{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" SHARON E NUNNERY","gend":1,"add":"169 W LEE ST ","city":"NEW MARKET                    ","state":"VA","zip":"22844-9657","dob":"1964-01-18","age":"","mstatus":"","insh":4940486,"cliId":"","pno":"5407402500, 2406108123","cno":5407402500,"email":"","ename":"","eno":"","pphy":"LONG, KEITH C                 ","ppno":"               ","pcpadd":"1661 S Main St ","pcpcity":"Harrisonburg                  ","pcpstate":"VA","pcpzip":228012728,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP - VIRGINIA PREMIER","program":"MEDICAID","lob":"VPM4","region":"NORTHERN","aligned":"","ano":"","add2":"","add3":"","madd1":"169 W LEE ST     ","madd2":"","madd3":"","mcity":"NEW MARKET                    ","mstate":"VA","mzip":"22844-9657","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E78.2","R79.89","I63.9","M62.81","I10","F17.200","D51.8","E53.8","J98.4","D21.3","R06.02","R07.9","D51.0","Z48.813","J93.9","R91.8","M54.2","J30.89","F41.1","J44.9","Z12.31","M54.9","G89.29","I67.89","Z74.3","Q21.1","I77.1","B85.0","J20.9","J43.9","Z46.82","Z98.890","I95.1","M25.512","E78.5","W01.0XXA","I63.89","G83.24","Z68.38","F17.210","R27.8","M47.22","E66.9","B00.9","F41.9","R40.2143","R40.2253","R40.2364","R68.89","R05","J02.9","Z20.828","J98.11","C34.12","C49.3","J01.00","R91.1","K21.0","R11.0","C76.1","K22.70","Z88.8","Z91.041","Z86.73","Z87.442","Z83.3","Z82.49","Z79.82","H10.31","H57.89","C45.7","K04.7","I70.0","I70.8","I08.8","F32.9","Z79.899","M25.519","K21.9","B37.2","I63.40","R29.898","R93.89","M89.8X8","Z03.818","R42","I67.82","Z87.891","Z01.818"],"date":["2020-06-08","2019-05-10","2019-07-03","2019-07-01","2021-01-28","2019-07-03","2020-11-25","2020-06-08","2021-01-28","2020-02-11","2020-07-22","2020-07-22","2020-11-25","2020-10-28","2020-10-28","2021-01-28","2019-12-19","2019-05-13","2020-06-08","2020-11-25","2019-05-13","2019-05-13","2019-05-13","2019-07-02","2019-07-01","2020-08-19","2019-08-08","2019-08-19","2019-09-10","2020-08-19","2020-10-28","2020-10-28","2021-01-28","2021-01-28","2021-01-28","2021-01-28","2019-07-01","2019-07-01","2019-07-01","2020-08-19","2019-07-01","2020-08-19","2019-07-01","2019-07-01","2020-08-19","2019-07-01","2019-07-01","2019-07-01","2020-02-11","2020-05-21","2020-05-21","2020-05-21","2020-08-20","2020-08-26","2020-08-26","2019-01-11","2020-01-28","2020-07-23","2020-07-22","2020-08-19","2020-08-19","2020-08-19","2020-08-19","2020-08-19","2020-08-19","2020-08-19","2020-08-19","2020-08-19","2020-10-08","2020-10-08","2020-11-25","2020-02-25","2019-07-03","2019-07-03","2019-08-08","2019-08-08","2019-08-08","2019-12-19","2020-07-22","2020-11-25","2019-07-08","2019-07-08","2020-01-28","2020-01-28","2020-08-15","2021-01-28","2021-01-28","2020-01-20","2020-10-28"],"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":[["","16729000517","SIMVASTATIN ","TAB 20MG","30","Select","Select",""],["","00186091706","PULMICORT ","INH 90MCG","1","Select","Select",""],["","00517003125","CYANOCOBALAM ","INJ 1000MCG","1","Select","Select",""],["","69097015305","VALACYCLOVIR ","TAB 500MG","30","Select","Select",""],["","45963055650","GABAPENTIN ","CAP 300MG","90","Select","Select",""],["","67877019910","AMLODIPINE ","TAB 10MG","30","Select","Select",""],["","49781008499","ASPIRIN ","CHW 81MG","30","Select","Select",""],["","66993001968","ALBUTEROL ","AER HFA","18","Select","Select",""],["","45802005911","NYSTATIN ","CRE 100000","30","Select","Select",""],["","57664037713","TRAMADOL ","TAB 50MG","28","Select","Select",""],["","27808003502","HYDROCO\/APAP ","TAB 5-325MG","12","Select","Select",""],["","69315012710","FOLIC ","TAB 1000MCG","30","Select","Select",""],["","00172572880","FAMOTIDINE ","TAB 20MG","30","Select","Select",""],["","49781002802","LICE ","LIQ 0.01","118","Select","Select",""],["","67877049005","EZETIMIBE ","TAB 10MG","30","Select","Select",""],["","24208091055","ERYTHROMYCIN ","OIN OP","3.5","Select","Select",""],["","62542030117","HYD ","SUS 10-8\/5ML","70","Select","Select",""],["","00536589588","NICOTINE ","DIS 14MG\/24H","30","Select","Select",""],["","00591293201","CLINDAMYCIN ","CAP 300MG","30","Select","Select",""],["","00781223410","OMEPRAZOLE ","CAP 40MG","30","Select","Select",""],["","00591544205","PREDNISONE ","TAB 10MG","42","Select","Select",""],["","55111028130","LEVOFLOXACIN ","TAB 750MG","10","Select","Select",""],["","69452014430","BENZONATATE ","CAP 200MG","30","Select","Select",""],["","60505267108","ATORVASTATIN ","TAB 80MG","30","Select","Select",""],["","67405065105","DOXYCYCL ","CAP 100MG","20","Select","Select",""],["","60432083460","LINDANE ","SHA 0.01","60","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":[[["Select","Select","","","","","Select","",""],["Select","Select","","","","","Select","",""],["Select","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Select","Select","","","","","Select","",""],["No","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":""}]}]}