{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"J ECYOJYRREP ","gend":1,"add":"          SINNIGCM ALEGNA                         ","city":"CULPEPER                 ","state":"VA","zip":"22701-8001","dob":"1942-08-25","age":"","mstatus":"","insh":"00111398","cliId":"","pno":"1304575757","cno":5403175749,"email":"","ename":"","eno":"","pphy":"GONZALEZ, AMAURI","ppno":5408256100,"pcpadd":"1200 SUNSET LN STE 2210,  STE 101","pcpcity":"Culpeper","pcpstate":"VA","pcpzip":227013376,"pcpcounty":"","pcpid":"","pcpname":"UVA PRIMARY CARE CULPEPER FAMILY PRACTICE","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"NORTHERN & WINCHESTER","aligned":"Y","ano":"","add2":"17338 HAWTHORNE AVENUE                            ","add3":"","madd1":"ANGELA MCGINNIS                                   ","madd2":"17338 HAWTHORNE AVENUE                            ","madd3":"","mcity":"CULPEPER                 ","mstate":"VA","mzip":"22701-8001","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z96.653","S89.92XA","I50.32","I35.0","Z79.899","Z79.01","I10","E78.2","I48.0","I49.5","U07.1","R53.81","R05.9","M47.812","M47.816","N39.41","M17.0","Z68.29","M62.81","R15.9","F03.90","I71.4","H04.123","M48.02","M25.78","Z12.11","Z80.0","R06.83","R53.83","I11.0","I50.9","K90.0","N32.81","F41.9","H40.033","F32.9","M85.80","F17.200","R91.1","E03.9","M1A.0420","S29.9XXA","R07.81","R42","I25.2","E05.90","Z90.710","Z95.0","Z90.09","F33.41","K59.1","Z01.818","I50.22","R06.09","M13.80","R06.02","I48.91","R53.1","Z23","R09.82","M47.12","M50.30","G89.29","R68.89","Z45.010","E78.5","E05.00","R19.7","M25.562","W19.XXXA","H25.11","R91.8","Z91.02","Z91.040","F41.1","Z00.00","G30.1","G31.84","K13.0","F02.80","R09.81","R05","J81.0","I34.1","I35.1","Z90.89","Z91.018","Z20.828","K21.9","H26.9","F17.210","F33.0","Z20.822","Z88.8","Z86.79","S60.221A","M79.641","W18.39XA","R06.00","I70.0","Z11.59","K90.41","Z98.51","M54.12","M54.2","S80.02XA","S50.02XA","W18.31XA","M19.90","Z79.890","W18.30XA","M18.12","H25.011","R68.83","R01.1","M85.89","M85.88","Z78.0","J04.2","H40.051","Z12.31","M10.9","M79.642","J01.90","M10.032","M25.532","I25.10","E86.0","Z87.19","Z87.09","Z92.3","Z72.0","F41.8","N63.10","N63.20","Z80.3"],"date":["2021-11-10","2021-06-01","2021-02-09","2021-02-09","2021-11-10","2021-11-10","2022-05-26","2021-09-07","2022-05-26","2022-06-02","2021-11-10","2021-11-10","2021-11-10","2020-08-04","2020-08-04","2022-06-29","2020-08-04","2020-08-04","2022-06-29","2022-06-29","2022-03-07","2022-08-03","2022-05-02","2020-01-31","2020-01-31","2021-04-21","2021-04-21","2021-06-18","2022-05-26","2021-07-08","2021-06-18","2022-05-26","2021-06-18","2022-05-26","2021-06-18","2022-05-26","2022-05-26","2022-05-26","2022-05-26","2021-05-11","2021-04-01","2021-05-11","2021-05-11","2021-08-12","2022-05-26","2021-11-10","2021-11-03","2021-11-10","2021-08-12","2021-09-07","2021-01-26","2021-03-26","2021-07-08","2021-03-26","2021-03-26","2021-11-10","2021-11-10","2021-11-03","2020-01-16","2021-11-03","2020-01-31","2020-01-31","2020-01-31","2021-11-03","2022-05-26","2022-05-26","2022-05-26","2022-05-26","2021-06-01","2021-06-01","2022-01-11","2020-04-02","2021-11-03","2021-11-03","2021-04-01","2021-04-01","2021-04-01","2021-04-01","2021-04-01","2021-04-01","2020-12-04","2020-12-04","2020-12-04","2021-04-19","2020-12-04","2020-12-04","2021-11-03","2020-12-04","2020-08-04","2020-08-04","2021-02-21","2020-08-04","2021-11-03","2021-11-03","2020-12-04","2020-05-26","2020-05-26","2020-05-26","2020-12-04","2021-08-10","2021-01-26","2020-08-13","2020-08-13","2020-01-31","2020-01-31","2021-05-11","2021-05-11","2021-05-11","2021-05-11","2021-05-11","2021-05-11","2021-02-21","2021-12-06","2021-02-10","2021-02-10","2021-03-05","2021-03-05","2021-03-05","2020-03-17","2021-01-26","2021-03-05","2021-02-21","2021-02-21","2020-03-07","2021-02-21","2021-02-21","2022-01-11","2021-02-11","2021-02-11","2021-02-11","2021-02-11","2020-08-13","2021-04-19","2021-03-05","2021-03-05","2021-03-05"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}}]},{"t":"Covid Screening","q":[{"a":[]}]},{"t":"Self-Assessment and Social History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"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":[["","68180029606","DULOXETINE","CAP 60MG","90","Select","Select",""],["","65862048901","QUETIAPINE","TAB 25MG","90","Select","Select",""],["","00003089421","ELIQUIS","TAB 5MG","60","Select","Select",""],["","00378001805","METOPROL","TAB 25MG","180","Select","Select",""],["","00172572860","FAMOTIDINE","TAB 20MG","90","Select","Select",""],["","65862029490","ROSUVASTATIN","TAB 10MG","90","Select","Select",""],["","00832059011","DIPHEN\/ATROP","TAB ","120","Select","Select",""],["","43547027611","DONEPEZIL","TAB 10MG","30","Select","Select",""],["","68180098003","LISINOPRIL","TAB 10MG","90","Select","Select",""],["","00054429731","FUROSEMIDE","TAB 20MG","7","Select","Select",""],["","16714066202","GABAPENTIN","CAP 300MG","60","Select","Select",""],["","00378180910","LEVOTHYROXIN","TAB 100MCG","30","Select","Select",""],["","00093314705","CEPHALEXIN","CAP 500MG","20","Select","Select",""],["","00054001925","PREDNISONE","TAB 50MG","5","Select","Select",""],["","47781091601","DEXAMETHASON","TAB 6MG","5","Select","Select",""],["","69097034135","DIFLUPREDNAT","EMU 0.0005","5","Select","Select",""],["","00143980305","DOXYCYCL","CAP 100MG","20","Select","Select",""],["","17478071310","OFLOXACIN","DRO 0.3% OP","5","Select","Select",""],["","69315090405","LORAZEPAM","TAB 0.5MG","15","Select","Select",""],["","00093356026","PEG\/NASUL,C","SOL NACL\/POT","1","Select","Select",""],["","65162062711","TRAMADOL","TAB 50MG","9","Select","Select",""],["","52268001201","SUPREP","SOL PREP KIT","354","Select","Select",""],["","00074659490","SYNTHROID","TAB 88MCG","90","Select","Select",""],["","68180096301","ALBUTEROL","AER HFA","8.5","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":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"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":""}]}]}