07","2019-11-19","2020-03-04","2019-06-03","2019-06-03","2019-06-03","2021-02-01","2019-07-31","2019-06-20","2019-11-19","2020-03-13","2019-06-20","2019-09-19","2019-12-19","2021-03-05","2019-07-31","2019-12-02","2021-02-01","2021-01-25","2020-07-12","2019-09-23","2019-09-30","2019-09-30","2019-09-30","2019-09-24","2019-10-29","2019-10-29","2020-01-21","2020-03-18","2020-03-14","2019-12-02","2020-10-23","2020-11-09","2020-03-04","2019-12-02","2020-03-14","2020-03-05","2020-03-14","2021-03-10","2021-03-05","2021-03-10","2020-07-17","2020-07-17","2021-03-05","2021-03-05","2021-03-05","2021-03-09","2021-03-09","2019-01-06","2021-03-05","2019-01-06","2019-01-06","2019-01-06","2019-05-21","2020-03-04","2019-08-23","2019-04-22","2019-11-08","2019-06-21","2019-07-10","2019-07-10","2020-05-18","2019-07-10","2019-09-11","2019-09-11","2019-11-08","2020-04-10","2020-04-10","2020-06-09","2021-02-19","2021-03-10","2020-05-18","2020-07-12","2021-01-15","2021-03-05","2021-03-05","2021-03-05","2021-03-05","2019-12-17","2019-01-04","2019-01-04","2019-06-21","2019-06-21","2019-07-11","2020-03-04","2021-04-14","2019-08-23","2019-12-14","2019-09-24","2019-09-24","2020-03-12","2020-03-18","2021-04-23","2021-04-23","2021-01-23","2019-12-17","2019-01-04","2019-01-04","2019-01-14","2019-01-14","2019-02-19","2019-11-09","2019-02-19","2019-02-19","2019-09-18","2019-01-06","2019-01-06","2019-02-08","2019-05-22","2019-06-03","2019-09-11","2019-11-13","2019-12-17","2019-12-17","2019-12-17","2020-01-21","2020-03-04","2020-03-04","2020-03-09","2020-10-23","2020-10-23","2021-01-18","2021-01-18","2021-01-18","2021-01-18","2021-02-01","2021-02-01","2021-03-10","2021-03-10","2021-03-10","2021-04-23","2019-01-07","2019-01-11","2019-06-03","2019-06-03","2019-11-08","2021-02-01","2020-02-24","2020-09-12","2020-10-12","2020-11-09","2020-11-09","2020-11-09","2020-11-09","2020-11-09","2020-11-09","2019-01-10","2020-01-21","2019-07-10","2019-08-23","2020-01-21","2020-07-17","2021-01-23","2019-01-11","2020-04-10","2020-09-12","2020-09-12","2020-09-12","2020-10-05","2020-10-05","2020-10-05","2021-02-01","2021-04-18"],"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":[["","64380078706","BUSPIRONE ","TAB 7.5MG","60","Select","Select",""],["","16571040250","CETIRIZINE ","TAB 10MG","30","Select","Select",""],["","65162010250","GABAPENTIN ","CAP 300MG","90","Select","Select",""],["","11917017023","MELATONIN ","TAB 10MG","180","Select","Select",""],["","00172572860","FAMOTIDINE ","TAB 20MG","60","Select","Select",""],["","70710122501","AMITRIPTYLIN ","TAB 10MG","30","Select","Select",""],["","00527133001","BACLOFEN ","TAB 10MG","90","Select","Select",""],["","70700026390","LANSOPRAZOLE ","CAP 30MG DR","90","Select","Select",""],["","00000000000",""," ","120","Select","Select",""],["","24208079535","NEO\/POLY\/DEX ","OIN 0.1% OP","3.5","Select","Select",""],["","61314063705","PREDNISOLONE ","SUS 1% OP","5","Select","Select",""],["","00093314705","CEPHALEXIN ","CAP 500MG","28","Select","Select",""],["","69238110305","IBUPROFEN ","TAB 800MG","60","Select","Select",""],["","45802014303","TRIPLE ","OIN ","28","Select","Select",""],["","43547038003","DULOXETINE ","CAP 30MG","30","Select","Select",""],["","65862001205","SERTRALINE ","TAB 50MG","90","Select","Select",""],["","57237007710","ONDANSETRON ","TAB 4MG ODT","15","Select","Select",""],["","00781577626","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","64380071206","BENZONATATE ","CAP 100MG","15","Select","Select",""],["","68462024901","RANITIDINE ","TAB 300MG","30","Select","Select",""],["","60505530601","ACYCLOVIR ","TAB 400MG","15","Select","Select",""],["","00713022515","TRIAMCINOLON ","CRE 0.001","45","Select","Select",""],["","00406055201","OXYCODONE ","TAB 5MG","10","Select","Select",""],["","00093532862","JUNEL ","TAB 44216","28","Select","Select",""],["","65862001705","AMOXICILLIN ","CAP 500MG","30","Select","Select",""],["","13107003134","MIRTAZAPINE ","TAB 15MG","30","Select","Select",""],["","00904698640","MUCUS ","TAB 600MG ER","30","Select","Select",""],["","69547035302","NARCAN ","SPR ","2","Select","Select",""],["","68382031910","TRAMADOL ","TAB 50MG","30","Select","Select",""],["","52544005872","NORETH\/ETHIN ","CHW FE 1\/20","28","Select","Select",""],["","71351001001","PHOSPHORUS ","POW SUPPLEME","90","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","14","Select","Select",""],["","00338004804","SODIUM ","SOL 0.9% IRR","6,000.00","Select","Select",""],["","76204020025","ALBUTEROL ","NEB 0.00083","75","Select","Select",""],["","00143992801","CIPROFLOXACN ","TAB 500MG","20","Select","Select",""],["","00121085416","SULFATRIM ","SUS 200-40\/5","280","Select","Select",""],["","51293061201","PHENAZOPYRID ","TAB 200MG","6","Select","Select",""],["","00472037915","CLOTRIM\/BETA ","CRE DIPROP","15","Select","Select",""],["","58914017014","CARAFATE ","SUS 1GM\/10ML","1,200.00","Select","Select",""],["","69543026810","VIRT-PHOS ","TAB 250 NEUT","9","Select","Select",""],["","00781613957","AMOX\/K ","SUS 600\/5ML","75","Select","Select",""],["","68180091111","MIBELAS ","CHW FE","28","Select","Select",""],["","00406012305","HYDROCO\/APAP ","TAB 5-325MG","15","Select","Select",""],["","65862018601","CLINDAMYCIN ","CAP 300MG","40","Select","Select",""],["","58657050916","GUAIFENESIN ","LIQ 100\/5ML","120","Select","Select",""],["","00536082585","COUGH ","SYP 100\/5ML","1,800.00","Select","Select",""],["","64980010401","PHOSPHA ","TAB NEUTRAL","51","Select","Select",""],["","10702000350","PROMETHAZINE ","TAB 25MG","12","Select","Select",""],["","70954005930","PREDNISONE ","PAK 10MG","21","Select","Select",""],["","11917011505","MILK ","SUS ","355","Select","Select",""],["","60258000601","PHOS-NAK ","POW CONCENTR","60","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","",""],["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":""}]}]}