{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JANA   L WOODS","gend":1,"add":"653 JEFFERSON DOCK ROAD","city":"PENHOOK","state":"VA","zip":"24137-3315","dob":"1983-06-29","age":"","mstatus":"","insh":6808399,"cliId":"","pno":5402381084,"cno":5408196359,"email":"","ename":"","eno":"","pphy":"SUBUHI, TABASSUM","ppno":5407257555,"pcpadd":"180 Ferrum Mountain Rd, ","pcpcity":"Ferrum","pcpstate":"VA","pcpzip":240882939,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":5408196359,"add2":"183 CHESTNUT PARK DRIVE","add3":"","madd1":"653 JEFFERSON DOCK ROAD","madd2":"183 CHESTNUT PARK DRIVE","madd3":"","mcity":"PENHOOK","mstate":"VA","mzip":"24137-3315","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["D64.9","N89.8","F31.32","N23","J20.9","J18.9","R05","I10","K21.9","T78.40XA","F31.81","F17.210","Z86.14","Z98.84","Z79.899","R10.12","E83.51","R11.0","R16.1","J02.9","R33.9","R50.9","G89.29","M17.11","M19.171","R06.02","F17.200","U07.1","M54.41","Z13.6","Z76.5","S63.502A","M25.532","W19.XXXA","G43.909","E66.9","Z68.38","R09.1","R07.9","M79.602","M19.90","M25.571","M54.5","Z88.1","Z88.6","Z88.8","R10.31","S02.2XXA","S09.92XA","Y04.0XXA","Y93.9","Y92.9","S02.40DA","Z76.0","R10.9","Z51.81","R52","Z20.828","R94.31","Z87.11","A08.4","R10.32","N30.00","N39.0","R31.9","Z87.442","E66.01","Z68.41","R07.89","J40","R06.89","Z74.3","L03.115","Z87.19","R10.10","R55","Z04.3","D50.8","R00.0","S63.92XA","M25.522","M25.562","M79.642","W10.1XXA","S50.02XA","S80.212A","T14.90XA","W01.0XXA","R53.83","R07.1","Z86.16","Z68.39","J10.1","R11.2","R19.7","R07.81","L29.9","Z48.00","Z90.49","M54.9","F15.10","F14.10","M79.18","G47.30","F31.9","R63.0","R09.81","Z01.89","R06.2","D53.9","J18.1","R82.90","Z68.42","M79.10","M54.6","E61.1","G62.9","Z86.19","D50.9","S80.02XA","F41.9","R53.1","V49.40XA","F41.8","K25.5","T23.171A","T23.012A","K29.50","R09.89","R91.8","K52.9","R20.2","R06.00","T23.072A","X17.XXXA","S02.42XA","Y04.8XXA","Y09","X58.XXXA","S31.104A","Z87.440","Z98.51","R68.89","L98.9","Z76.89","M51.37","G43.009","G47.33","E87.6","R79.89"],"date":["2020-11-30","2019-03-20","2021-04-05","2019-06-10","2020-10-13","2020-03-16","2021-04-25","2021-02-01","2021-02-01","2020-03-24","2020-08-25","2021-03-28","2020-10-26","2021-01-24","2020-12-03","2020-06-04","2020-05-30","2021-02-01","2020-05-30","2021-02-01","2020-08-27","2021-02-07","2021-01-26","2020-08-27","2020-11-02","2021-02-19","2021-04-25","2021-02-07","2020-12-03","2020-12-03","2020-12-03","2021-01-26","2021-01-27","2021-03-28","2021-01-26","2021-04-25","2021-01-26","2021-02-19","2021-04-25","2021-02-19","2021-03-28","2021-03-28","2021-03-28","2021-03-28","2021-03-28","2021-03-28","2019-06-10","2019-10-23","2019-10-23","2019-10-23","2019-10-23","2020-01-25","2020-01-16","2021-04-25","2020-05-21","2020-03-09","2021-01-10","2020-06-19","2021-02-19","2019-08-19","2019-09-18","2020-01-25","2020-01-25","2020-05-14","2020-05-14","2020-08-25","2020-09-23","2020-05-25","2021-04-25","2020-10-14","2020-03-16","2020-03-24","2020-04-24","2020-09-23","2020-05-25","2020-10-26","2021-03-28","2020-11-30","2021-01-23","2021-01-24","2021-01-24","2021-01-24","2021-01-24","2021-01-24","2021-01-24","2021-01-24","2021-01-24","2021-01-24","2021-02-19","2021-04-25","2021-04-25","2021-04-25","2019-03-14","2020-03-29","2019-03-14","2020-01-27","2020-03-24","2020-04-24","2020-05-21","2020-08-25","2021-01-23","2021-01-23","2021-01-23","2021-02-01","2021-01-23","2021-02-01","2021-02-01","2021-02-19","2019-03-14","2019-03