{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"HEATHER   D GLENN","gend":1,"add":"1950 OAK LEVEL ROAD","city":"BASSETT","state":"VA","zip":"24055-4255","dob":"1983-03-22","age":"","mstatus":"","insh":4103390,"cliId":"","pno":2768066109,"cno":2767905507,"email":"","ename":"","eno":"","pphy":"WATERS, MICHAEL G","ppno":4346562224,"pcpadd":"305 N Main St, ","pcpcity":"Gretna","pcpstate":"VA","pcpzip":245574176,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"1950 OAK LEVEL ROAD","madd2":"                                                            ","madd3":"","mcity":"BASSETT","mstate":"VA","mzip":"24055-4255","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["D68.61","M79.605","M54.42","Z79.01","K52.9","K92.2","R10.9","R11.2","G50.1","K08.89","M51.16","F41.9","J44.9","Z86.718","M79.7","Z79.899","Z87.891","M54.2","R51","G44.219","M51.36","M54.16","G89.29","M51.17","M47.27","M79.18","R07.9","R06.02","Z88.6","Z91.040","Z01.818","N34.2","R79.1","K02.9","Z88.5","Z20.828","Z48.89","Z98.1","R06.00","F17.210","Z71.6","J30.9","R07.81","E55.9","R29.898","G43.009","M54.41","Z71.3","Z71.89","L81.9","J06.9","Z13.6","R07.1","R05","R09.1","Z32.02","Z86.711","Z90.710","Z88.8","R09.89","S80.211A","M54.5","M25.531","W18.30XA","D64.9","D68.62","M62.838","K52.89","K92.1","G43.909","N83.201","Z12.4","I44.4","R94.31","R07.89","R10.33","R19.7","R58","K62.5","Z12.39","G43.111","B37.0","Z01.812","Z01.810","R01.1","R52","M54.89","G43.709","G25.81","R11.0","D62","T45.515A","R31.9","Z87.442","K04.7","J00","S39.92XA","W01.0XXS","M32.9","I26.99","M79.604","R32","M54.30","Z86.69","J01.90","J11.1","R14.0","M79.81","Z12.31","R92.1","S89.91XA","W01.0XXA","Y92.9","Z86.2","Z79.51","Z79.891","R53.83","G89.4","R10.84","A09","S29.9XXA","R39.81","T14.90XA","M25.561","R68.84","R07.2","M54.6","K55.9","S20.221A","Z79.02","U07.1","G47.10","E66.9"],"date":["2021-01-27","2019-03-05","2019-09-16","2021-04-13","2019-03-19","2019-03-20","2020-10-13","2019-10-30","2019-07-18","2020-10-31","2020-07-21","2019-09-25","2021-04-13","2019-09-25","2019-09-25","2021-02-05","2021-04-13","2019-09-26","2019-09-26","2019-10-30","2020-09-21","2020-09-21","2021-04-21","2021-04-21","2021-04-21","2021-02-05","2021-03-07","2021-01-12","2021-03-07","2021-03-07","2020-11-27","2020-10-15","2020-10-15","2020-10-31","2021-03-07","2021-01-12","2021-03-25","2021-03-25","2021-04-13","2020-04-27","2020-04-27","2021-04-13","2021-04-13","2019-11-08","2019-05-22","2020-02-21","2019-09-16","2020-11-24","2020-11-24","2019-10-02","2020-02-09","2020-02-21","2021-03-07","2021-01-12","2020-03-06","2020-03-06","2021-03-07","2020-03-06","2020-10-02","2020-09-29","2020-10-02","2020-10-13","2020-10-02","2020-10-02","2020-10-21","2021-03-29","2019-03-03","2019-03-18","2019-03-18","2020-10-13","2019-03-18","2019-11-08","2020-03-23","2020-03-23","2021-03-07","2019-03-17","2019-09-03","2019-03-18","2019-03-18","2019-11-08","2019-11-08","2019-11-08","2020-03-23","2020-03-23","2020-03-23","2020-10-02","2020-10-02","2021-03-22","2021-03-22","2020-10-09","2020-10-13","2020-10-13","2020-10-13","2020-10-13","2021-03-03","2019-04-06","2019-01-01","2019-01-01","2019-01-01","2019-01-01","2019-01-15","2019-01-15","2019-01-15","2019-01-15","2019-02-09","2019-03-08","2019-03-17","2019-05-18","2019-11-25","2019-11-25","2020-10-02","2020-10-02","2020-10-02","2020-10-02","2020-10-02","2020-10-02","2020-11-24","2021-03-07","2019-03-18","2019-03-18","2019-05-18","2020-07-21","2020-10-02","2020-10-02","2020-12-31","2021-03-07","2019-04-09","2019-04-09","2019-05-18","2019-05-18","2021-01-12","2021-04-13","2021-04-13"],"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":[["","00955100810","ENOXAPARIN ","INJ 80\/0.8ML","11.2","Select","Select",""],["","00093172101","WARFARIN ","TAB 5MG","45","Select","Select",""],["","00406012305","HYDROCO\/APAP ","TAB 5-325MG","60","Select","Select",""],["","67877032105","IBUPROFEN ","TAB 800MG","16","Select","Select",""],["","55111029236","SUMATRIPTAN ","TAB 50MG","9","Select","Select",""],["","00093031401","KETOROLAC ","TAB 10MG","20","Select","Select",""],["","00904759080","FEROSUL ","TAB 325MG","45","Select","Select",""],["","65862001501","AMOXICILLIN ","TAB 875MG","20","Select","Select",""],["","00378064205","PREDNISONE ","TAB 20MG","10","Select","Select",""],["","65162010250","GABAPENTIN ","CAP 300MG","180","Select","Select",""],["","68462010530","ONDANSETRON ","TAB 4MG","30","Select","Select",""],["","52817033200","CYCLOBENZAPR ","TAB 10MG","15","Select","Select",""],["","00781577626","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","00378967130","IPRATROPIUM\/ ","SOL ALBUTER","180","Select","Select",""],["","66993001968","ALBUTEROL ","AER HFA","18","Select","Select",""],["","00054327099","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","69452015120","VITAMIN ","CAP 50000UNT","4","Select","Select",""],["","00310460012","BEVESPI ","AER 9-4.8MCG","10.7","Select","Select",""],["","59651000305","OMEPRAZOLE ","CAP 40MG","30","Select","Select",""],["","59746000103","METHYLPRED ","TAB 4MG","21","Select","Select",""],["","69238126601","OSELTAMIVIR ","CAP 75MG","10","Select","Select",""],["","63304069301","CLINDAMYCIN ","CAP 300MG","40","Select","Select",""],["","65862057490","MONTELUKAST ","TAB 10MG","30","Select","Select",""],["","45802091987","CETIRIZINE ","TAB 10MG","30","Select","Select",""],["","64380071206","BENZONATATE ","CAP 100MG","30","Select","Select",""],["","50428026496","CVS ","TAB 8.6MG","30","Select","Select",""],["","71093014005","METHOCARBAM ","TAB 500MG","60","Select","Select",""],["","00406055201","OXYCODONE ","TAB 5MG","42","Select","Select",""],["","69547035302","NARCAN ","SPR ","2","Select","Select",""],["","00093221001","SUCRALFATE ","TAB 1GM","100","Select","Select",""],["","65862050320","AMOX\/K ","TAB 875-125","20","Select","Select",""],["","00116200116","CHLORHEX ","SOL 0.0012","473","Select","Select",""],["","65862053820","LEVOFLOXACIN ","TAB 750MG","7","Select","Select",""],["","00378034505","DIAZEPAM ","TAB 5MG","5","Select","Select",""],["","60505025203","TIZANIDINE ","TAB 4MG","90","Select","Select",""],["","00574110416","BROM\/PSE\/DM ","SYP ","250","Select","Select",""],["","70710122501","AMITRIPTYLIN ","TAB 10MG","60","Select","Select",""],["","00067003028","BENEFIBER ","POW DRINK MX","28","Select","Select",""],["","65862007701","CIPROFLOXACN ","TAB 500MG","20","Select","Select",""],["","50111033401","METRONIDAZOL ","TAB 500MG","30","Select","Select",""],["","00054414622","CLOTRIMAZOLE ","TRO 10MG","60","Select","Select",""],["","53489011905","DOXYCYCL ","CAP 100MG","10","Select","Select",""],["","00603233832","APAP\/CODEINE ","TAB 300-30MG","10","Select","Select",""],["","00093117410","PENICILLN ","TAB 500MG","40","Select","Select",""],["","49884093547","DICLOFENAC ","GEL 0.01","100","Select","Select",""],["","50428209452","MAG ","SOL LEMON","296","Select","Select",""],["","00832105410","BACLOFEN ","TAB 10MG","90","Select","Select",""],["","00904671960","ACETAMINOPHE ","TAB 325MG","100","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":""}]}]}