{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ANN   C ROGERS","gend":1,"add":"13496 COUNTY LINE CHURCH ROAD","city":"WOODFORD","state":"VA","zip":"22580-9998","dob":"1963-03-13","age":"","mstatus":"","insh":"20034247*01","cliId":"","pno":"804\/994-1994","cno":"","email":"","ename":"","eno":"","pphy":"KAPUSTKA, HEIDI NP","ppno":"540\/423-6000","pcpadd":"SUITE 200 4604 SPOTSYVANIA PKWY","pcpcity":"FREDERICKSBURG","pcpstate":"VA","pcpzip":22408,"pcpcounty":"","pcpid":"","pcpname":"SPOTSYLVANIA MULTI SPECIALTY GROUP LLC","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"540\/423-6655","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K35.80","NO DATA","A09.","F41.8","V62.84","K62.5","E55.9","G43.001","Z12.31","G43.709","M25.551","R30.0","Z01.419","M54.5","L03.119","V58.89","R73.03","R35.0","R53.82","M13.0","R10.13","R13.19","K22.2","K22.8","K31.89","M94.0","I10.","J45.21","K59.09","R19.7","M54.16","R10.30","J45.41","K59.04","K21.9","J20.9","R05.","R06.02","J44.9","R10.33","K22.70","Z86.010","R19.8","R10.31","R10.32","M25.512","Z20.822","J45.909","K92.1","K57.30","K64.9","R13.10","R11.2","R76.8","R68.89","M26.609","S29.011A","S39.91XA","E53.8","M25.561","M17.11","S39.011A","N20.0","R31.0","R94.31","R06.2","F34.1","Z78.0","H10.9","R10.2","K57.90","K44.9","E87.0","G47.00","M54.42","G89.29","J40.","Z86.19","J06.9","K52.9","M25.571","I88.0","R11.0","K59.00","S46.911A","R10.9","S63.501A","F41.9","R40.2441"],"date":["2020-02-13","2020-02-13","2020-02-26","2021-08-12","2021-03-04","2021-03-04","2021-12-13","2021-03-04","2021-03-04","2021-04-26","2021-04-26","2021-04-26","2021-04-26","2021-04-26","2020-10-13","2021-08-12","2021-12-13","2021-05-04","2021-12-13","2021-12-13","2021-07-23","2021-06-28","2021-06-28","2021-06-28","2021-06-28","2020-02-04","2021-10-01","2021-08-12","2021-07-23","2020-09-28","2021-08-12","2021-01-13","2021-12-13","2020-09-28","2021-10-01","2021-06-11","2021-07-14","2021-07-14","2021-07-14","2020-02-12","2020-02-12","2020-02-12","2020-10-29","2021-06-12","2021-10-01","2021-05-21","2021-06-12","2021-10-01","2021-01-13","2021-01-13","2021-01-13","2021-07-23","2021-07-23","2021-12-13","2021-12-13","2020-06-25","2021-08-12","2021-10-01","2021-08-12","2021-09-16","2021-09-16","2021-10-01","2020-02-27","2020-02-27","2021-05-21","2019-03-25","2019-06-13","2019-06-13","2019-06-13","2019-07-18","2019-07-18","2019-07-18","2019-07-18","2019-11-26","2019-11-26","2019-11-26","2019-09-27","2019-04-29","2019-05-10","2019-03-29","2019-07-27","2019-03-28","2019-07-11","2019-07-11","2019-09-27","2019-07-03","2019-02-23","2019-08-23","2019-03-29"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}}]},{"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":[]},{"a":[]},{"a":{"indx":[false,false],"comment":["",""],"score":["",""]}},{"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":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","","PANTOPRAZOLE"," PANTOPRAZOLE ","30","Select","Select",""],["","","CYCLOBENZAPR"," CYCLOBENZAPR ","21","Select","Select",""],["","89076085383","AIRIAL","MIS COMPACT","1","Select","Select",""],["","","ESCITALOPRAM"," ESCITALOPRAM ","30","Select","Select",""],["","","CETIRIZINE"," CETIRIZINE ","30","Select","Select",""],["","","HYDROCHLOROT","TAB 12.5MG","","Select","Select",""],["","","VITAMIN","CAP 50MCG","","Select","Select",""],["","","SYMBICORT"," SYMBICORT ","10","Select","Select",""],["","00121087316","LACTULOSE","SOL 10GM\/15","473","Select","Select",""],["","10702025350","BUT\/APAP\/CAF","TAB ","45","Select","Select",""],["","","DICYCLOMINE"," DICYCLOMINE ","60","Select","Select",""],["","64980052621","NITAZOXANIDE","TAB 500MG","20","Select","Select",""],["","00781502207","METHYLPRED","TAB 4MG","21","Select","Select",""],["","","AMITRIPTYLIN"," AMITRIPTYLIN ","120","Select","Select",""],["","69097015907","MELOXICAM","TAB 15MG","30","Select","Select",""],["","","CVS","POW ","","Select","Select",""],["","","NAPROXEN"," NAPROXEN ","14","Select","Select",""],["","00310461612","BREZTRI","AER