{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CRYSTAL   A BOWMAN","gend":1,"add":"350 MORTON LANE","city":"CLAUDVILLE","state":"VA","zip":"24076-3446","dob":"1977-10-14","age":"","mstatus":"","insh":7094322,"cliId":"","pno":2762511729,"cno":2762511729,"email":"","ename":"","eno":"","pphy":"FRANCE, AARON M","ppno":3367869430,"pcpadd":"200 N Pointe Blvd, ","pcpcity":"Mount Airy","pcpstate":"NC","pcpzip":270302267,"pcpcounty":"","pcpid":"","pcpname":"FRANCE MEDICAL CENTER","ano":"","add2":"                                                            ","add3":"","madd1":"350 MORTON LANE","madd2":"                                                            ","madd3":"","mcity":"CLAUDVILLE","mstate":"VA","mzip":"24076-3446","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"ROANOKE\/ ALLEGHANY","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11.3513","M51.16","F41.9","M19.90","I25.10","F32.9","I10","J44.9","Z87.891","E11.8","Z79.4","E78.2","G89.29","M47.26","M62.830","M54.5","M25.60","M62.81","Z71.3","I21.4","R06.02","R06.00","E11.9","Z95.1","Z79.899","R07.9","R07.89","N17.8","D50.8","Z09","J10.1","R26.2","M54.16","M47.816","G47.9","G47.10","R06.83","K21.9","E78.5","E11.69","I25.83","C64.9","N28.89","Z23","I51.7","I50.22","K22.4","E10.43","K31.84","K59.00","M54.9","J18.9","R55","Z88.5","J42","R60.0","H43.13","E11.3511","R27.9","Z74.3","R09.02","N17.9","E66.9","R93.422","I25.2","I11.0","E11.40","F41.8","N28.9","E11.65","K59.09","E11.43","Z01.810","Z12.11","Z80.0","R13.10","Z86.79","K63.5","Z13.810","G93.89","R40.4","L89.319","F17.210","E66.01","Z68.42","I50.9","Z03.818","G25.81","G47.33","D50.9","Z30.42","G43.919","K29.70","R10.9","D12.0","D12.3","Z79.82","K31.89","K22.8","N92.0","J01.00","J30.9","R09.82","I25.110","I42.9","D50.0","Z98.890","D63.1","N18.9","N25.81","M62.08","Z68.41","I25.5","Z79.01","Z79.02","R11.10","R16.0","K76.0","W19.XXXA","Y93.01","Y92.009","E11.319","F41.0","M16.11","M51.26","S81.802A","R12","R13.19","R09.89","I28.8","R91.8","R06.2","J80","N19","R93.429","M51.36","R11.0","F41.1","R53.1","M79.602","I50.20","F17.211","E66.09","N28.1","D49.519","Z90.49","M48.062","M96.1","I50.23","Z20.828","I25.118","K21.0","J98.11","I25.119","I11.9","Z72.0"],"date":["2021-03-22","2019-08-15","2020-05-28","2019-05-02","2021-03-11","2020-09-29","2021-03-11","2020-09-29","2020-05-27","2019-10-22","2021-03-29","2021-02-26","2021-05-11","2021-05-11","2021-05-20","2019-08-19","2019-08-19","2020-12-17","2020-04-02","2020-07-22","2020-09-28","2020-09-28","2021-03-29","2021-03-11","2021-02-26","2020-07-22","2020-08-28","2020-10-06","2020-10-16","2020-10-06","2020-10-06","2020-12-17","2021-05-20","2021-05-20","2020-11-19","2021-03-11","2021-03-11","2020-11-19","2020-11-19","2021-03-11","2020-11-19","2021-03-24","2021-03-29","2021-03-29","2021-05-19","2021-05-19","2019-01-02","2019-01-02","2020-07-21","2019-07-03","2019-04-04","2019-07-12","2020-09-28","2019-08-12","2019-08-12","2020-07-07","2021-03-22","2019-12-19","2020-07-22","2020-07-22","2020-07-22","2021-02-25","2020-10-01","2020-10-01","2020-10-01","2020-10-01","2020-10-01","2021-02-26","2020-12-01","2021-02-26","2019-01-18","2020-07-21","2019-06-26","2019-06-26","2019-07-03","2019-07-03","2019-06-26","2019-07-03","2019-07-03","2019-07-12","2019-07-12","2019-11-05","2020-05-28","2020-07-22","2020-06-19","2020-07-21","2020-09-28","2021-02-26","2021-03-11","2020-07-21","2019-05-07","2019-03-28","2019-07-03","2020-02-17","2019-07-03","2019-07-03","2020-09-01","2019-07-03","2019-07-03","2019-08-16","2020-01-06","2020-01-06","2020-01-06","2020-07-21","2020-07-21","2021-03-03","2020-08-05","2021-02-25","2021-02-25","2021-02-25","2019-05-29","2020-07-22","2021-03-11","2020-09-01","2020-09-01","2020-09-28","2021-03-24","2021-03-24","2020-09-29","2020-09-29","2020-09-29","2020-09-29","2020-09-29","2019-02-13","2019-02-13","2019-04-30","2019-07-03","2019-07-03","2020-07-21","2020-05-27","2020-05-27","2020-07-21","2020-07-22","2020-09-29","2020-09-30","2019-07-03","2019-05-20","2019-08-15","2020-05-26","2020-07-21","2020-09-29","2020-09-29","2021-03-11","2021-03-24","2021-03-24","2021-03-24","2019-04-04","2019-04-04","2020-05-28","2020-09-28","2020-05-28","2020-05-28","2020-07-21","2020-07-22","2020-07-22","2020-07-22"],"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":[["","68645058259","METFORMIN ","TAB 500MG","120","Select","Select",""],["","68645049554","ATORVASTATIN ","TAB 80MG","30","Select","Select",""],["","50111091701","TORSEMIDE ","TAB 20MG","60","Select","Select",""],["","00904645780","DOK ","CAP 100MG","120","Select","Select",""],["","73070010315","INSULIN ","INJ FLEXPEN","30","Select","Select",""],["","65862035705","CLOPIDOGREL ","TAB 75MG","90","Select","Select",""],["","16714079903","CETIRIZINE ","TAB 10MG","90","Select","Select",""],["","62332003231","ROPINIROLE ","TAB 1MG","90","Select","Select",""],["","16714061305","SERTRALINE ","TAB 100MG","90","Select","Select",""],["","65862006399","METOPROL ","TAB 50MG","180","Select","Select",""],["","00193658621","MICROLET ","MIS LANCETS","300","Select","Select",""],["","57896030301","STOOL ","TAB 8.6-50MG","180","Select","Select",""],["","59746000103","METHYLPRED ","TAB 4MG","21","Select","Select",""],["","00088221905","LANTUS ","INJ 100\/ML","30","Select","Select",""],["","55111018015","TIZANIDINE ","TAB 4MG","10","Select","Select",""],["","16714007106","BACLOFEN ","TAB 10MG","60","Select","Select",""],["","50228018105","GABAPENTIN ","CAP 400MG","180","Select","Select",""],["","00169633910","NOVOLOG ","INJ FLEXPEN","18","Select","Select",""],["","00193731150","CONTOUR ","TES NEXT","250","Select","Select",""],["","50580072824","ZYRTEC-D ","TAB 5-120MG","24","Select","Select",""],["","08290320119","BD  PEN NEEDL","MIS 31GX5MM","100","Select","Select",""],["","00069046903","CHANTIX ","PAK 1MG","56","Select","Select",""],["","45802088830","OMEPRAZOLE ","TAB 20MG","60","Select","Select",""],["","66685100200","AMOX\/K ","TAB 500-125","14","Select","Select",""],["","68462018022","MUPIROCIN ","OIN 0.02","22","Select","Select",""],["","00406012301","HYDROCO\/APAP ","TAB 5-325MG","5","Select","Select",""],["","43547040111","FUROSEMIDE ","TAB 20MG","90","Select","Select",""],["","10135066901","SENNA ","TAB 8.6-50MG","180","Select","Select",""],["","65862055990","PANTOPRAZOLE ","TAB 20MG","30","Select","Select",""],["","59762453802","MEDROXYPR ","INJ 150MG\/ML","1","Select","Select",""],["","50111032701","HYDRALAZINE ","TAB 25MG","180","Select","Select",""],["","00597015230","JARDIANCE ","TAB 10MG","90","Select","Select",""],["","23155017801","ISOSORB ","TAB 60MG ER","30","Select","Select",""],["","42858010201","OXYCOD\/APAP ","TAB 5-325MG","10","Select","Select",""],["","00574200830","NYSTOP ","POW 100000","30","Select","Select",""],["","50458057760","XARELTO ","TAB 2.5MG","180","Select","Select",""],["","00143314250","DOXYCYCL ","CAP 100MG","20","Select","Select",""],["","33342012307","ARIPIPRAZOLE ","TAB 5MG","90","Select","Select",""],["","00193654621","BAYER ","MIS LANCETS","300","Select","Select",""],["","29300011516","TOPIRAMATE ","TAB 25MG","30","Select","Select",""],["","00002143380","TRULICITY ","INJ 0.75\/0.5","6","Select","Select",""],["","00113200760","ALLERGY\/CONG ","TAB 5-120MG","20","Select","Select",""],["","11523716201","CLARITIN-D ","TAB 5-120MG","10","Select","Select",""],["","49035023860","EQ ","CAP SOFTENER","120","Select","Select",""],["","59762311001","AZITHROMYCIN ","SUS 100\/5ML","105","Select","Select",""],["","00006027731","JANUVIA ","TAB 100MG","90","Select","Select",""],["","31722070190","LOSARTAN ","TAB 50MG","90","Select","Select",""],["","57599000101","FREESTYLE    KIT SENSOR","KIT SENSOR","2","Select","Select",""],["","65162083366","DICLOFENAC ","GEL 0.01","200","Select","Select",""],["","45802086803","POLYETH ","POW 3350 NF","510","Select","Select",""],["","57599000200","FREESTYLE    MIS READER","MIS READER","1","Select","Select",""],["","43598043611","NITROGLYCERN ","SUB 0.4MG","25","Select","Select",""],["","10572010001","PEG-3350 ","SOL ELECTROL","4,000.00","Select","Select",""],["","68645051890","CYCLOBENZAPR ","TAB 10MG","20","Select","Select",""],["","00169406012","VICTOZA ","INJ 18MG\/3ML","6","Select","Select",""],["","45802014753","CETIRIZ\/PSE ","TAB 5-120MG","24","Select","Select",""],["","64380079701","OSELTAMIVIR ","CAP 30MG","3","Select","Select",""],["","49281041950","FLUZONE ","INJ 2019-20","0.5","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":""}]}]}