{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BRANDIE   L KING","gend":1,"add":"PO BOX 954","city":"CASTLEWOOD","state":"VA","zip":"24224-0954","dob":"1983-07-08","age":"","mstatus":"","insh":7730665,"cliId":"","pno":2767627093,"cno":2767627093,"email":"","ename":"","eno":"","pphy":"PHILLIPS, PAUL A","ppno":2768893700,"pcpadd":"16431 Wise St, ","pcpcity":"Saint Paul","pcpstate":"VA","pcpzip":242833537,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"SOUTHWEST","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"4249 MECKLENBERG ROAD","madd2":"                                                            ","madd3":"","mcity":"COEBURN","mstate":"VA","mzip":"24230-6623","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F41.9","N94.6","E78.5","R53.83","J01.90","Z72.0","M54.2","M48.02","M54.12","M47.22","R51.9","F51.01","F33.1","G89.29","F32.9","G47.00","E53.8","J01.00","R06.02","R05","F31.31","F31.60","F11.21","F14.21","F11.20","N92.6","R10.2","N85.8","J40","J02.9","F17.210","R11.2","R51","R19.7","H60.513","F14.20","B18.2","F11.99","F41.1","S61.412A","W45.8XXA","R10.31","N83.209","R92.8","K21.9","S16.1XXA","S39.012A","S00.83XA","S10.11XA","Z03.89","H92.01","F31.9","F90.9","Z79.899","W26.0XXA","Y93.G1","F98.8","Z12.31","J45.20","J20.9","R49.0","M79.10","M54.5","V47.5XXA","Y92.410","S10.91XA"],"date":["2021-05-18","2020-09-28","2019-11-26","2020-12-16","2020-01-26","2020-12-16","2021-02-09","2020-12-03","2021-01-21","2020-12-03","2021-02-09","2020-12-07","2020-12-07","2020-12-07","2020-09-09","2020-04-23","2020-11-17","2020-12-01","2020-12-16","2020-12-16","2020-03-14","2020-04-30","2020-04-30","2020-04-30","2020-04-30","2020-09-28","2020-09-28","2020-09-28","2020-12-16","2020-12-16","2020-12-16","2019-01-24","2019-01-24","2019-01-24","2019-10-27","2020-01-13","2020-05-20","2021-05-18","2019-02-07","2020-03-11","2020-03-11","2020-08-11","2020-08-03","2020-08-03","2020-09-09","2021-02-09","2021-02-09","2021-02-09","2021-02-09","2019-02-06","2019-10-27","2020-03-11","2019-10-27","2020-03-11","2020-03-11","2020-03-11","2020-03-11","2020-08-11","2020-11-17","2020-12-16","2020-01-26","2020-01-26","2021-02-09","2021-02-09","2021-02-09","2021-02-09"],"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":[["","29300011616","TOPIRAMATE ","TAB 50MG","60","Select","Select",""],["","68645056354","IBUPROFEN ","TAB 800MG","90","Select","Select",""],["","68645052054","ESCITALOPRAM ","TAB 20MG","30","Select","Select",""],["","68462015713","ONDANSETRON ","TAB 4MG ODT","15","Select","Select",""],["","10702000709","CYCLOBENZAPR ","TAB 10MG","60","Select","Select",""],["","68462039730","OMEPRAZOLE ","CAP 40MG","30","Select","Select",""],["","00555901658","SPRINTEC ","TAB 28 DAY","28","Select","Select",""],["","00781261305","AMOXICILLIN ","CAP 500MG","28","Select","Select",""],["","00093005805","TRAMADOL ","TAB 50MG","12","Select","Select",""],["","33342008841","RIZATRIPTAN ","TAB 10MG","12","Select","Select",""],["","65862057490","MONTELUKAST ","TAB 10MG","30","Select","Select",""],["","68180071160","CEFDINIR ","CAP 300MG","20","Select","Select",""],["","59746017310","PREDNISONE ","TAB 10MG","10","Select","Select",""],["","68382080601","TRAZODONE ","TAB 100MG","30","Select","Select",""],["","68645057054","CITALOPRAM ","TAB 20MG","30","Select","Select",""],["","00054327099","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","16729017317","AMITRIPTYLIN ","TAB 50MG","30","Select","Select",""],["","65162027250","SMZ\/TMP ","TAB 800-160","10","Select","Select",""],["","66993001968","ALBUTEROL ","AER HFA","18","Select","Select",""],["","59746000103","METHYLPRED ","TAB 4MG","21","Select","Select",""],["","55111029209","SUMATRIPTAN ","TAB 50MG","18","Select","Select",""],["","12496120803","SUBOXONE ","MIS 8-2MG","14","Select","Select",""],["","65162083366","DICLOFENAC ","GEL 0.01","100","Select","Select",""],["","00832105415","BACLOFEN ","TAB 10MG","30","Select","Select",""],["","69547035302","NARCAN ","SPR ","2","Select","Select",""],["","16714008210","HYDROXYZ ","TAB 25MG","90","Select","Select",""],["","00185041501","BUPROPION ","TAB 150MG SR","30","Select","Select",""],["","16714069211","FLUCONAZOLE ","TAB 150MG","1","Select","Select",""],["","55111068405","IBU ","TAB 800MG","90","Select","Select",""],["","42806071401","BENZONATATE ","CAP 100MG","21","Select","Select",""],["","50111078751","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","12496030001","SUBLOCADE ","300\/1.5","1.5","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":[[["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":""}]}]}