{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CHERYL   M WHITLEY","gend":1,"add":"100 PRINCESS ANNE STREET","city":"FREDERICKSBURG","state":"VA","zip":"22401-6143","dob":"1989-07-02","age":"","mstatus":"","insh":4742316,"cliId":"","pno":5406427889,"cno":5406427889,"email":"","ename":"","eno":"","pphy":"ALEXANDER, DAWN","ppno":5407109100,"pcpadd":"231 Garrisonville Rd, Ste 101","pcpcity":"Stafford","pcpstate":"VA","pcpzip":225541604,"pcpcounty":"","pcpid":"","pcpname":"SPOTSYLVANIA MULTI SPECIALTY G","ano":"","add2":"APT 125","add3":"","madd1":"100 PRINCESS ANNE STREET","madd2":"APT 125","madd3":"","mcity":"FREDERICKSBURG","mstate":"VA","mzip":"22401-6143","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"CENTRAL","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I89.0","E11.9","I10","Z79.84","Z79.899","Z30.017","E66.01","F41.8","M25.572","F50.81","M77.41","Z20.828","R60.9","M79.672","F41.9","Z01.411","E28.2","L97.912","Z87.891","R30.0","Z03.818","J01.10","R05","G44.209","K12.0","M25.50","N91.5","D50.9","M76.72","S82.92XB","R26.89","T81.42XA","L03.115","B95.62","B96.5","T81.31XA","S89.301D","E11.40","M48.00","F32.9","T82.42XA","L02.611","A49.02","M72.2","S82.64XD","R00.0","R53.83","R11.2","R19.7","A08.4","J06.9","H69.81","M25.562","M25.471","Z11.1","R51.9","J40","M84.371A","D64.9","S93.431D","Z98.890","E55.9","F43.0","L60.1","M25.571","R34","Z30.011","Z30.46","R23.4","Z23","L60.3","M77.42"],"date":["2021-02-05","2021-02-05","2021-02-05","2020-09-01","2019-02-19","2019-11-01","2020-12-17","2021-02-05","2020-01-28","2021-02-05","2020-10-21","2021-02-25","2021-02-05","2020-01-16","2020-09-01","2019-07-30","2019-08-27","2020-07-31","2020-09-01","2020-09-17","2021-02-25","2019-02-21","2019-02-21","2019-02-21","2019-05-29","2019-05-29","2019-08-27","2019-08-27","2020-01-28","2020-09-01","2020-09-01","2020-06-01","2020-06-01","2020-06-01","2020-06-01","2020-06-01","2020-06-01","2020-06-01","2020-06-01","2020-06-01","2020-06-01","2020-06-06","2020-06-06","2020-08-26","2020-09-25","2020-09-01","2021-02-25","2019-01-15","2019-01-15","2019-01-15","2019-01-17","2019-01-17","2020-07-02","2021-03-24","2021-01-12","2021-02-25","2019-02-12","2020-06-05","2020-08-28","2020-09-25","2020-09-25","2020-08-28","2020-09-03","2020-09-25","2020-09-25","2020-10-06","2019-01-08","2020-10-23","2021-03-24","2020-10-21","2021-03-24","2021-03-24"],"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":[["","00143992950","CIPROFLOXACN ","TAB 750MG","52","Select","Select",""],["","00378020810","FUROSEMIDE ","TAB 20MG","60","Select","Select",""],["","49884051303","MINOCYCLINE ","TAB 100MG","60","Select","Select",""],["","00093310905","AMOXICILLIN ","CAP 500MG","60","Select","Select",""],["","65162083366","DICLOFENAC ","GEL 0.01","200","Select","Select",""],["","13107015590","PAROXETINE ","TAB 20MG","30","Select","Select",""],["","00193731150","CONTOUR ","TES NEXT","100","Select","Select",""],["","70710113908","FLUCONAZOLE ","TAB 150MG","1","Select","Select",""],["","59417010610","VYVANSE ","CAP 60MG","30","Select","Select",""],["","55111015810","OMEPRAZOLE ","CAP 20MG","180","Select","Select",""],["","13107008305","LORAZEPAM ","TAB 0.5MG","10","Select","Select",""],["","55111029236","SUMATRIPTAN ","TAB 50MG","12","Select","Select",""],["","13668001105","CITALOPRAM ","TAB 40MG","30","Select","Select",""],["","00591565810","CYCLOBENZAPR ","TAB 10MG","30","Select","Select",""],["","00193654621","BAYER ","MIS LANCETS","100","Select","Select",""],["","68180051901","LISINOP\/HCTZ ","TAB 20-12.5","30","Select","Select",""],["","50428053560","SERIES ","MIS BLOOD PR","1","Select","Select",""],["","67877032105","IBUPROFEN ","TAB 800MG","90","Select","Select",""],["","69097094312","GABAPENTIN ","CAP 300MG","180","Select","Select",""],["","53746010901","HYDROCO\/APAP ","TAB 5-325MG","12","Select","Select",""],["","64380080307","RANITIDINE ","TAB 150MG","60","Select","Select",""],["","68382076010","METFORMIN ","TAB 1000MG","60","Select","Select",""],["","10702001150","HYDROXYZ ","TAB 25MG","45","Select","Select",""],["","63304069301","CLINDAMYCIN ","CAP 300MG","21","Select","Select",""],["","50458058030","XARELTO ","TAB 10MG","30","Select","Select",""],["","47781030301","NITROFURANTN ","CAP 100MG","14","Select","Select",""],["","68180016013","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","00603533815","PREDNISONE ","PAK 10MG","21","Select","Select",""],["","00555901858","TRI-SPRINTEC ","TAB ","28","Select","Select",""],["","00603766317","TRI-PREVIFEM ","TAB ","28","Select","Select",""],["","67877057305","BENZONATATE ","CAP 100MG","30","Select","Select",""],["","65862053750","LEVOFLOXACIN ","TAB 500MG","10","Select","Select",""],["","50383080416","PROMETH\/COD ","SYP 6.25-10","140","Select","Select",""],["","68462010530","ONDANSETRON ","TAB 4MG","15","Select","Select",""],["","69097015907","MELOXICAM ","TAB 15MG","30","Select","Select",""],["","00406048401","APAP\/CODEINE ","TAB 300-30MG","12","Select","Select",""],["","00052433001","NEXPLANON ","IMP 68MG","1","Select","Select",""],["","00228202950","ALPRAZOLAM ","TAB 0.5MG","10","Select","Select",""],["","65862057490","MONTELUKAST ","TAB 10MG","90","Select","Select",""],["","00193658621","MICROLET ","LANCETS","100","Select","Select",""],["","24658031205","DOXYCYCL ","100MG","14","Select","Select",""],["","69842080601","CVS ","600MG","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":[[["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":""}]}]}