{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LORI   R FORD","gend":1,"add":"135 S CHARLES STREET","city":"STRASBURG","state":"VA","zip":"22657-2658","dob":"1968-06-12","age":"","mstatus":"","insh":8080625,"cliId":"","pno":5409745054,"cno":"               ","email":"","ename":"","eno":"","pphy":"LAMAS RODRIGUEZ, CANDY","ppno":5407222369,"pcpadd":"525 Amherst St Ste 104, ","pcpcity":"Winchester","pcpstate":"VA","pcpzip":226013881,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"NORTHERN\/ WINCHESTER","aligned":"","ano":2404526541,"add2":"APT 4","add3":"","madd1":"135 S CHARLES STREET","madd2":"APT 4","madd3":"","mcity":"STRASBURG","mstate":"VA","mzip":"22657-2658","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G47.33","N92.0","N94.6","R87.810","R87.610","N84.0","L29.2","N89.8","N76.0","R06.00","J30.89","R13.19","K92.1","Z80.0","J44.9","I50.9","E66.9","Z68.43","E11.9","M79.7","G20","N84.1","N88.8","E66.01","I48.91","K21.9","I11.0","I50.42","I42.8","D63.8","Z98.61","I10","E78.2","S89.91XA","S99.921A","M17.11","W01.0XXA","D64.9","N95.1","N12","S09.90XA","R10.9","W19.XXXA","R73.01","J45.20","R13.12","Z01.84","Z01.818","R42","J45.31","Z11.51","Z12.4","Z01.810","Z01.419","R13.10","Z00.00","Z12.11","Z12.31","D48.5","R23.8","Z78.9","L08.89","Z20.828","Z23"],"date":["2021-03-01","2020-12-09","2020-11-30","2020-11-09","2020-11-30","2020-12-09","2020-11-20","2020-11-20","2020-11-20","2020-12-07","2020-12-07","2020-11-04","2020-11-04","2020-11-04","2020-12-09","2020-11-04","2020-11-04","2020-11-30","2021-03-17","2020-12-09","2020-12-09","2020-12-09","2020-12-09","2020-12-14","2020-12-09","2020-12-09","2020-12-09","2020-12-14","2020-12-14","2020-12-09","2020-12-09","2021-03-17","2021-03-17","2021-04-07","2021-04-07","2021-04-07","2021-04-07","2020-12-02","2020-11-03","2021-05-16","2021-05-16","2021-05-16","2021-05-16","2020-10-13","2020-10-13","2020-10-15","2020-12-02","2020-12-12","2021-02-10","2021-04-17","2020-10-13","2020-10-13","2021-03-10","2020-10-13","2020-09-10","2020-09-22","2020-09-22","2020-09-22","2020-11-10","2020-11-10","2020-11-10","2020-11-10","2020-11-24","2021-03-18"],"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":[["","57237021930","PIOGLITAZONE ","TAB 15MG","30","Select","Select",""],["","00363058714","ASPIRIN ","TAB 81MG EC","30","Select","Select",""],["","59746021605","SPIRONOLACT ","TAB 25MG","30","Select","Select",""],["","00597007541","SPIRIVA ","CAP HANDIHLR","30","Select","Select",""],["","76385011350","CARVEDILOL ","TAB 25MG","60","Select","Select",""],["","00054327099","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","63304007601","POT  CHLORIDE","TAB 10MEQ ER","60","Select","Select",""],["","68180071909","AMLODIPINE ","TAB 2.5MG","30","Select","Select",""],["","69097094312","GABAPENTIN ","CAP 300MG","90","Select","Select",""],["","42799012001","BUMETANIDE ","TAB 1MG","60","Select","Select",""],["","00904759080","FEROSUL ","TAB 325MG","60","Select","Select",""],["","60505025203","TIZANIDINE ","TAB 4MG","15","Select","Select",""],["","00093317431","ALBUTEROL ","FAT E HFA INH","8.5","Select","Select",""],["","00186037020","SYMBICORT ","AER 160-4.5","10.2","Select","Select",""],["","68180051902","LISINOP\/HCTZ ","TAB 20-12.5","60","Select","Select",""],["","69238111701","BUSPIRONE ","TAB 10MG","60","Select","Select",""],["","00781571010","POT  CL MICRO","TAB 10MEQ ER","60","Select","Select",""],["","65862057490","MONTELUKAST ","TAB 10MG","30","Select","Select",""],["","42806031250","DOXYCYCL ","TAB 100MG","20","Select","Select",""],["","00378395205","ATORVASTATIN ","TAB 40MG","90","Select","Select",""],["","00378034505","DIAZEPAM ","TAB 5MG","12","Select","Select",""],["","00143993905","AMOXICILLIN ","CAP 500MG","20","Select","Select",""],["","67877056305","METFORMIN ","TAB 1000MG","180","Select","Select",""],["","68180071160","CEFDINIR ","CAP 300MG","14","Select","Select",""],["","65862092205","TRAMADL\/APAP ","TAB 37.5-325","10","Select","Select",""],["","59746012106","MECLIZINE ","TAB 25MG","30","Select","Select",""],["","33342025866","OSELTAMIVIR ","CAP 75MG","10","Select","Select",""],["","69547035302","NARCAN ","SPR ","2","Select","Select",""],["","66685100100","AMOX\/K ","TAB 875-125","20","Select","Select",""],["","68382091634","METHYLPRED ","TAB 4MG","21","Select","Select",""],["","51672128901","NYSTATIN ","CRE 100000","15","Select","Select",""],["","45802006335","TRIAMCINOLON ","CRE 0.00025","15","Select","Select",""],["","55111012701","CIPROFLOXACN ","TAB 500MG","14","Select","Select",""],["","57237000511","FLUCONAZOLE ","TAB 150MG","2","Select","Select",""],["","53885001110","ONETOUCH ","MIS PLUS 30G","100","Select","Select",""],["","10572010001","PEG-3350 ","SOL ELECTROL","4,000.00","Select","Select",""],["","00591544305","PREDNISONE ","TAB 20MG","5","Select","Select",""],["","64380080707","IBUPROFEN ","TAB 800MG","30","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":""}]}]}