{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"HEIDI   M TAYLOR","gend":1,"add":"25368   PARKS ROAD                                          ","city":"PARKSLEY                      ","state":"VA","zip":"23421-9998","dob":"1982-08-30","age":"","mstatus":"","insh":6942178,"cliId":"","pno":7576948812,"cno":7576948812,"email":"","ename":"","eno":"","pphy":"BALMORIA, SANDRA K                                          ","ppno":"","pcpadd":"5219 LANKFORD HIGHWAY,Ste 100","pcpcity":"NEW CHURCH                    ","pcpstate":"VA","pcpzip":234153332,"pcpcounty":"","pcpid":"P9058354","pcpname":"ATLANTIC COMMUNITY HEALTH CENTER","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"TIDEWATER","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"25368   PARKS ROAD                                          ","madd2":"                                                            ","madd3":"","mcity":"PARKSLEY                      ","mstate":"VA","mzip":"23421-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G47.33","I10","F33.9","J45.21","Z71.3","G47.34","G47.10","R35.0","Z11.3","Z32.01","O09.522","Z13.79","Z36.87","Z3A.25","O10.012","O34.211","O99.212","O99.332","F17.200","Z36.9","O10.919","O09.90","O09.92","O10.912","Z3A.27","O35.9XX0","O09.523","O10.013","Z3A.29","Z23","E66.01","O09.93","O10.913","O99.213","Z3A.32","O36.5930","O99.89","O76","O09.529","O26.90","Z3A.00","R73.09","O32.1XX0","Z3A.35","O10.019","O24.419","M79.604","M79.605","R60.9","O11.4","Z34.83","W57.XXXA","Y92.019","Y92.238","J96.02","J96.01","J45.31","O98.82","O99.354","O99.62","K92.89","K21.9","O24.420","O99.344","O14.13","Z30.2","O24.410","Z37.0","Z3A.36","O60.14X0","P22.9","Z34.90","J95.821","I95.9","O34.219","F32.9","O14.15","O99.53","N76.0","B37.3","M25.512","O99.215","Z46.82","I51.7","P22.0","P28.89","R91.8","O14.93","J45.998","I36.1","I27.20","R05","G47.30","R06.02","O99.893","L03.818","L02.211","K68.11","O86.00","O86.01","L02.91","E66.2","O24.33","Z68.43","J45.909","E11.9","Z98.891","Z87.891","M79.609","T81.32XA","N99.89","Z97.8","T81.49XA","Z98.890","Z88.0","F53.0","F33.1","F32.2","Z99.89","Z20.822","Z68.42","J20.9","J98.01","R06.2","U07.1","J40"],"date":["2021-03-11","2020-11-16","2021-03-18","2021-06-14","2021-03-18","2020-02-14","2020-08-17","2020-03-11","2020-03-11","2020-08-17","2020-07-28","2020-07-08","2020-07-08","2020-07-08","2020-07-08","2020-09-25","2020-07-28","2020-07-08","2020-07-08","2020-08-17","2020-09-15","2020-07-28","2020-07-28","2020-07-28","2020-07-28","2020-07-28","2020-09-21","2020-08-06","2020-08-06","2020-08-06","2021-03-18","2020-08-26","2020-08-26","2020-08-26","2020-08-26","2020-09-21","2020-09-26","2020-09-22","2020-09-15","2020-09-17","2020-09-17","2020-09-17","2020-09-25","2020-09-21","2020-09-22","2020-09-27","2020-09-25","2020-09-25","2020-09-25","2020-09-25","2020-09-25","2020-09-25","2020-09-25","2020-09-25","2020-09-30","2020-09-27","2020-09-25","2020-09-25","2020-09-25","2020-09-25","2020-09-25","2020-09-26","2020-09-25","2020-09-25","2020-09-25","2020-09-30","2020-09-25","2020-09-25","2020-09-27","2020-09-25","2020-09-25","2020-09-25","2020-10-01","2020-09-26","2020-09-27","2020-09-26","2020-09-26","2020-09-26","2020-09-26","2020-09-26","2020-09-27","2020-10-11","2020-11-16","2020-09-30","2020-09-26","2020-09-26","2020-09-26","2020-09-27","2020-10-01","2020-09-29","2020-09-30","2021-08-30","2020-09-30","2020-09-30","2020-10-08","2020-11-09","2020-11-16","2020-10-15","2020-10-16","2020-10-11","2020-10-11","2020-10-11","2020-10-11","2020-10-11","2020-10-11","2020-10-11","2020-10-11","2020-10-11","2020-10-12","2020-10-12","2020-10-12","2020-10-15","2020-11-16","2020-11-09","2020-11-16","2020-12-28","2021-01-18","2021-03-10","2021-02-19","2021-08-30","2