{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LAKEN   L WHITE","gend":1,"add":"166 DOGWOOD TERRACE","city":"BIG STONE GAP","state":"VA","zip":"24219-2776","dob":"1992-03-24","age":"","mstatus":"","insh":7721606,"cliId":"","pno":2762102701,"cno":2762102701,"email":"","ename":"","eno":"","pphy":"WILSON, JAMES MATTHEW","ppno":2765230419,"pcpadd":"310 Cloverleaf Sq, Ste B3","pcpcity":"Big Stone Gap","pcpstate":"VA","pcpzip":242193074,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"SOUTHWEST","aligned":"","ano":2762104776,"add2":"BOX F 16","add3":"","madd1":"166 DOGWOOD TERRACE","madd2":"BOX F 16","madd3":"","mcity":"BIG STONE GAP","mstate":"VA","mzip":"24219-2776","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R19.7","F31.9","F41.1","F34.1","M25.519","R73.09","N92.6","G89.29","R94.5","J40","J02.9","R05","R50.9","F11.23","R11.2","N91.2","R10.84","K21.9","K52.9","F31.5","Z87.11","G43.909","F60.3","F41.9","Z72.89","Z56.0","Z82.49","F17.200","E66.9","G25.81","G47.00","F12.90","R44.0","R45.851","R45.850","M54.5","G58.8","F11.20","Z20.828","J06.9","F43.9","F43.21","R11.0","G43.709","S29.012A","M54.9","V89.2XXA","Y92.410","Z79.899","B34.9","R07.9","R42","R06.02","F17.210","D72.829","F32.9","K25.9","K21.00","R00.2","R79.89","R20.2","B37.0","R25.3","F12.10","M79.89","M79.661","M79.662","R10.9","R07.89","R10.11","R53.81","R53.83","Z86.69","N91.1","Z20.2","F11.21","R68.89","Z86.19","R44.1","M54.6","J44.9","Z72.0","E88.81","R07.1","F11.10","M79.10","N18.9","K75.81","R11.11","K92.1","M25.532","J20.9","H16.223","H47.393","Z71.6","E28.2","A60.09","L03.114","S40.862A","M79.601","M79.602","R30.0","R39.9","M79.672","Z90.49","F11.90","F19.10","R09.89","N39.0","A49.9","R10.2","N93.9","R51.9","R11.10","Z20.822","G47.10","G47.33","R06.83","R51","H53.149","H57.10","M54.2","M25.511","M25.512","F33.3","M79.604","M79.605","K29.50","K20.8","Z91.5","G62.9","Z68.36","J44.1","N83.202","R10.31","F19.939","K59.03","R32","R09.81","Z98.51","Z90.89","F31.12","R20.0","R35.0","E87.6","R10.13","M62.838","R40.0","F34.81","F32.89","T14.91XA","Z87.828","T14.8XXA","B02.9","Z87.898","F43.10","F19.11","G43.109","M25.561","M25.562","M99.00","S00.522A","R22.0","R13.10","M79.18","Z04.3","R10.10","J32.9","K22.70","K25.7","T50.901A","Z51.81","K21.0","Z13.220","E78.2","R10.813","G47.419","W19.XXXA","F31.4","M54.30","W57.XXXA","J01.00"],"date":["2021-04-10","2021-04-15","2021-03-15","2019-01-25","2019-01-25","2019-12-16","2019-01-25","2021-04-29","2019-02-11","2021-04-10","2020-10-06","2021-04-10","2020-07-12","2019-05-15","2021-02-10","2019-08-13","2020-01-27","2021-02-04","2019-09-05","2021-05-11","2019-09-18","2020-07-12","2019-09-18","2020-07-29","2019-09-18","2019-09-18","2019-09-18","2020-11-03","2020-01-27","2021-03-15","2019-09-18","2019-09-18","2019-09-18","2019-09-18","2019-09-18","2020-06-30","2019-12-21","2021-05-11","2020-10-30","2021-03-05","2020-07-30","2020-07-30","2021-02-04","2021-03-15","2020-08-16","2020-08-17","2020-08-16","2020-08-16","2021-04-10","2020-10-30","2020-10-30","2020-10-30","2021-04-15","2021-04-10","2020-11-03","2021-03-15","2021-03