{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"J MAILLIWNOTSNUD ","gend":0,"add":"    ENAL KRAP NEDRAG 5717                         ","city":"MECHANICSVILLE           ","state":"VA","zip":"23111-1128","dob":"1962-06-08","age":"","mstatus":"","insh":"00115408","cliId":"","pno":"1840838274","cno":8043371215,"email":"","ename":"","eno":"","pphy":"DOMAH, NAU","ppno":8047643291,"pcpadd":"8220 MEADOWBRIDGE RD STE 203,","pcpcity":"Mechanicsville","pcpstate":"VA","pcpzip":231162339,"pcpcounty":"","pcpid":"","pcpname":"LABURNUM MEDICAL CENTER","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"APARTMENT 103                                     ","add3":"","madd1":"7175 GARDEN PARK LANE                             ","madd2":"APARTMENT 103                                     ","madd3":"","mcity":"MECHANICSVILLE           ","mstate":"VA","mzip":"23111-1128","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M06.09","F25.9","G47.33","L03.032","L03.116","M79.672","L53.9","E11.9","I10","E78.5","Z79.84","Z79.4","E08.621","L97.401","F25.1","H25.12","H43.811","H26.491","R60.0","R35.0","Z79.899","J00","Z68.41","F41.1","M19.021","F33.3","Z96.1","H25.012","L03.012","M79.89","M79.645","E11.65","F17.210","E78.2","E78.1","R00.0","R94.31","R06.02","F17.200","R91.1","R06.00","F41.9","R09.81","E55.9","F17.290","E78.00","E11.40","Z91.19","H60.392","G47.9","Z01.00","E66.01","Z12.5","Z13.29","M20.12","M20.11","E11.49","E11.21","Z68.39","B37.89","M25.561","L98.493","L08.9","Z68.42","L97.829","L97.221","M79.674","S91.201A","X58.XXXA","M06.9","L97.922","T79.8XXA","E11.622","L97.822","M20.41","J32.0","M70.61","R26.89","M70.62","Z00.00","E08.41","B37.2","S81.812A","W22.8XXA","Z45.1","M25.521","T79.9XXA","S91.114A","I87.312","M20.42","I87.2","N30.00","Z20.2","J20.9","F20.9","A41.01","E87.1","N41.2","E66.9","E83.42","E86.0","B95.62","G47.30","N40.0","R65.20","A41.9","R50.9","N39.0","I51.7","N41.9","R70.0","B35.1","E11.42","Z12.11","R39.9","R78.81","J44.9","M25.572","M25.472","H10.9","H57.89","Z71.89","R32","Z90.79","R31.9","G57.93","K43.9","L60.9","M21.6X1","M21.6X2","L97.522","L03.119","M77.42","M77.41","K52.9","R11.2","R10.9","R51.9","R19.7","Z20.822","L08.89","R10.33"," "],"date":["2022-03-07","2022-11-01","2022-05-03","2022-02-01","2022-02-01","2022-02-01","2022-02-01","2022-07-21","2022-07-21","2022-07-21","2022-07-21","2022-07-21","2022-02-02","2022-02-02","2020-06-09","2021-02-10","2021-02-10","2021-02-10","2020-04-28","2021-12-21","2021-11-01","2020-02-21","2022-07-19","2021-08-23","2020-06-25","2020-03-26","2020-03-30","2020-03-30","2021-04-17","2021-04-17","2021-04-17","2021-12-01","2021-04-17","2021-12-21","2020-06-03","2022-07-21","2022-07-21","2021-06-20","2022-07-13","2021-06-07","2021-06-20","2021-06-20","2022-01-26","2021-06-28","2021-06-24","2021-06-24","2021-06-24","2020-06-25","2021-06-28","2021-06-28","2021-06-28","2021-06-28","2021-06-28","2021-06-28","2020-09-10","2020-09-10","2020-10-19","2021-07-23","2022-01-18","2021-07-23","2021-07-23","2019-08-02","2019-09-18","2019-11-19","2019-08-08","2019-08-14","2020-09-01","2020-09-01","2020-09-01","2020-09-01","2019-10-07","2019-09-05","2019-10-07","2019-10-07","2020-12-08","2022-01-12","2020-09-16","2020-09-16","2020-09-16","2019-09-18","2019-11-11","2019-09-18","2020-09-23","2020-09-23","2020-12-03","2019-10-04","2019-10-07","2019-10-07","2020-10-19","2020-12-08","2020-12-08","2019-11-19","2019-11-06","2021-11-10","2019-11-11","2019-11-19","2019-11-26","2019-11-19","2022-01-18","2019-11-18","2019-11-26","2019-11-18","2019-11-18","2019