{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"PATRICE   G GLYMPH-MOORE","gend":1,"add":"102 GREENWOOD LANE","city":"DANVILLE","state":"VA","zip":"24540-1957","dob":"1964-08-03","age":"","mstatus":"","insh":4366138,"cliId":"","pno":4347090580,"cno":4345495988,"email":"","ename":"","eno":"","pphy":"STEPHENS, AMBER","ppno":4347925964,"pcpadd":"2767 Franklin Tpke, ","pcpcity":"Danville","pcpstate":"VA","pcpzip":245405273,"pcpcounty":"","pcpid":"","pcpname":"SOVAH SURGICAL SPECIALISTS","ano":4347132318,"add2":"                                                            ","add3":"","madd1":"102 GREENWOOD LANE","madd2":"                                                            ","madd3":"","mcity":"DANVILLE","mstate":"VA","mzip":"24540-1957","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"WESTERN\/ CHARLOTTESVILLE","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R07.89","E11.65","R35.8","M79.604","Z79.4","R63.4","E78.00","Z88.6","Z88.0","M25.50","Z12.31","R07.9","R27.0","R73.9","M25.561","E11.9","F17.210","E05.90","R10.9","E11.10","E43","Z68.1","E87.1","E86.0","E78.5","I95.89","E04.9","Z98.51","Z09","Z23","M25.562","M25.572","R60.0","M25.571","E03.9","R35.0","R53.1","R51.9","R42","K59.00","E83.52","R20.2","Z79.84","R94.31","E11.40","N17.9","E04.1","E87.6","E83.39","E83.42","Z66","R53.82","M25.461","J20.9","I21.3","R00.0","I95.9","M54.5","H53.8","R20.0","E08.65","E08.40","R00.2","Z53.20","E13.10","I10","Z01.419","R11.0","N32.9","M79.641","L03.115","K29.90","R07.2","N32.89","R64","E87.8","E11.51","E53.8","D50.9","E11.42","Z12.6","Z13.220","R10.32","E07.9","R26.89","R41.82","Z91.14","E08.10","K64.9","R05","K29.70","K29.80","R10.13","H92.01"],"date":["2019-10-11","2021-03-24","2019-05-26","2019-09-28","2021-03-24","2019-06-20","2019-10-11","2019-06-19","2021-03-24","2019-05-29","2019-06-20","2019-06-30","2019-07-11","2019-10-25","2021-03-12","2021-03-12","2019-10-12","2019-11-11","2019-12-21","2019-12-21","2019-10-19","2019-10-19","2019-12-23","2019-10-19","2019-12-21","2019-10-19","2019-10-19","2019-10-19","2019-10-25","2021-03-11","2021-03-12","2021-03-12","2021-03-12","2021-03-12","2021-03-24","2021-03-24","2021-03-24","2021-03-24","2021-03-24","2019-02-05","2019-07-10","2019-09-22","2019-12-21","2019-09-22","2019-09-22","2019-10-12","2019-10-12","2019-10-12","2019-10-12","2019-10-12","2019-10-12","2019-11-11","2021-03-12","2019-02-17","2019-06-30","2019-06-30","2019-07-10","2019-07-06","2019-07-07","2019-09-22","2019-09-22","2019-09-22","2019-10-11","2019-12-18","2019-12-21","2020-01-10","2019-06-20","2019-06-30","2019-06-30","2019-09-14","2019-04-27","2019-06-19","2019-06-30","2019-06-30","2019-07-10","2019-07-10","2020-01-08","2019-11-11","2019-11-11","2019-11-11","2020-01-08","2020-01-08","2019-02-05","2019-05-26","2019-07-07","2019-07-07","2019-10-12","2019-10-12","2019-02-05","2019-02-17","2019-06-19","2019-06-19","2019-12-18","2019-12-18"],"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":[["","70377000712","ROSUVASTATIN ","TAB 10MG","14","Select","Select",""],["","68180051202","LISINOPRIL ","TAB 2.5MG","30","Select","Select",""],["","57237015801","REPAGLINIDE ","TAB 1MG","60","Select","Select",""],["","00088221905","LANTUS ","INJ 100\/ML","15","Select","Select",""],["","08290320122","BD  PEN NEEDL","MIS 32GX4MM","400","Select","Select",""],["","00002751659","HUMALOG ","INJ 100\/ML","15","Select","Select",""],["","00169643810","LEVEMIR ","INJ FLEXTOUC","15","Select","Select",""],["","42806054701","VITAMIN ","CAP 1.25MG","6","Select","Select",""],["","62037056005","POT  CHLORIDE","CAP 10MEQ ER","30","Select","Select",""],["","68645058259","METFORMIN ","TAB 500MG","180","Select","Select",""],["","99073070805","FREESTYLE    MIS LITE","MIS LITE","1","Select","Select",""],["","60505257908","ATORVASTATIN ","TAB 20MG","30","Select","Select",""],["","99073070827","FREESTYLE    TES LITE","TES LITE","100","Select","Select",""],["","99073013001","FREESTYLE    MIS LANCETS","MIS LANCETS","100","Select","Select",""],["","65162027250","SMZ\/TMP ","TAB 800-160","14","Select","Select",""],["","00904645780","DOK ","CAP 100MG","14","Select","Select",""],["","51672401801","ETODOLAC ","TAB 400MG","30","Select","Select",""],["","67877032005","IBUPROFEN ","TAB 600MG","30","Select","Select",""],["","59746017509","PREDNISONE ","TAB 20MG","6","Select","Select",""],["","65862007701","CIPROFLOXACN ","TAB 500MG","14","Select","Select",""],["","47781030301","NITROFURANTN ","CAP 100MG","20","Select","Select",""],["","51672128901","NYSTATIN ","CRE 100000","30","Select","Select",""],["","64980010401","PHOSPHA ","TAB NEUTRAL","6","Select","Select",""],["","65862039010","ONDANSETRON ","TAB 4MG ODT","30","Select","Select",""],["","67877022210","GABAPENTIN ","CAP 100MG","90","Select","Select",""],["","67877057305","BENZONATATE ","CAP 100MG","15","Select","Select",""],["","59310057922","PROAIR ","AER ","8.5","Select","Select",""],["","70710113908","FLUCONAZOLE ","TAB 150MG","1","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":""}]}]}