{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" ELLEHCIMSELAREP R","gend":1,"add":"            DR HSIRI 8686                         ","city":"CHATHAM                  ","state":"VA","zip":"24531-9998","dob":"1973-07-16","age":"","mstatus":"","insh":"00118003","cliId":"","pno":"2743494444","cno":4342500474,"email":"","ename":"","eno":"","pphy":"WHITE, VALERIE A","ppno":4347972828,"pcpadd":"723 PINEY FOREST RD,","pcpcity":"Danville","pcpstate":"VA","pcpzip":245402860,"pcpcounty":"","pcpid":"","pcpname":"FAMILY HEALTHCARE CENTER OF DANVILLE","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"","add2":"                                                  ","add3":"","madd1":"6868 IRISH RD                                     ","madd2":"                                                  ","madd3":"","mcity":"CHATHAM                  ","mstate":"VA","mzip":"24531-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I10","R73.02","R10.11","R13.10","F33.2","N32.81","R15.9","G89.29","J45.901","M51.36","F41.1","R06.02","Z72.0","J20.9","Z71.6","F17.200","L90.5","R91.1","K22.2","R11.2","K92.1","K22.70","K21.9","K63.5","K63.89","R19.7","Z86.010","F41.9","F32.9","J45.909","Z79.899","K62.1","R10.13","K22.8","R10.10","K31.1","M54.31","R26.2","R06.09","M19.90","J44.9","R79.89","R07.9","J42","F90.8","N20.2","E78.00","Z87.442","F17.210","Z88.0","M54.9","R11.0","M54.5","N20.0","N20.1","K44.9","K22.9","K29.50","K31.89","K21.0","Z80.0","R05","R35.0","R06.2","J40","R39.14","R35.1","R39.15","N39.41","R93.8","R10.9","K92.2","K20.9","K29.70","K31.9","F41.8","K59.00","R10.31","L03.114","S61.412A","W55.03XA","Z90.710","E78.5","M79.642","R60.9","L03.113","F90.9","J45.20","Z91.14","G89.4","M79.606","R10.12","D50.8","N39.0","Z12.31","N39.3","E55.9","F51.04","E66.3","K90.49","Z00.00","Z13.89","Z91.018","W57.XXXS","Z71.89","J06.9","A41.9","J18.9","J96.01","J44.0","J44.1","Z90.2","Z90.49","R06.9","B37.0","J22","Z09","Z23","Z12.12","T14.8XXA","M79.604","M79.605","R09.89","M79.81","R58","M79.602","K57.92","N76.4","N76.0","F12.90","L73.8","R10.32","Z87.891","L73.9","R30.9","Z76.89","R73.03","A77.0","J47.9","K57.30","Z87.19","K57.32","D72.829","K62.5","K62.6","H02.889","H52.4","M54.50","M79.661","J41.0","R06.00","J30.2","R10.84","M48.07","F17.209","M54.40","F33.1","M16.0","M25.551","F19.10","R45.851","M70.61","H00.011","H10.12","J01.11","R31.29","J98.4","L03.116","M79.673","N39.44","Z76.0","M62.9","Z53.20","N64.4","M79.672","R07.89","R05.9","R52","R00.0"," "],"date":["2021-12-01","2021-09-02","2022-01-13","2022-01-13","2019-05-22","2022-11-04","2022-11-04","2022-11-04","2022-11-04","2022-11-04","2019-05-29","2022-07-09","2022-03-23","2019-06-08","2019-06-08","2022-03-02","2019-06-08","2022-03-23","2021-06-10","2021-07-08","2021-07-08","2022-09-06","2022-01-13","2021-06-10","2021-06-10","2021-06-10","2022-01-13","2021-06-10","2021-06-10","2021-06-10","2022-03-23","2021-06-10","2021-06-10","2021-06-10","2020-08-04","2019-07-09","2018-11-19","2018-11-19","2022-02-04","2018-11-19","2022-09-06","2018-06-21","2022-07-09","2022-09-06","2018-06-27","2018-06-28","2022-07-09","2021-08-10","2022-07-09","2022-07-09","2018-08-13","2018-11-07","2021-08-10","2018-07-06","2018-07-26","2019-08-20","2019-07-09","2019-07-09","2019-07-09","2020-08-26","2019-07-09","2021-09-17","2021-08-10","2022-07-09","2020-07-23","2018-08-27","2018-07-26","2018-07-26","2018-07-26","2018-07-26","2021-08-10","2020-08-04","2018-08-08","2019-10-21","2018-08-08","2022-09-06","2021-08-10","2021-08-10","2018-08-13","2018-08-13","2018-08-13","2018-09-06","2022-09-06","2018-08-13","2018-08-13","2018-08-13","2022-09-06","2018-09-20","2018-09-20","2022-09-06","2