{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BRITTANY   N BRODFUEHRER","gend":1,"add":"2 SHANNONDALE COURT","city":"FREDERICKSBURG","state":"VA","zip":"22406-7277","dob":"1989-01-23","age":"","mstatus":"","insh":7908604,"cliId":"","pno":5403000630,"cno":5408470217,"email":"","ename":"","eno":"","pphy":"JANUS, THOMAS A","ppno":5403714700,"pcpadd":"418 Chatham Square Office Park, ","pcpcity":"Fredericksburg","pcpstate":"VA","pcpzip":224052561,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"CENTRAL","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"2 SHANNONDALE COURT","madd2":"                                                            ","madd3":"","mcity":"FREDERICKSBURG","mstate":"VA","mzip":"22406-7277","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F31.31","F90.0","N39.0","B96.29","Z16.12","Z34.90","O23.40","O35.5XX1","O99.341","O99.281","O99.282","O99.342","O23.02","Z3A.21","O35.8XX1","O99.283","O99.343","O24.419","Z34.01","Z3A.01","O23.12","D72.829","N13.5","N30.01","N89.8","Z34.83","Z3A.36","M79.89","M79.672","O99.89","M79.652","O13.3","O09.293","Z3A.37","Z87.440","Z90.49","Z87.891","Z82.5","Z83.3","Z88.1","O69.81X0","E03.9","Z3A.39","O80","Z37.0","Z3A.00","N92.6","Z32.01","N13.30","O26.832","N20.0","N28.89","O13.4","O24.420","O99.284","J06.9","J45.909","J30.89","J02.9","R53.81","O20.0","O20.8","N83.201","Z3A.08","O26.893","R03.0","O12.03","O26.841","N13.2","Z39.1","Z34.82","Z3A.24","O99.810","Z34.80","O23.42","A49.8","Z86.19","N13.6","N28.1","Z87.442","B96.89","Z3A.30","Z34.81","O34.81","O99.111","O99.011","D64.9","O99.511","R10.2","O23.92","N12","F39","O99.344","F90.9","O70.0","O99.52","K21.9","J01.90","B37.9","T36.95XA","T50.Z95A"],"date":["2021-05-10","2021-05-10","2019-07-28","2019-07-28","2019-07-28","2020-03-02","2019-09-05","2020-01-28","2019-09-05","2019-09-05","2020-01-28","2020-01-16","2019-11-08","2019-11-08","2020-02-12","2020-02-12","2020-02-12","2020-02-12","2019-07-11","2019-07-31","2019-11-05","2019-11-05","2019-11-05","2019-11-06","2020-02-20","2020-02-20","2020-02-23","2020-02-23","2020-02-23","2020-02-23","2020-02-23","2020-02-23","2020-02-23","2020-02-23","2020-02-23","2020-02-23","2020-02-23","2020-02-23","2020-02-23","2020-02-23","2020-03-06","2020-03-06","2020-03-06","2020-03-06","2020-03-07","2020-03-06","2019-07-15","2019-07-15","2019-11-05","2019-11-05","2019-11-05","2019-11-05","2020-03-07","2020-03-07","2020-03-07","2019-02-04","2020-03-06","2019-02-04","2019-02-04","2019-02-04","2019-08-06","2019-08-06","2019-08-06","2019-08-06","2020-02-23","2020-02-23","2020-02-23","2019-07-31","2019-11-07","2019-11-01","2019-12-19","2019-12-19","2020-01-07","2019-07-15","2019-10-29","2019-10-29","2019-10-29","2019-11-05","2019-11-05","2020-03-06","2019-11-05","2019-12-23","2019-07-31","2019-08-06","2019-08-06","2019-08-06","2019-08-06","2019-08-06","2019-10-03","2019-10-03","2019-11-05","2020-03-06","2020-03-06","2020-03-06","2020-03-06","2020-03-06","2020-03-06","2020-08-09","2020-08-09","2020-08-09","2021-04-28"],"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":[["","59417010610","VYVANSE ","CAP 60MG","30","Select","Select",""],["","00904531360","PRENATAL ","TAB 27-0.8MG","30","Select","Select",""],["","00378180010","LEVOTHYROXIN ","TAB 25MCG","30","Select","Select",""],["","68645056354","IBUPROFEN ","TAB 800MG","30","Select","Select",""],["","49035007860","EQ ","CAP SOFTENER","60","Select","Select",""],["","99073070914","FREESTYLE    KIT FREEDOM","KIT FREEDOM","1","Select","Select",""],["","99073070827","FREESTYLE    TES LITE","TES LITE","100","Select","Select",""],["","99073013001","FREESTYLE    MIS LANCETS","MIS LANCETS","100","Select","Select",""],["","70710113908","FLUCONAZOLE ","TAB 150MG","1","Select","Select",""],["","65862050320","AMOX\/K ","TAB 875-125","20","Select","Select",""],["","00093005405","BUSPIRONE ","TAB 10MG","120","Select","Select",""],["","50428708884","BP ","KIT AUTO","1","Select","Select",""],["","55111029136","SUMATRIPTAN ","TAB 25MG","14","Select","Select",""],["","65862001501","AMOXICILLIN ","TAB 875MG","20","Select","Select",""],["","65862009520","CEFPODOXIME ","TAB 100MG","30","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","28","Select","Select",""],["","58160088552","FLUARIX ","INJ 2020-21","0.5","Select","Select",""],["","49281041950","FLUZONE ","INJ 2019-20","0.5","Select","Select",""],["","10702025350","BUT\/APAP\/CAF ","TAB ","60","Select","Select",""],["","65862039010","ONDANSETRON ","TAB 4MG ODT","30","Select","Select",""],["","68180012202","CEPHALEXIN ","CAP 500MG","28","Select","Select",""],["","58160084252","BOOSTRIX ","INJ ","0.5","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","",""],["No","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":""}]}]}