{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SABRENA   L FLEMING","gend":1,"add":"332 HENRY DRIVE","city":"WOODSTOCK","state":"VA","zip":"22664-1109","dob":"1981-04-12","age":"","mstatus":"","insh":7314935,"cliId":"","pno":5403336818,"cno":5403336818,"email":"","ename":"","eno":"","pphy":"LONG, KEITH C","ppno":5404773808,"pcpadd":"1661 S Main St, ","pcpcity":"Harrisonburg","pcpstate":"VA","pcpzip":228012728,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"NORTHERN\/ WINCHESTER","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"332 HENRY DRIVE","madd2":"                                                            ","madd3":"","mcity":"WOODSTOCK","mstate":"VA","mzip":"22664-1109","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z98.1","M75.122","M19.012","Y83.8","M94.212","S40.252A","G89.18","M25.512","J44.9","K21.9","F41.9","F32.9","M06.9","F17.210","Z86.19","G43.709","G89.4","Z02.89","M54.41","E04.1","G89.29","R20.2","J43.9","Z79.899","Z51.81","M54.16","M51.36","S32.001S","M51.06","M54.5","M43.26","Z98.890","J01.00","J20.8","R29.898","F32.1","J30.89","H66.001","G25.81","Z20.828","Z01.818","M75.102","M67.922","M75.42","M65.812","S43.432A","R06.00","J84.9","Z72.0","J84.116","D64.9","Z68.37","M12.812","S46.012D","L98.9","M79.18","Z79.891","R06.83","G47.10","Z72.821","G47.00","M85.80","S43.402A","M48.56XD","M79.12","G62.9","M62.830","M47.812","E04.2","M51.27","J43.2","R91.8","S46.812A","M62.512","M25.812","S46.012A","G43.901","Z02.71"],"date":["2020-09-17","2019-01-22","2019-05-28","2019-01-22","2019-01-22","2019-01-22","2019-01-22","2021-03-09","2019-02-06","2019-02-15","2021-05-20","2019-01-22","2019-01-22","2019-02-06","2019-01-22","2021-05-18","2021-03-09","2019-12-20","2021-03-09","2021-05-20","2021-03-09","2020-09-17","2021-05-20","2021-05-20","2021-05-20","2021-05-21","2021-05-21","2021-05-21","2019-01-11","2019-04-08","2019-01-11","2019-08-07","2019-03-12","2019-03-12","2019-08-07","2020-04-14","2020-04-14","2020-04-14","2020-04-14","2021-02-03","2019-01-09","2019-05-10","2019-01-22","2019-05-28","2019-01-22","2019-05-28","2019-02-06","2019-02-06","2019-02-06","2019-02-06","2019-02-06","2019-02-06","2019-05-31","2019-06-05","2019-06-05","2021-05-10","2019-04-08","2019-03-20","2019-03-20","2019-03-20","2019-03-20","2019-04-10","2019-05-28","2020-09-17","2021-01-11","2019-04-08","2019-04-08","2019-04-08","2020-01-02","2020-09-17","2019-02-05","2019-02-05","2019-05-28","2019-05-28","2019-05-28","2019-05-28","2020-12-08","2020-08-20"],"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":[["","00591215990","CICLOPIROX ","SHA 0.01","120","Select","Select",""],["","63824005632","MUCINEX ","TAB 30-600ER","30","Select","Select",""],["","00093317431","ALBUTEROL ","FAT E HFA INH","8.5","Select","Select",""],["","57237001401","TAMSULOSIN ","CAP 0.4MG","30","Select","Select",""],["","68180012202","CEPHALEXIN ","CAP 500MG","30","Select","Select",""],["","00597008717","ATROVENT ","AER 17MCG","12.9","Select","Select",""],["","59651000305","OMEPRAZOLE ","CAP 40MG","30","Select","Select",""],["","70710122801","AMITRIPTYLIN ","TAB 75MG","30","Select","Select",""],["","67877057505","BENZONATATE ","CAP 200MG","30","Select","Select",""],["","43598029590","PREGABALIN ","CAP 150MG","90","Select","Select",""],["","42858080101","MORPHINE ","TAB 15MG ER","60","Select","Select",""],["","43547027110","ROPINIROLE ","TAB 2MG","30","Select","Select",""],["","43547030303","ARIPIPRAZOLE ","TAB 5MG","30","Select","Select",""],["","00832105515","BACLOFEN ","TAB 20MG","120","Select","Select",""],["","66993066430","DULOXETINE ","CAP 60MG","30","Select","Select",""],["","64380080307","RANITIDINE ","TAB 150MG","30","Select","Select",""],["","50111043401","TRAZODONE ","TAB 100MG","30","Select","Select",""],["","16729020201","BUSPIRONE ","TAB 10MG","90","Select","Select",""],["","65162019050","NAPROXEN ","TAB 500MG","60","Select","Select",""],["","00054327099","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","00378020810","FUROSEMIDE ","TAB 20MG","30","Select","Select",""],["","45802065078","LORATADINE ","TAB 10MG","30","Select","Select",""],["","59779061295","ALLERGY ","TAB 10MG","30","Select","Select",""],["","53746010901","HYDROCO\/APAP ","TAB 5-325MG","120","Select","Select",""],["","00597007541","SPIRIVA ","CAP HANDIHLR","30","Select","Select",""],["","65224031560","ZOHYDRO ","CAP 15MG","60","Select","Select",""],["","00071101668","LYRICA ","CAP 150MG","90","Select","Select",""],["","42858000201","OXYCODONE ","TAB 10MG","90","Select","Select",""],["","67877026218","RIZATRIPTAN ","TAB 10MG","9","Select","Select",""],["","50428038158","VITAMIN ","TAB 500MG","30","Select","Select",""],["","00781502207","METHYLPRED ","TAB 4MG","21","Select","Select",""],["","00069047103","CHANTIX ","PAK 0.5& 1MG","53","Select","Select",""],["","55111029336","SUMATRIPTAN ","TAB 100MG","9","Select","Select",""],["","65862050320","AMOX\/K ","TAB 875-125","20","Select","Select",""],["","53489011905","DOXYCYCL ","CAP 100MG","20","Select","Select",""],["","57664050658","METOPROL ","TAB 25MG","30","Select","Select",""],["","00093742698","MONTELUKAST ","TAB 10MG","30","Select","Select",""],["","63304069301","CLINDAMYCIN ","CAP 300MG","40","Select","Select",""],["","00186037220","SYMBICORT ","80-4.5","10.2","Select","Select",""],["","50458058030","XARELTO ","10MG","14","Select","Select",""],["","69547035302","NARCAN ","","2","Select","Select",""],["","42858010250","OXYCOD\/APAP ","5-325MG","30","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":""}]}]}