{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"M SIOLSIWEL ","gend":1,"add":"RETS 583TS GNIL","city":"HARRISONBURG","state":"VA","zip":"22802-9998","dob":"1976-01-26","age":"","mstatus":"","insh":"10117772","cliId":"9T88Q20PX55","pno":"4404577237","cno":5404473277,"email":"","ename":"","eno":"","pphy":"DOMINGUS, JEFF LEWIS ","ppno":5404334913,"pcpadd":"339 NEBO SCHOOL RD","pcpcity":"NEBO  ","pcpstate":"NC","pcpzip":287616848,"pcpcounty":"","pcpid":"P0124711","pcpname":"HARRISONBURG COMMUNITY HEALTH CENTER INC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"","add2":"","add3":"","madd1":"385 STERLING ST","madd2":"","madd3":"","mcity":"HARRISONBURG","mstate":"VA","mzip":"22802-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["F31.81","M25.561","W19.XXXA","J30.89","Y92.009","Z20.828","Z96.651","F31.9","Z86.711","M81.0","Z82.49","Z83.42","Z83.438","Z83.3","Z80.3","Z87.891","Z88.8","Z88.1","Z88.5","Z88.2","Z91.040","Z91.018","Z47.1","R20.2","G81.94","V29.9XXA","V43.52XA","Y92.410","I71.2","I10","E78.5","R53.1","R29.898","V89.2XXA","R52","R41.0","M25.519","R10.9","Z04.1","M54.9","Z79.899","S29.9XXA","S39.91XA","R93.89","S39.93XA","S30.1XXA","S39.92XA","S79.919A","R07.9","R29.2","R07.89","I77.810","R06.02","G89.29","F17.200","Z86.718","S09.90XA","H53.2","Z91.81","Z74.01","S19.9XXA","S09.93XA","M54.2","G44.209","R06.89","S80.01XA","S89.91XA","W10.9XXA","Z91.02","R19.09","I71.4","G81.90","R20.0","R41.89","R60.0","I49.8","R94.31","R00.1","F43.0","Z86.69","R56.9","F41.9","M79.605","M79.89","Z96.659","T84.84XA","M43.6","M25.461","M25.569","S83.91XA","M25.572","S93.402A","W51.XXXA","Y93.83","Z87.828","S83.411D","W19.XXXD","X50.9XXD","R11.2","W18.30XA","W50.0XXA","X50.9XXA","S99.912A","T14.90XA","Z74.3","R10.31","R10.32","R30.0","N20.0","R10.84","R11.0","R11.11","K59.00","W01.10XA","F17.210","N28.89","I87.8","I70.0","F31.10","R29.810","R25.3","G40.909","R51.9","R13.10","M62.81","Z72.0","R07.81","W01.0XXA","S93.401A"],"date":["2021-10-18","2021-07-13","2021-07-13","2020-04-24","2020-04-24","2021-01-30","2021-08-10","2020-09-14","2021-05-18","2021-05-18","2020-09-03","2020-09-03","2020-09-03","2020-09-03","2020-09-03","2021-09-23","2021-09-23","2021-09-23","2021-11-23","2021-11-23","2021-11-23","2021-09-23","2020-09-03","2021-01-02","2020-09-14","2020-09-14","2020-09-14","2020-09-14","2021-11-23","2021-11-24","2021-07-04","2021-09-21","2020-09-14","2020-09-15","2021-09-23","2020-09-14","2020-09-14","2021-09-29","2020-11-01","2021-07-04","2021-11-23","2020-11-01","2020-11-01","2020-09-14","2020-11-01","2020-09-14","2020-11-01","2020-09-14","2020-10-28","2020-09-15","2020-10-28","2021-10-11","2020-10-28","2021-07-04","2021-07-04","2021-07-04","2020-11-01","2021-11-23","2020-11-01","2020-11-01","2020-11-02","2020-11-01","2020-11-01","2020-11-01","2021-01-02","2021-01-02","2021-01-02","2021-01-02","2021-09-23","2021-02-05","2021-01-27","2020-09-14","2021-11-24","2020-09-16","2020-09-16","2020-10-28","2020-10-28","2020-10-28","2021-05-18","2021-05-18","2021-05-18","2021-11-23","2021-06-12","2021-06-12","2021-06-12","2021-06-12","2021-06-28","2021-07-04","2021-06-12","2021-08-10","2021-07-26","2021-07-26","2021-07-26","2021-07-26","2021-07-26","2021-08-10