SPHERE","11","Select","Select",""],["","","LEVOFLOXACIN"," LEVOFLOXACIN ","7","Select","Select",""],["","","ALBUTEROL"," ALBUTEROL ","75","Select","Select",""],["","","MUPIROCIN","OIN 0.02","","Select","Select",""],["","","TRIAMCINOLON","CRE 0.001","","Select","Select",""],["","","TIZANIDINE"," TIZANIDINE ","30","Select","Select",""],["","","PREDNISONE"," PREDNISONE ","16","Select","Select",""],["","","SERTRALINE"," SERTRALINE ","30","Select","Select",""],["","43386048024","ORPHENADRINE","TAB 100MG ER","10","Select","Select",""],["","","PROAIR"," PROAIR ","8","Select","Select",""],["","67877041301","METFORMIN","TAB 500MG ER","30","Select","Select",""],["","","SUCRALFATE"," SUCRALFATE ","56","Select","Select",""],["","59779045888","ALLERGY","TAB 10MG","30","Select","Select",""],["","23155076701","TETRACYCLINE","CAP 500MG","56","Select","Select",""],["","","AZITHROMYCIN"," AZITHROMYCIN ","6","Select","Select",""],["","69842093108","ACETAMINOPHN","TAB 500MG","120","Select","Select",""],["","","PROMETHAZINE","TAB 12.5MG","","Select","Select",""],["","50428027563","STOMACH","CHW 262MG","56","Select","Select",""],["","","GAVILAX","POW ","","Select","Select",""],["","45802048678","DOCUSATE","CAP 100MG","30","Select","Select",""],["","74300000412","RID","LIQ ","1","Select","Select",""],["","","OMEPRAZOLE"," OMEPRAZOLE ","30","Select","Select",""],["","","METRONIDAZOL"," METRONIDAZOL ","30","Select","Select",""],["","53489011905","DOXYCYCL","CAP 100MG","10","Select","Select",""],["","69097052444","DICLOFENAC","GEL 0.01","500","Select","Select",""],["","","CHOLESTYRAM"," CHOLESTYRAM ","30","Select","Select",""],["","","HYDROCO\/APAP"," HYDROCO\/APAP ","20","Select","Select",""],["","","LISINOPRIL"," LISINOPRIL ","30","Select","Select",""],["","","TRAZODONE"," TRAZODONE ","30","Select","Select",""],["","","OXYCODONE"," OXYCODONE ","10","Select","Select",""],["","","LINZESS"," LINZESS ","30","Select","Select",""],["","","HYD"," HYD ","70","Select","Select",""],["","","CHLORHEX"," CHLORHEX ","473","Select","Select",""],["","","CITALOPRAM"," CITALOPRAM ","30","Select","Select",""],["","","BENZONATATE"," BENZONATATE ","30","Select","Select",""],["","","ONDANSETRON"," ONDANSETRON ","21","Select","Select",""],["","","LUBRICNT"," LUBRICNT ","10","Select","Select",""],["","","SYSTANE"," SYSTANE ","10","Select","Select",""],["","","CARAFATE"," CARAFATE ","560","Select","Select",""],["","","PROBIOTIC"," PROBIOTIC ","120","Select","Select",""],["","","CODEINE\/GG"," CODEINE\/GG ","150","Select","Select",""],["","","BISACODYL"," BISACODYL ","10","Select","Select",""],["","","POLYMYXIN"," POLYMYXIN ","10","Select","Select",""],["","","CIPROFLOXACN"," CIPROFLOXACN ","20","Select","Select",""],["","","SUMATRIPTAN"," SUMATRIPTAN ","10","Select","Select",""],["","","ALPRAZOLAM"," ALPRAZOLAM ","14","Select","Select",""],["","","PAROXETINE"," PAROXETINE ","30","Select","Select",""],["","","LIDOCAINE","SOL 2% VISC","","Select","Select",""],["","","DIPHEN\/ATROP","TAB 2.5MG","","Select","Select",""],["","","ONETOUCH","TES ULTRA BL","","Select","Select",""],["","","TOBRA\/DEXAME","SUS 0.3-0.1%","","Select","Select",""],["","","STOOL","CAP 100MG","","Select","Select",""],["","","BUDES\/FORMOT","AER 160-4.5","","Select","Select",""],["","","HYOSCYAMINE","TAB 0.125MG","","Select","Select",""],["","","MIRALAX","POW 3350 NF","","Select","Select",""],["","","PROVENTIL","AER HFA","","Select","Select",""],["","","PEG\/NASUL,C","SOL NACL\/POT","","Select","Select",""],["","","NEO\/POLY\/DEX","SUS 0.1% OP","","Select","Select",""],["","","VENTOLIN","AER ","","Select","Select",""],["","","POLYETH","POW 3350 NF","","Select","Select",""],["","","XARELTO","TAB 10MG","","Select","Select",""],["","","DOXYCYC","CAP 100MG","","Select","Select",""],["","","METHOCARBAM","TAB 500MG","","Select","Select",""]]}},{"a":[]},{"a":[]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":[]}]},{"t":"Mini-Cog","q":[{"a":[]},{"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":"","a13":""}]}]}