{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" CYNTHIA A FLORIA","gend":1,"add":"PO BOX 235","city":"FERRUM","state":"VA","zip":"24088-0235","dob":"1966-05-12","age":"","mstatus":"","insh":4194866,"cliId":"","pno":"5403652070, 5402431606","cno":"","email":"","ename":"","eno":"","pphy":"HAYES, BRITTANY B","ppno":"               ","pcpadd":"390 S Main St Ste 201, ","pcpcity":"Rocky Mount","pcpstate":"VA","pcpzip":241511767,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP - VIRGINIA PREMIER","program":"MEDICAID","lob":"MLTSS","region":"ROANOKE","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"PO BOX 235","madd2":"                                                            ","madd3":"","mcity":"FERRUM","mstate":"VA","mzip":"24088-0235","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J96.10","R53.81","J44.9","G47.33","J44.1","J96.21","J96.22","I50.33","E66.01","E03.9","F32.9","J98.4","R09.02","E66.9","I50.20","Z99.81","R10.13","J96.11","R68.89","R91.8","I13.0","I27.81","Z68.43","N18.9","E87.6","E78.5","F41.9","K22.70","I07.1","R60.0","Z23","R35.0","J96.01","R06.02","Z79.899","F17.210","R93.89","K21.0","R06.00","R10.9","I50.32","R30.0","F33.41","E55.9","R59.0","G47.30","G25.81","G47.00","I50.31","R63.5","I50.9","E78.00","Z68.42","F33.1","H10.13","I51.89","N17.9","Z68.44","I48.92","R91.1","J98.11","J43.9","J98.09","I25.10","D17.4","I70.0","R16.1","J45.909","I10","Z87.891","Z09","I27.20","R53.1","K21.9","F41.1","K76.0","R16.0","K83.8","E87.3","L03.115","L03.116","R60.9","M54.9","I11.0","R50.9","Z82.49","E87.8","Z53.20","Z86.14","Z02.89","Z72.821","Z99.89"],"date":["2020-12-27","2020-10-06","2021-05-03","2021-03-19","2020-08-26","2020-07-17","2019-12-24","2020-08-25","2021-03-22","2021-03-22","2019-12-24","2019-12-24","2020-02-27","2020-08-26","2020-02-27","2020-08-12","2020-01-17","2021-03-22","2020-01-21","2021-02-10","2020-08-12","2020-06-10","2020-08-12","2020-08-12","2020-08-12","2020-08-03","2020-08-12","2020-06-10","2020-06-11","2020-08-11","2020-09-30","2021-02-17","2019-12-18","2020-07-15","2020-06-12","2019-12-19","2019-12-19","2020-06-17","2020-07-15","2020-08-12","2021-03-22","2020-02-24","2020-02-24","2021-03-22","2020-04-17","2020-06-23","2020-06-26","2020-06-26","2020-07-15","2020-08-11","2020-08-12","2019-09-05","2021-03-22","2020-04-27","2019-09-16","2019-12-19","2019-12-24","2019-12-19","2020-06-11","2020-08-03","2020-08-03","2020-08-03","2020-08-03","2020-08-03","2020-08-03","2020-08-03","2020-08-03","2020-08-03","2020-08-12","2021-03-22","2020-08-25","2021-02-10","2019-12-24","2021-03-22","2021-03-22","2020-01-16","2020-01-16","2020-01-16","2020-08-12","2020-08-12","2020-08-12","2020-08-12","2020-08-12","2020-09-25","2019-12-18","2020-06-12","2020-07-16","2020-07-16","2020-07-16","2020-08-25","2020-08-26","2020-08-28"],"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":[["","00832054111","BUMETANIDE ","TAB 1MG","180","Select","Select",""],["","00378181510","LEVOTHYROXIN ","TAB 150MCG","30","Select","Select",""],["","00173088210","BREO ","INH 200-25","60","Select","Select",""],["","00054327099","FLUTICASONE ","SPR 50MCG","48","Select","Select",""],["","59676058015","JANSSEN ","INJ COVID-19","0.5","Select","Select",""],["","00173087310","INCRUSE ","INH 62.5MCG","90","Select","Select",""],["","62175061743","PANTOPRAZOLE ","TAB 40MG","180","Select","Select",""],["","65862039010","ONDANSETRON ","TAB 4MG ODT","30","Select","Select",""],["","53746010901","HYDROCO\/APAP ","TAB 5-325MG","20","Select","Select",""],["","69452015120","VITAMIN ","CAP 50000UNT","4","Select","Select",""],["","00378021610","FUROSEMIDE ","TAB 40MG","60","Select","Select",""],["","13668008190","MONTELUKAST ","TAB 10MG","30","Select","Select",""],["","16729020001","BUSPIRONE ","TAB 5MG","90","Select","Select",""],["","00527221537","METOLAZONE ","TAB 2.5MG","30","Select","Select",""],["","00173088710","TRELEGY ","AER ELLIPTA","60","Select","Select",""],["","51293081001","PHENAZOPYRID ","TAB 100MG","6","Select","Select",""],["","53746051101","SPIRONOLACT ","TAB 25MG","30","Select","Select",""],["","00245531911","KLOR-CON ","TAB 20MEQ ER","60","Select","Select",""],["","00378967130","IPRATROPIUM\/ ","SOL ALBUTER","360","Select","Select",""],["","71093014005","METHOCARBAM ","TAB 500MG","28","Select","Select",""],["","00378064110","PREDNISONE ","TAB 10MG","12","Select","Select",""],["","53489011905","DOXYCYCL ","CAP 100MG","10","Select","Select",""],["","68180071160","CEFDINIR ","CAP 300MG","20","Select","Select",""],["","43547026810","ROPINIROLE ","TAB 0.25MG","60","Select","Select",""],["","00597007541","SPIRIVA ","CAP HANDIHLR","30","Select","Select",""],["","13668013601","ESCITALOPRAM ","TAB 10MG","30","Select","Select",""],["","70710113908","FLUCONAZOLE ","TAB 150MG","1","Select","Select",""],["","00472016630","NYSTATIN ","OIN 100000","30","Select","Select",""],["","50428016183","CVS ","CAP 2000UNIT","90","Select","Select",""],["","68180032201","ESZOPICLONE ","TAB 1MG","30","Select","Select",""],["","47781030301","NITROFURANTN ","CAP 100MG","10","Select","Select",""],["","65862007701","CIPROFLOXACN ","TAB 500MG","14","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","",""],["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":""}]}]}