{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CHRISTY   B WRIGHT","gend":1,"add":"41 GLENWOOD LANE","city":"NATIURAL BRIDGE S","state":"VA","zip":"24579-3029","dob":"1981-02-17","age":"","mstatus":"","insh":4253810,"cliId":"","pno":5402911070,"cno":5402911070,"email":"","ename":"","eno":"","pphy":"SAILOR, JANE P","ppno":5404648700,"pcpadd":"25 Northridge Ln Ste 1, ","pcpcity":"Lexington","pcpstate":"VA","pcpzip":244503399,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":5405700303,"add2":"                                                            ","add3":"","madd1":"41 GLENWOOD LANE","madd2":"                                                            ","madd3":"","mcity":"NATIURAL BRIDGE S","mstate":"VA","mzip":"24579-3029","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J45.901","J30.9","J45.909","M72.2","B36.9","Z87.892","Z91.018","L20.9","E66.01","F43.20","K12.2","R06.02","R53.83","R11.0","R09.1","R05","I10","Z01.810","G47.30","K21.9","Z01.818","J45.41","R73.01","E78.5","E55.9","Z11.59","Z11.4","J45.50","G47.33","L20.82","Z99.89","H10.13","E16.2","Z86.2","E56.9","R42","R63.4","Z98.84","M54.2","R68.82","R03.0","R07.81","M41.9","I11.9","K76.0","Z68.42","N39.0","K66.0","J45.40","M19.90","F32.9","F41.9","G43.909","R07.9","J90","J98.11","E03.9","K80.10","K29.00","K82.4","K91.2","Z13.21","J45.20","L30.9","E66.9","Z23","M54.6","N60.02","N64.4","R79.9","E83.51","R09.02","R10.2","R73.9","K44.9","R63.5","M71.571","M21.6X1","M79.671","H81.10","R10.9","R07.89","R79.1","K81.1","R56.9","Z68.38","Z87.01","Z98.0","Z91.89","R94.31","N92.1","E63.9","R73.09","R11.2","R10.11","R10.811","R93.2","R10.84","R93.5","Z00.00","M54.5","J11.1","H66.001","L30.1","K82.9","Z71.3","F41.8","E86.0","K80.80","Z79.899","K80.20","M25.60","J30.89","Z68.41","R16.0","K76.89","Z98.890"],"date":["2019-12-23","2021-05-13","2021-05-26","2019-11-06","2019-05-29","2019-11-13","2019-11-13","2021-05-20","2020-04-10","2019-11-19","2019-12-16","2020-01-12","2020-01-12","2020-04-22","2020-01-15","2020-01-12","2020-10-01","2020-01-28","2021-05-20","2020-04-10","2020-01-28","2021-04-23","2020-09-23","2020-09-23","2021-02-09","2020-09-23","2020-09-23","2021-01-18","2021-01-18","2021-01-18","2021-01-18","2021-04-23","2021-04-09","2021-02-09","2021-02-09","2021-02-10","2021-02-09","2021-02-09","2019-11-20","2019-11-20","2019-11-20","2020-03-01","2020-02-19","2020-02-19","2020-02-19","2020-02-19","2020-02-19","2020-04-10","2020-02-19","2020-02-19","2021-05-20","2020-02-19","2020-02-19","2020-04-07","2020-02-29","2020-02-29","2020-04-07","2020-04-10","2020-04-10","2020-04-10","2021-02-09","2021-02-09","2021-04-23","2019-07-12","2020-10-28","2020-10-01","2020-11-30","2020-12-23","2020-12-23","2021-02-11","2021-02-11","2019-01-24","2019-05-01","2019-05-01","2019-07-23","2019-08-08","2019-11-06","2019-11-06","2019-11-06","2019-12-04","2020-03-01","2020-02-29","2020-03-01","2020-04-10","2020-04-10","2020-04-10","2020-04-10","2020-04-10","2020-04-10","2021-02-05","2021-05-20","2020-04-22","2020-04-22","2020-04-07","2020-04-07","2020-04-07","2020-04-07","2020-04-07","2020-04-07","2020-10-01","2020-10-01","2019-01-11","2019-01-11","2020-07-13","2020-04-10","2019-09-18","2020-02-19","2020-04-07","2020-04-07","2020-04-07","2020-04-07","2020-11-30","2019-01-03","2019-01-03","2019-07-23","2019-07-23","2020-04-22"],"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":[["","13668013701","ESCITALOPRAM ","TAB 20MG","90","Select","Select",""],["","00024591401","DUPIXENT ","INJ 300\/2ML","4","Select","Select",""],["","31722070430","VALACYCLOVIR ","TAB 500MG","30","Select","Select",""],["","45802013132","HALOBETASOL ","OIN 0.0005","50","Select","Select",""],["","45802006535","TRIAMCINOLON ","CRE 0.005","75","Select","Select",""],["","68180030360","CEFUROXIME ","TAB 500MG","20","Select","Select",""],["","69097012203","TOPIRAMATE ","TAB 25MG","60","Select","Select",""],["","43547027310","ROPINIROLE ","TAB 4MG","30","Select","Select",""],["","00378235193","ESOMEPRA ","CAP 40MG DR","30","Select","Select",""],["","00085461001","DULERA ","AER 200-5MCG","13","Select","Select",""],["","68462030529","NORETHINDRON ","TAB 0.35MG","28","Select","Select",""],["","00378064110","PREDNISONE ","TAB 10MG","10","Select","Select",""],["","59746011506","PROCHLORPER ","TAB 10MG","30","Select","Select",""],["","00173068220","VENTOLIN ","AER ","18","Select","Select",""],["","60505025203","TIZANIDINE ","TAB 4MG","10","Select","Select",""],["","00093742698","MONTELUKAST ","TAB 10MG","30","Select","Select",""],["","45802091987","CETIRIZINE ","TAB 10MG","30","Select","Select",""],["","55111029236","SUMATRIPTAN ","TAB 50MG","10","Select","Select",""],["","00115521116","COLESTIPOL ","TAB 1GM","30","Select","Select",""],["","66993001968","ALBUTEROL ","AER HFA","18","Select","Select",""],["","68682000710","DILTIAZEM ","TAB 60MG","60","Select","Select",""],["","00093220305","METOCLOPRAM ","TAB 10MG","90","Select","Select",""],["","00555902658","JUNEL ","TAB 44216","28","Select","Select",""],["","00406012301","HYDROCO\/APAP ","TAB 5-325MG","20","Select","Select",""],["","49884093547","DICLOFENAC ","GEL 0.01","100","Select","Select",""],["","64380080438","RANITIDINE ","TAB 300MG","30","Select","Select",""],["","65862039110","ONDANSETRON ","TAB 8MG ODT","30","Select","Select",""],["","10370010150","BUPROPN ","TAB 150MG XL","30","Select","Select",""],["","67877057305","BENZONATATE ","CAP 100MG","20","Select","Select",""],["","00115169449","EPINEPHRINE ","INJ 0.3MG","2","Select","Select",""],["","69238126601","OSELTAMIVIR ","CAP 75MG","7","Select","Select",""],["","50419077301","CIPRO ","SUS 500MG\/5","100","Select","Select",""],["","65862052305","GABAPENTIN ","TAB 600MG","45","Select","Select",""],["","68180016013","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","68462047301","URSODIOL ","TAB 250MG","60","Select","Select",""],["","00456315467","AEROCHAMBER ","MIS PLUS","1","Select","Select",""],["","66685100200","AMOX\/K ","TAB 500-125","30","Select","Select",""],["","00378797052","IPRATROPIUM ","SOL 0.02%INH","62.5","Select","Select",""],["","65162044210","MECLIZINE ","TAB 25MG","15","Select","Select",""],["","70700012185","TRI-ESTARYLL ","TAB ","28","Select","Select",""],["","59779010112","PAIN ","TAB 500MG","100","Select","Select",""],["","00591565810","CYCLOBENZAPR ","TAB 10MG","7","Select","Select",""],["","58657050016","CODEINE\/GG ","SOL 10-100\/5","120","Select","Select",""],["","51862088603","ERRIN ","TAB 0.35MG","28","Select","Select",""],["","65162019050","NAPROXEN ","TAB 500MG","20","Select","Select",""],["","68180012202","CEPHALEXIN ","500MG","40","Select","Select",""],["","65162052110","PROMETHAZINE ","25MG","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":[[["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":""}]}]}