{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MELISSA   A CROSS","gend":1,"add":"13247 MENDOTA ROAD","city":"ABINGDON","state":"VA","zip":"24210-4093","dob":"1977-07-22","age":"","mstatus":"","insh":7507781,"cliId":"","pno":2764515235,"cno":2764515235,"email":"","ename":"","eno":"","pphy":"EASTON, BRIAN T","ppno":4232395141,"pcpadd":"60 Town and Country Dr, ","pcpcity":"Lebanon","pcpstate":"VA","pcpzip":242665409,"pcpcounty":"","pcpid":"","pcpname":"HOLSTON MEDICAL GROUP PC","ano":"","add2":"                                                            ","add3":"","madd1":"13247 MENDOTA ROAD","madd2":"                                                            ","madd3":"","mcity":"ABINGDON","mstate":"VA","mzip":"24210-4093","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"SOUTHWEST","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R11.2","R19.7","E86.0","I10","E11.9","F41.9","E87.6","J20.9","K29.70","K29.80","K64.8","E78.5","G47.30","R10.9","F41.8","R07.9","R94.31","D72.829","R16.0","R10.13","I25.119","K25.9","K44.9","E66.9","F11.10","F43.10","F32.9","F17.210","R07.2","E11.65","Z79.4","R10.84","R07.89","R51","R06.02","E78.00","Z68.41","R53.1","Z72.0","B34.9","G47.00","G47.9","Z79.899","K08.89","S02.5XXA","K02.9","X58.XXXA","R51.9","R22.0","F17.200","K29.50","K20.9","B19.20","R68.81","K21.9","G56.01","J06.9","B97.89","F33.1","E66.01","E11.29","M23.91","M25.562","B35.1","E11.43","F13.239","K76.0","Z80.0","R11.0","E87.1","Z88.0","M17.0","K59.00","Z51.81","R00.0","R10.10","K52.9","R11.10","M79.10","M54.2","M54.89","Z20.89","R68.83","R61","R11.11","S29.9XXA","W19.XXXA","Z79.84","W01.10XA","Z53.21","R06.00","I26.99","K62.5","R69","Z86.19","R94.30","F45.42","I20.9","Z82.49","Z83.3","R29.1","K14.0","R05","R07.0","Z20.822","F33.2","F41.0","F43.12","R94.39","K31.84","F19.10","R42","R91.8","K14.8","R20.2","Z79.82","Z88.8","K64.9","K80.20","I25.10","I16.0","E88.89","U07.1","G47.33","B37.2","M54.5","R21","J02.9","R50.9","R91.1","R10.32","Z53.9","M25.561","D72.821","L02.211"],"date":["2020-02-13","2020-02-16","2019-06-28","2021-04-20","2021-04-20","2021-04-19","2020-02-13","2019-01-12","2019-07-22","2019-01-13","2019-04-09","2020-02-16","2019-04-09","2020-02-11","2019-09-11","2021-02-03","2019-06-28","2019-07-22","2019-07-22","2019-09-14","2019-08-25","2019-08-26","2019-08-26","2020-02-13","2019-08-26","2020-04-08","2021-01-15","2021-04-20","2020-02-13","2019-09-11","2021-04-20","2019-09-15","2021-02-03","2020-02-13","2021-04-20","2020-02-13","2020-02-13","2020-02-14","2021-04-19","2020-02-13","2020-02-16","2020-02-14","2021-04-20","2020-12-06","2020-12-06","2020-12-06","2020-12-06","2020-12-06","2020-12-06","2021-02-03","2019-07-24","2019-01-13","2021-04-20","2019-01-24","2019-07-24","2019-02-22","2019-03-08","2019-03-08","2019-05-20","2020-02-25","2019-05-20","2019-05-20","2019-06-12","2019-06-24","2019-09-15","2019-06-25","2020-02-16","2019-06-25","2019-09-15","2019-07-01","2020-02-16","2019-07-19","2019-07-22","2019-08-09","2019-09-11","2019-09-15","2020-02-12","2019-09-15","2020-02-11","2020-02-11","2020-02-11","2020-02-11","2020-02-11","2020-02-11","2020-02-12","2021-02-03","2021-02-03","2021-02-03","2021-02-03","2021-04-19","2021-04-19","2021-04-19","2019-04-09","2019-06-24","2019-07-24","2019-07-24","2020-04-08","2020-02-16","2020-02-16","2020-02-16","2020-12-05","2020-12-05","2021-01-13","2021-01-13","2021-01-13","2019-03-13","2019-03-13","2019-03-13","2019-07-02","2019-09-15","2019-08-26","2019-09-13","2021-04-19","2020-12-05","2021-01-15","2021-01-15","2019-01-12","2019-04-09","2019-06-26","2019-07-02","2019-07-04","2019-07-03","2021-04-20","2019-09-13","2020-11-25","2020-11-25","2020-12-05","2021-01-13","2019-01-07","2019-01-10","2019-01-10","2019-03-19","2019-06-12","2019-06-30","2021-01-15"],"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":[["","00169185550","NOVOFINE ","MIS 32GX4MM","100","Select","Select",""],["","68382018205","BUSPIRONE ","TAB 15MG","60","Select","Select",""],["","51991070505","ALPRAZOLAM ","TAB 0.5MG","30","Select","Select",""],["","00093081201","NORTRIPTYLIN ","CAP 50MG","120","Select","Select",""],["","65862018730","ONDANSETRON ","TAB 4MG","30","Select","Select",""],["","65162052111","PROMETHAZINE ","TAB 25MG","30","Select","Select",""],["","00093221001","SUCRALFATE ","TAB 1GM","120","Select","Select",""],["","68645035059","CARVEDILOL ","TAB 6.25MG","60","Select","Select",""],["","00536100836","ASPIRIN ","CHW 81MG","30","Select","Select",""],["","00406012301","HYDROCO\/APAP ","TAB 5-325MG","5","Select","Select",""],["","64380080807","IBUPROFEN ","TAB 600MG","30","Select","Select",""],["","65862001005","METFORMIN ","TAB 1000MG","60","Select","Select",""],["","49884068901","METOCLOPRAM ","TAB 10MG","30","Select","Select",""],["","31722071390","PANTOPRAZOLE ","TAB 40MG","30","Select","Select",""],["","68462010340","FLUCONAZOLE ","TAB 150MG","4","Select","Select",""],["","31722053301","METHOCARBAM ","TAB 500MG","14","Select","Select",""],["","67877024201","QUETIAPINE ","TAB 25MG","90","Select","Select",""],["","68180037709","LOSARTAN ","TAB 50MG","60","Select","Select",""],["","00713013512","PROCHLORPER ","SUP 25MG","14","Select","Select",""],["","00169368712","LEVEMIR ","INJ ","10","Select","Select",""],["","68180072103","AMLODIPINE ","TAB 10MG","30","Select","Select",""],["","53746051401","SPIRONOLACT ","TAB 50MG","30","Select","Select",""],["","64380080307","RANITIDINE ","TAB 150MG","30","Select","Select",""],["","70377003012","ATORVASTATIN ","TAB 80MG","30","Select","Select",""],["","00172572860","FAMOTIDINE ","TAB 20MG","30","Select","Select",""],["","65862015901","ZOLPIDEM ","TAB 5MG","10","Select","Select",""],["","12496120803","SUBOXONE ","MIS 8-2MG","14","Select","Select",""],["","13668001105","CITALOPRAM ","TAB 40MG","30","Select","Select",""],["","10702001801","OXYCODONE ","TAB 5MG","30","Select","Select",""],["","45802048678","DOCUSATE ","CAP 100MG","60","Select","Select",""],["","08290320122","BD  PEN NEEDL","MIS 32GX4MM","100","Select","Select",""],["","00054327099","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","00169406013","VICTOZA ","INJ 18MG\/3ML","9","Select","Select",""],["","56151172301","INSULIN ","MIS 1ML\/30G","100","Select","Select",""],["","67877057505","BENZONATATE ","CAP 200MG","20","Select","Select",""],["","42571025201","CLINDAMYCIN ","CAP 300MG","30","Select","Select",""],["","70436000203","POT  CHLORIDE","TAB 10MEQ ER","30","Select","Select",""],["","00378247401","DICLOFEN ","TAB 50MG","30","Select","Select",""],["","68180016013","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","65862047030","LOSARTAN\/HCT ","TAB 100-25","30","Select","Select",""],["","00591079401","DICYCLOMINE ","CAP 10MG","20","Select","Select",""],["","00000000000",""," ","480","Select","Select",""],["","52817033200","CYCLOBENZAPR ","TAB 10MG","21","Select","Select",""],["","00069047103","CHANTIX ","PAK 0.5& 1MG","53","Select","Select",""],["","51991052633","TERBINAFINE ","TAB 250MG","30","Select","Select",""],["","00406051205","OXYCOD\/APAP ","TAB 5-325MG","8","Select","Select",""],["","37000045502","PRILOSEC ","TAB 20MG","60","Select","Select",""],["","00904530660","BANOPHEN ","CAP 25MG","30","Select","Select",""],["","00093317431","ALBUTEROL ","FAT E","8.5","Select","Select",""],["","17478071130","LIDOCAINE ","GEL 2% JELLY","30","Select","Select",""],["","68462039610","OMEPRAZOLE ","CAP 20MG","60","Select","Select",""],["","59762330403","NITROGLYCERN ","SUB 0.4MG","25","Select","Select",""],["","55566410001","EUFLEXXA ","INJ 10MG\/ML","12","Select","Select",""],["","62037099901","POT  CL MICRO","TAB 20MEQ ER","20","Select","Select",""],["","00378001805","METOPROL ","TAB 25MG","10","Select","Select",""],["","69547035302","NARCAN ","SPR ","2","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":""}]}]}