-11-19","2019-11-18","2019-11-26","2019-11-18","2020-01-03","2019-11-18","2019-11-18","2020-12-03","2022-10-05","2022-10-05","2020-12-09","2019-12-17","2019-12-17","2021-12-21","2021-12-21","2021-12-21","2020-12-31","2020-12-31","2020-01-03","2020-01-03","2020-01-03","2020-01-03","2021-01-21","2021-01-21","2022-10-05","2022-11-21","2022-11-21","2022-11-21","2022-08-05","2022-10-05","2022-10-05","2022-07-13","2022-07-21","2022-07-13","2022-07-21","2022-07-21","2022-07-21","2022-11-21","2022-07-19","2022-11-21"],"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":[["","55111012701","CIPROFLOXACN","TAB 500MG","14","Select","Select",""],["","00093520006","BUSPIRONE","TAB 30MG","60","Select","Select",""],["","68180051303","LISINOPRIL","TAB 5MG","30","Select","Select",""],["","27241009903","DULOXETINE","CAP 60MG","60","Select","Select",""],["","43547040211","FUROSEMIDE","TAB 40MG","30","Select","Select",""],["","00193737701","CONTOUR","KIT NEXT","1","Select","Select",""],["","70010006505","METFORMIN","TAB 1000MG","60","Select","Select",""],["","70748013006","LEFLUNOMIDE","TAB 20MG","30","Select","Select",""],["","99073013001","FREESTYLE    MIS LANCETS","MIS LANCETS","100","Select","Select",""],["","16714087603","ATORVASTATIN","TAB 40MG","30","Select","Select",""],["","00074055402","HUMIRA","INJ 40\/0.4ML","2","Select","Select",""],["","00088221905","LANTUS","INJ 100\/ML","45","Select","Select",""],["","66685100100","AMOX\/K","TAB 875-125","10","Select","Select",""],["","00193658621","MICROLET","MIS LANCETS","100","Select","Select",""],["","11917004813","INSULIN","MIS 1ML\/31G","10","Select","Select",""],["","00093101042","MUPIROCIN","OIN 0.02","22","Select","Select",""],["","61703035038","METHOTREXATE","INJ 25MG\/ML","24","Select","Select",""],["","50458060801","INVEGA","INJ 546MG","1.75","Select","Select",""],["","61314062810","POLYMYXIN","SOL TRIMETHP","10","Select","Select",""],["","65862001705","AMOXICILLIN","CAP 500MG","14","Select","Select",""],["","50111064801","FLUOXETINE","CAP 20MG","30","Select","Select",""],["","08470184001","UNFINE","MIS 32GX4MM","30","Select","Select",""],["","57237007710","ONDANSETRON","TAB 4MG ODT","15","Select","Select",""],["","50924097110","SOFTCLIX","MIS LANCETS","100","Select","Select",""],["","53885039310","ONETOUCH","MIS LANCETS","100","Select","Select",""],["","23155013525","DOXYCYC","TAB 100MG","20","Select","Select",""],["","51672128402","TRIAMCINOLON","OIN 0.001","30","Select","Select",""],["","59746011306","PROCHLORPER","TAB 5MG","12","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","20","Select","Select",""],["","00093314705","CEPHALEXIN","CAP 500MG","40","Select","Select",""],["","42806031250","DOXYCYCL","TAB 100MG","20.00","Select","Select",""],["","08290320109","BD  PEN NEEDL","MIS 31GX8MM","100","Select","Select",""],["","13811071910","NITROFURANTN","CAP 100MG","14","Select","Select",""],["","65702040810","ACCU-CHEK","TES AVIVA PL","200","Select","Select",""],["","00472037915","CLOTRIM\/BETA","CRE DIPROP","15","Select","Select",""],["","68382013201","TAMSULOSIN","CAP 0.4MG","30","Select","Select",""],["","65862076990","FENOFIBRATE","TAB 145MG","90","Select","Select",""],["","68462013801","OXCARBAZEPIN","TAB 300MG","90","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","00591024005","LORAZEPAM","TAB 0.5MG","10","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":["",""],"sub":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""],[""]],"sub":[]}}},{"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":""}]}]}