{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MELISSA   L CLINE","gend":1,"add":"2039 WHITETOP ROAD","city":"CHILHOWIE","state":"VA","zip":"24319-6053","dob":"1980-01-23","age":"","mstatus":"","insh":7584300,"cliId":"","pno":5402748941,"cno":5402778941,"email":"","ename":"","eno":"","pphy":"HAMMAN, CHELSEA C","ppno":2767838123,"pcpadd":"1046 Terrace Dr, ","pcpcity":"Marion","pcpstate":"VA","pcpzip":243544138,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"SOUTHWEST","aligned":"","ano":5402778941,"add2":"                                                            ","add3":"","madd1":"2039 WHITETOP ROAD","madd2":"                                                            ","madd3":"","mcity":"CHILHOWIE","mstate":"VA","mzip":"24319-6053","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K21.9","F10.20","R10.11","F10.10","F41.8","D64.9","E87.6","M79.604","M79.605","R53.81","R53.83","L73.9","R68.89","M54.9","F33.1","F41.1","F11.20","F43.10","R06.2","R41.82","K70.10","E80.6","E87.4","E87.0","E83.39","E87.1","G83.14","K70.0","K72.90","Z30.42","Z32.02","F19.10","Z01.419","J44.1","R09.1","Z72.0","F17.210","G93.41","M54.40","M54.5","M54.17","H04.123","H53.002","H52.203","H52.03","J98.09","R69","Z46.82","R17","D72.829","F17.200","E72.20","J44.9","K70.9","G89.29","F32.9","K30","Z79.1","Z91.81","Z79.899","Z12.31","J40","R49.0","J01.00","R05","F13.10","E87.2","R11.2","R19.7","K76.0","K42.9","Z46.59","R30.0","R89.9","M79.606","E86.9","E83.51","R31.9","N25.81","R07.81","F41.9","H02.882","H02.885","H16.223","R03.0","R10.9","R50.9","K44.9","Z11.3","Z00.00","R09.89","R06.02","I45.81","Z79.51","G47.00","Z82.49","E66.9","N25.89"],"date":["2021-02-13","2020-09-21","2019-06-05","2020-10-16","2019-05-28","2020-06-14","2020-08-01","2019-08-13","2019-08-13","2020-12-14","2019-06-12","2019-07-26","2019-12-06","2020-02-26","2020-09-21","2020-09-21","2020-09-21","2020-09-21","2020-06-13","2020-06-19","2020-06-19","2020-06-13","2020-06-13","2020-06-17","2020-06-14","2020-06-16","2020-06-14","2020-10-22","2020-10-16","2021-03-17","2021-03-17","2019-01-22","2020-02-04","2019-04-30","2019-04-30","2020-01-27","2021-02-13","2020-06-18","2021-02-13","2021-02-13","2019-05-20","2019-12-16","2019-12-16","2019-12-16","2019-12-16","2020-01-27","2020-06-12","2020-06-14","2020-06-19","2020-06-19","2020-09-15","2020-08-01","2021-02-13","2020-08-01","2021-02-13","2021-02-13","2020-08-01","2020-08-01","2020-08-01","2021-02-13","2021-03-30","2020-01-27","2020-02-26","2020-02-26","2020-06-12","2020-02-26","2020-06-16","2020-12-14","2020-06-12","2020-06-12","2020-06-12","2020-06-15","2020-07-01","2020-07-01","2019-08-13","2020-06-14","2020-06-14","2020-06-14","2020-06-14","2019-04-30","2019-04-30","2020-09-15","2020-09-15","2020-09-15","2020-09-15","2020-12-14","2020-12-14","2020-12-14","2019-01-29","2019-05-28","2020-01-27","2020-01-27","2020-06-12","2020-06-12","2020-06-12","2020-06-12","2020-06-12","2020-06-17"],"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":[["","67877032105","IBUPROFEN ","TAB 800MG","90","Select","Select",""],["","59746032430","VALACYCLOVIR ","TAB 500MG","30","Select","Select",""],["","11534016501","FOLIC ","TAB 1MG","30","Select","Select",""],["","00832532311","POT  CHLORIDE","TAB 10MEQ ER","60","Select","Select",""],["","50111043402","TRAZODONE ","TAB 100MG","30","Select","Select",""],["","00378623305","CITALOPRAM ","TAB 40MG","30","Select","Select",""],["","00781577626","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","00054001829","PREDNISONE ","TAB 20MG","15","Select","Select",""],["","31722071390","PANTOPRAZOLE ","TAB 40MG","30","Select","Select",""],["","00173068220","VENTOLIN ","AER ","36","Select","Select",""],["","71093011105","GABAPENTIN ","TAB 600MG","150","Select","Select",""],["","64980032430","PROCTOZONE ","CRE -HC 2.5%","30","Select","Select",""],["","00000000000",""," ","100","Select","Select",""],["","59310057922","PROAIR ","AER ","17","Select","Select",""],["","70010075401","METHOCARBAM ","TAB 500MG","40","Select","Select",""],["","68462019217","MOMETASONE ","CRE 0.001","15","Select","Select",""],["","00781572010","POT  CL MICRO","TAB 20MEQ ER","30","Select","Select",""],["","70000051102","NICOTINE ","DIS 14MG\/24H","28","Select","Select",""],["","00904705060","FEXOFENADINE ","TAB 180MG","30","Select","Select",""],["","00832046515","NYAMYC ","POW 100000","15","Select","Select",""],["","00168001531","HYDROCORT ","CRE 0.01","28.35","Select","Select",""],["","50383077916","LACTULOSE ","SOL 10GM\/15","946","Select","Select",""],["","65862018830","ONDANSETRON ","TAB 8MG","9","Select","Select",""],["","00093221005","SUCRALFATE ","TAB 1GM","120","Select","Select",""],["","59746011506","PROCHLORPER ","TAB 10MG","10","Select","Select",""],["","00143992801","CIPROFLOXACN ","TAB 500MG","20","Select","Select",""],["","65862001501","AMOXICILLIN ","TAB 875MG","20","Select","Select",""],["","62332042631","BENZONATATE ","CAP 100MG","15","Select","Select",""],["","47781030301","NITROFURANTN ","CAP 100MG","14","Select","Select",""],["","00023916360","RESTASIS ","EMU 0.0005","60","Select","Select",""],["","59746000103","METHYLPRED ","TAB 4MG","21","Select","Select",""],["","00487950125","ALBUTEROL ","0.08%","300","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":""}]}]}