019-01-11","2018-08-21","2019-08-23","2019-08-23","2021-10-20","2022-03-02","2020-08-26","2022-02-08","2020-08-26","2020-08-26","2020-08-26","2020-08-26","2021-09-02","2021-09-02","2021-09-02","2019-09-05","2018-09-07","2022-07-09","2018-09-07","2019-09-09","2022-07-09","2018-09-06","2018-09-06","2018-09-06","2019-09-08","2019-09-09","2018-09-20","2020-11-02","2019-10-21","2019-10-27","2022-01-20","2022-01-20","2020-11-02","2019-10-28","2019-10-28","2019-10-28","2018-11-07","2018-11-07","2018-11-07","2018-11-07","2018-11-07","2018-12-04","2018-11-07","2018-11-07","2021-12-01","2021-12-01","2022-03-02","2021-12-01","2021-12-01","2018-12-04","2018-12-04","2018-12-04","2018-12-12","2018-12-18","2018-12-18","2021-12-22","2021-12-22","2022-02-04","2022-02-07","2022-02-08","2022-02-08","2022-02-08","2020-02-21","2018-02-28","2018-02-28","2018-02-28","2018-02-28","2019-03-22","2019-03-22","2018-03-24","2018-03-24","2018-04-05","2018-04-05","2018-04-05","2019-04-17","2022-03-02","2022-03-23","2022-05-29","2022-06-04","2022-03-02","2022-09-06","2022-03-02","2022-06-29","2022-11-07","2022-06-04","2022-07-09","2022-07-09","2022-06-29","2022-06-29","2022-11-07"],"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":[["","62332002531","THEOPHYLLINE","TAB 300MG ER","90","Select","Select",""],["","55111015810","OMEPRAZOLE","CAP 20MG","90","Select","Select",""],["","00143122701","DICYCLOMINE","TAB 20MG","20","Select","Select",""],["","00093221001","SUCRALFATE","TAB 1GM","360","Select","Select",""],["","00093317431","ALBUTEROL","FAT E","8.5","Select","Select",""],["","70377000215","SIMVASTATIN","TAB 10MG","90","Select","Select",""],["","70461032003","FLUCLVX","INJ 2020-21","0.5","Select","Select",""],["","00832105410","BACLOFEN","TAB 10MG","90","Select","Select",""],["","65162052110","PROMETHAZINE","TAB 25MG","30","Select","Select",""],["","00093816301","QUETIAPINE","TAB 200MG","30","Select","Select",""],["","66993066430","DULOXETINE","CAP 60MG","30","Select","Select",""],["","69097015807","MELOXICAM","TAB 7.5MG","30","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","30","Select","Select",""],["","65162019050","NAPROXEN","TAB 500MG","30","Select","Select",""],["","59746028490","PANTOPRAZOLE","TAB 40MG","90","Select","Select",""],["","68180016006","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","00378967130","IPRATROPIUM\/","SOL ALBUTER","360","Select","Select",""],["","76385012350","METHOCARBAM","TAB 500MG","40","Select","Select",""],["","00378064010","PREDNISONE","TAB 5MG","30","Select","Select",""],["","50111033401","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","70710113908","FLUCONAZOLE","TAB 150MG","2","Select","Select",""],["","53489011905","DOXYCYCL","CAP 100MG","14","Select","Select",""],["","10702001250","HYDROXYZ","TAB 50MG","60","Select","Select",""],["","43547040611","CLONAZEPAM","TAB 0.5MG","30","Select","Select",""],["","47781030301","NITROFURANTN","CAP 100MG","14","Select","Select",""],["","68382001601","LEVOFLOXACIN","TAB 500MG","7","Select","Select",""],["","59310057922","PROAIR","AER ","8.5","Select","Select",""],["","69097094312","GABAPENTIN","CAP 300MG","90","Select","Select",""],["","69097012403","TOPIRAMATE","TAB 100MG","60","Select","Select",""],["","00185094098","CHOLESTYRAM","POW 4GM","60","Select","Select",""],["","43386009019","GAVILYTE-G","SOL ","4,000.00","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","65162062710","TRAMADOL","TAB 50MG","30","Select","Select",""],["","60432053760","NYSTATIN","SUS 100000","140","Select","Select",""],["","52268001201","SUPREP","SOL PREP KIT","354","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":""}]}]}