-14","2020-03-15","2020-05-14","2020-05-14","2020-06-19","2020-08-25","2020-10-13","2020-10-13","2020-10-13","2020-11-02","2021-01-26","2021-02-19","2021-02-19","2021-02-19","2019-03-07","2019-03-07","2019-08-06","2019-08-06","2019-08-06","2020-10-13","2020-01-25","2020-03-09","2020-03-24","2020-10-14","2019-08-06","2019-08-06","2019-10-23","2019-10-23","2019-10-23","2020-01-25","2020-01-25","2020-01-25","2020-01-25","2020-03-16","2020-03-29","2020-09-23","2020-09-23","2020-09-23","2020-09-23","2021-02-01","2021-02-01"],"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":[["","68180045001","QUETIAPINE ","TAB 400MG","45","Select","Select",""],["","65862052305","GABAPENTIN ","TAB 600MG","90","Select","Select",""],["","55111018010","TIZANIDINE ","TAB 4MG","90","Select","Select",""],["","69097052444","DICLOFENAC ","GEL 0.01","200","Select","Select",""],["","68382004110","PROMETHAZINE ","TAB 25MG","12","Select","Select",""],["","57237007530","ONDANSETRON ","TAB 4MG","15","Select","Select",""],["","68462010340","FLUCONAZOLE ","TAB 150MG","2","Select","Select",""],["","00527169501","BUT\/APAP\/CAF ","TAB ","60","Select","Select",""],["","68682045570","METRONIDAZOL ","GEL 0.75%VAG","70","Select","Select",""],["","64380080307","RANITIDINE ","TAB 150MG","30","Select","Select",""],["","13668000701","ZOLPIDEM ","TAB 5MG","30","Select","Select",""],["","62175061743","PANTOPRAZOLE ","TAB 40MG","60","Select","Select",""],["","51991074890","DULOXETINE ","CAP 60MG","60","Select","Select",""],["","00904630477","MAG ","SOL LEMON","296","Select","Select",""],["","00536105224","PEG3350 ","POW ","238","Select","Select",""],["","00406012301","HYDROCO\/APAP ","TAB 5-325MG","5","Select","Select",""],["","55111016330","OLANZAPINE ","TAB 2.5MG","30","Select","Select",""],["","00527058610","DICYCLOMINE ","CAP 10MG","60","Select","Select",""],["","16729013616","CLONAZEPAM ","TAB 0.5MG","60","Select","Select",""],["","00472103016","HYDROMET ","SYP 5-1.5\/5","100","Select","Select",""],["","50111043403","TRAZODONE ","TAB 100MG","60","Select","Select",""],["","00781185220","AMOX\/K ","TAB 875-125","10","Select","Select",""],["","00172392770","DIAZEPAM ","TAB 10MG","90","Select","Select",""],["","00143980305","DOXYCYCL ","CAP 100MG","20","Select","Select",""],["","80681013500","ZINC ","CAP 220MG","30","Select","Select",""],["","00527293441","PREDNISONE ","TAB 20MG","10","Select","Select",""],["","00904052360","VITAMIN ","TAB 500MG","20","Select","Select",""],["","70710101002","OSELTAMIVIR ","CAP 75MG","10","Select","Select",""],["","31604002743","MELATONIN ","TAB 5MG","10","Select","Select",""],["","68382013210","TAMSULOSIN ","CAP 0.4MG","5","Select","Select",""],["","33342002208","LEVOFLOXACIN ","TAB 500MG","8","Select","Select",""],["","65162071110","GUANFACINE ","TAB 1MG","60","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","14","Select","Select",""],["","68180012202","CEPHALEXIN ","CAP 500MG","28","Select","Select",""],["","13925015901","LIDOCAINE ","CRE 0.03","28.35","Select","Select",""],["","42571025201","CLINDAMYCIN ","CAP 300MG","20","Select","Select",""],["","00054418425","DEXAMETHASON ","TAB 4MG","10","Select","Select",""],["","00904674860","BISACODYL ","TAB 5MG EC","4","Select","Select",""],["","00536121429","DIPHENHYDRAM ","TAB 25MG","12","Select","Select",""],["","43598081112","CETIRIZINE ","TAB 10MG","24","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","",""],["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":""}]}]}