021-03-18","2021-08-12","2021-08-12","2021-08-12","2021-09-07","2021-09-07"],"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":[["","00603533715","PREDNISONE","5MG","21","Select","Select",""],["","00955100310","ENOXAPARIN","30\/0.3ML","21","Select","Select",""],["","67877031901","IBUPROFEN","400MG","20","Select","Select",""],["","59779058401","STOOL","8.6-50MG","10","Select","Select",""],["","49884012201","LABETALOL","100MG","60","Select","Select",""],["","59762219803","AZITHROMYCIN","250MG","6","Select","Select",""],["","66993001968","ALBUTEROL","HFA","18","Select","Select",""],["","00456112030","VIIBRYD","20MG","90","Select","Select",""],["","67877021905","CEPHALEXIN","500MG","21","Select","Select",""],["","70436001102","BUPROPN","300MG XL","90","Select","Select",""],["","00378035301","NIFEDIPINE","30MG ER","30","Select","Select",""],["","65862042005","SMZ\/TMP","800-160","14","Select","Select",""],["","10702001801","OXYCODONE","5MG","10","Select","Select",""],["","72647033104","METHYLPRED","4MG","21","Select","Select",""],["","00536408501","PRENATAL","28-0.8MG","90","Select","Select",""],["","00536123441","ASPIRIN","81MG EC","30","Select","Select",""],["","99073013001","FREESTYLE MIS LANCETS","LANCETS","100","Select","Select",""],["","99073070805","FREESTYLE MIS LITE","LITE","1","Select","Select",""],["","99073070827","FREESTYLE TES LITE","LITE","100","Select","Select",""],["","68180051303","LISINOPRIL","5MG","30","Select","Select",""],["","13107015490","PAROXETINE","10MG","30","Select","Select",""],["","68462015713","ONDANSETRON","4MG ODT","30","Select","Select",""],["","00904645780","DOK","100MG","30","Select","Select",""],["","65862053820","LEVOFLOXACIN","750MG","3","Select","Select",""],["","50428085942","PREP","","100","Select","Select",""],["","68308015215","NYSTATIN","100000","45","Select","Select",""],["","00603533715","PREDNISONE ","PAK 5MG","21","Select","Select",""],["","00955100310","ENOXAPARIN ","INJ 30\/0.3ML","21","Select","Select",""],["","67877031901","IBUPROFEN ","TAB 400MG","20","Select","Select",""],["","59779058401","STOOL ","TAB 8.6-50MG","10","Select","Select",""],["","49884012201","LABETALOL ","TAB 100MG","60","Select","Select",""],["","59762219803","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","66993001968","ALBUTEROL ","AER HFA","18","Select","Select",""],["","00456112030","VIIBRYD ","TAB 20MG","90","Select","Select",""],["","67877021905","CEPHALEXIN ","CAP 500MG","21","Select","Select",""],["","70436001102","BUPROPN ","TAB 300MG XL","90","Select","Select",""],["","00378035301","NIFEDIPINE ","TAB 30MG ER","30","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","14","Select","Select",""],["","10702001801","OXYCODONE ","TAB 5MG","10","Select","Select",""],["","72647033104","METHYLPRED ","TAB 4MG","21","Select","Select",""],["","00536408501","PRENATAL ","TAB 28-0.8MG","90","Select","Select",""],["","00536123441","ASPIRIN ","TAB 81MG EC","30","Select","Select",""],["","99073013001","FREESTYLE    MIS LANCETS","MIS LANCETS","100","Select","Select",""],["","99073070805","FREESTYLE    MIS LITE","MIS LITE","1","Select","Select",""],["","99073070827","FREESTYLE    TES LITE","TES LITE","100","Select","Select",""],["","68180051303","LISINOPRIL ","TAB 5MG","30","Select","Select",""],["","13107015490","PAROXETINE ","TAB 10MG","30","Select","Select",""],["","68462015713","ONDANSETRON ","TAB 4MG ODT","30","Select","Select",""],["","00904645780","DOK ","CAP 100MG","30","Select","Select",""],["","65862053820","LEVOFLOXACIN ","TAB 750MG","3","Select","Select",""],["","50428085942","PREP ","PAD ","100","Select","Select",""],["","68308015215","NYSTATIN ","POW 100000","45","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":""}]}]}