-15","2021-03-15","2020-11-03","2020-12-08","2020-11-03","2021-03-05","2021-03-15","2021-05-11","2019-01-22","2019-05-06","2019-05-06","2020-09-16","2020-09-30","2019-05-18","2020-07-12","2019-05-20","2019-08-26","2019-08-13","2019-08-13","2021-03-15","2020-01-31","2019-09-18","2019-09-18","2020-09-22","2021-04-10","2021-04-10","2020-12-08","2020-11-03","2021-02-23","2019-01-22","2020-01-27","2019-01-22","2019-05-18","2019-06-03","2019-06-20","2019-10-26","2019-11-07","2019-11-07","2019-11-07","2021-04-05","2020-08-17","2020-02-24","2020-02-24","2020-04-28","2020-04-28","2020-10-06","2020-05-30","2020-07-01","2021-02-10","2021-02-22","2021-02-22","2021-02-22","2021-02-22","2021-02-22","2021-04-29","2021-04-05","2021-04-10","2021-04-10","2021-04-10","2021-04-15","2021-04-15","2021-04-15","2020-07-29","2019-04-05","2019-04-05","2019-12-16","2019-04-05","2019-04-05","2019-04-24","2019-05-06","2019-05-06","2019-09-24","2019-09-24","2019-11-09","2020-01-27","2020-01-27","2020-03-11","2021-02-10","2021-02-10","2021-02-23","2021-03-04","2021-03-29","2019-05-13","2019-05-18","2019-05-18","2019-05-23","2020-01-02","2020-01-31","2020-01-31","2020-01-31","2021-02-04","2021-02-04","2019-04-11","2019-04-11","2019-06-03","2019-06-03","2019-06-03","2019-06-03","2019-06-03","2019-10-17","2019-10-17","2020-09-22","2020-09-22","2020-09-22","2020-09-22","2021-03-05","2021-03-05","2021-03-05","2019-01-22","2019-05-31","2019-08-26","2020-12-08","2019-09-24","2019-09-24","2020-01-31","2020-01-31","2020-07-23","2020-11-03","2020-12-08","2021-02-10","2021-03-11","2019-06-17","2019-09-18","2019-12-21","2020-02-24","2020-10-14"],"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":[["","65162044210","MECLIZINE ","TAB 25MG","14","Select","Select",""],["","00228212750","CLONIDINE ","TAB 0.1MG","60","Select","Select",""],["","12496120803","SUBOXONE ","MIS 8-2MG","4","Select","Select",""],["","50111078751","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","69547035302","NARCAN ","SPR ","2","Select","Select",""],["","51991029301","OXCARBAZEPIN ","TAB 300MG","60","Select","Select",""],["","68462033290","PRAMIPEXOLE ","TAB 0.5MG","30","Select","Select",""],["","00555021110","NORETHIN ","TAB 5MG","30","Select","Select",""],["","70700026330","LANSOPRAZOLE ","CAP 30MG DR","30","Select","Select",""],["","68462025501","ROPINIROLE ","TAB 1MG","90","Select","Select",""],["","69097015915","MELOXICAM ","TAB 15MG","30","Select","Select",""],["","00185067401","HYDROXYZ ","CAP 25MG","90","Select","Select",""],["","65162090103","ARIPIPRAZOLE ","TAB 20MG","30","Select","Select",""],["","68382009906","PAROXETINE ","TAB 30MG","30","Select","Select",""],["","65862044830","VALACYCLOVIR ","TAB 500MG","60","Select","Select",""],["","65862039010","ONDANSETRON ","TAB 4MG ODT","20","Select","Select",""],["","00054001925","PREDNISONE ","TAB 50MG","5","Select","Select",""],["","68382080510","TRAZODONE ","TAB 50MG","30","Select","Select",""],["","47781049005","DOXYCYCL ","CAP 100MG","20","Select","Select",""],["","68382013905","TOPIRAMATE ","TAB 50MG","30","Select","Select",""],["","29300016810","TIZANIDINE ","TAB 2MG","20","Select","Select",""],["","00406012505","HYDROCO\/APAP ","TAB 10-325MG","10","Select","Select",""],["","65162025350","RANITIDINE ","TAB 150MG","60","Select","Select",""],["","50111033402","METRONIDAZOL ","TAB 500MG","30","Select","Select",""],["","43199001101","HYOSCYAMINE ","SUB 0.125MG","30","Select","Select",""],["","65162052110","PROMETHAZINE ","TAB 25MG","30","Select","Select",""],["","62332042631","BENZONATATE ","CAP 100MG","30","Select","Select",""],["","17478071710","KETOTIF ","DRO 0.025%OP","5","Select","Select",""],["","65862085901","FAMOTIDINE ","TAB 20MG","30","Select","Select",""],["","62175061743","PANTOPRAZOLE ","TAB 40MG","30","Select","Select",""],["","00093317431","ALBUTEROL ","FAT E HFA INH","8.5","Select","Select",""],["","66689000816","NYSTATIN ","SUS 100000","200","Select","Select",""],["","16571020106","DICLOFENAC ","TAB 75MG DR","20","Select","Select",""],["","00781261305","AMOXICILLIN ","CAP 500MG","30","Select","Select",""],["","00113201760","SINUS ","TAB 120MG ER","60","Select","Select",""],["","00536589688","NICOTINE ","DIS 21MG\/24H","28","Select","Select",""],["","71093014005","METHOCARBAM ","TAB 500MG","15","Select","Select",""],["","00054004544","IPRATROPIUM ","SPR 0.0003","30","Select","Select",""],["","47781030301","NITROFURANTN ","CAP 100MG","14","Select","Select",""],["","59746000103","METHYLPRED ","TAB 4MG","21","Select","Select",""],["","57664049983","MIRTAZAPINE ","TAB 15MG","30","Select","Select",""],["","42571016242","AMOX\/K ","TAB 875-125","20","Select","Select",""],["","57237023305","SMZ-TMP ","TAB 800-160","20","Select","Select",""],["","43547034006","RISPERIDONE ","TAB 0.5MG","30","Select","Select",""],["","57664037713","TRAMADOL ","TAB 50MG","10","Select","Select",""],["","63402030430","LATUDA ","TAB 40MG","30","Select","Select",""],["","16729008110","NALTREXONE ","TAB 50MG","30","Select","Select",""],["","65162027250","SMZ\/TMP ","TAB 800-160","14","Select","Select",""],["","65862007701","CIPROFLOXACN ","TAB 500MG","14","Select","Select",""],["","57237009960","CEFDINIR ","CAP 300MG","20","Select","Select",""],["","31722077701","ACYCLOVIR ","TAB 400MG","21","Select","Select",""],["","43386048024","ORPHENADRINE ","TAB 100MG ER","30","Select","Select",""],["","75826011510","PHENAZOPYRID ","TAB 200MG","10","Select","Select",""],["","60758088005","FLUOROMETHOL ","SUS 0.1% OP","5","Select","Select",""],["","69097084615","CYCLOBENZAPR ","TAB 10MG","6","Select","Select",""],["","00713052612","PROMETHEGAN ","SUP 25MG","10","Select","Select",""],["","45802011222","MUPIROCIN ","OIN 0.02","22","Select","Select",""],["","00904675859","ROBAFEN ","LIQ 10-100MG","277","Select","Select",""],["","70000012401","EYE ","DRO 0.025%OP","5","Select","Select",""],["","65862059401","DIVALPROEX ","250MG ER","30","Select","Select",""],["","50428394374","CVS ","4MGFRUIT","100","Select","Select",""],["","00093117410","PENICILLN ","500MG","30","Select","Select",""],["","65862053820","LEVOFLOXACIN ","750MG","10","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":""}]}]}