","2021-08-10","2021-08-10","2021-09-23","2021-07-04","2021-07-04","2021-07-13","2021-07-26","2021-07-04","2021-07-04","2021-09-23","2021-09-23","2021-09-23","2021-09-29","2021-09-23","2021-09-23","2021-09-23","2021-09-29","2021-07-04","2021-09-21","2021-09-23","2021-09-23","2021-10-11","2021-11-24","2021-11-23","2021-11-23","2021-11-23","2021-11-23","2021-11-23","2021-11-23","2021-11-23","2021-11-14","2021-11-14","2021-07-26"],"priorHcc":[null,"","","","","","","","","","","","","","","","","",null,null,null,"","","","","","","",null,null,"","","","","","","","","","",null,"","","","","","","","","","","","","","","","",null,"","","","","","","","","","","","","","",null,"","","","","","","","",null,"","","","","","","","","","","","","","","","","","","","","","","",null,"","","","","","","","","","","","",null,null,null,null,null,null,null,null,null,null,null]}},{"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":{"indx":["","",""],"comment":["","",""],"sub":[]}},{"a":{"indx":["","",""],"comment":["","",""],"sub":[]}}]},{"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":[["","68382000914","LAMOTRIGINE","TAB 150MG","","Select","Select",""],["","406012305","HYDROCO\/APAP","TAB 5-325MG","","Select","Select",""],["","93506110","HYDROXYZ HCL","TAB 25MG","","Select","Select",""],["","63402030630","LATUDA","TAB 60MG","","Select","Select",""],["","143980305","DOXYCYCL HYC","CAP 100MG","","Select","Select",""],["","10702001801","OXYCODONE","TAB 5MG","","Select","Select",""],["","69097094312","GABAPENTIN","CAP 300MG","","Select","Select",""],["","69315090505","LORAZEPAM","TAB 1MG","","Select","Select",""],["","67877032005","IBUPROFEN","TAB 600MG","","Select","Select",""],["","68382000914","LAMOTRIGINE ","TAB 150MG","30","Select","Select",""],["","93506110","HYDROXYZ ","TAB 25MG","180","Select","Select",""],["","406012305","HYDROCO\/APAP ","TAB 5-325MG","3","Select","Select",""],["","143980305","DOXYCYCL ","CAP 100MG","14","Select","Select",""],["","63402030630","LATUDA ","TAB 60MG","30","Select","Select",""],["","591024110","LORAZEPAM ","TAB 1MG","60","Select","Select",""],["","67877032005","IBUPROFEN ","TAB 600MG","30","Select","Select",""],["","10702001801","OXYCODONE ","TAB 5MG","5","Select","Select",""],["","69097094312","GABAPENTIN ","CAP 300MG","90","Select","Select",""],["","00093506110","HYDROXYZ","25MG","180","Select","Select",""],["","00143980305","DOXYCYCL","100MG","14","Select","Select",""],["","68180051201","LISINOPRIL","2.5MG","90","Select","Select",""],["","69543038810","KETOROLAC","10MG","12","Select","Select",""],["","00591530710","PROMETHAZINE","25MG","12","Select","Select",""],["","65862042005","SMZ\/TMP","800-160","20","Select","Select",""],["","68180051201","LISINOPRIL ","TAB 2.5MG","90","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","20","Select","Select",""],["","69543038810","KETOROLAC ","TAB 10MG","12","Select","Select",""],["","68462019001","NAPROXEN ","TAB 500MG","20","Select","Select",""],["","00591530710","PROMETHAZINE ","TAB 25MG","12","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","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","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":""}]}]}