{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"D AILEGNADIACNIK ","gend":1,"add":"        DAOR  S E V   038                         ","city":"LYNCHBURG                ","state":"VA","zip":"24503-1237","dob":"1962-09-07","age":"","mstatus":"","insh":"00118786","cliId":"","pno":"6404595334","cno":5404643359,"email":"","ename":"","eno":"","pphy":"BEE, ROBERT","ppno":4342003908,"pcpadd":"125 NATIONWIDE DR,","pcpcity":"Lynchburg","pcpstate":"VA","pcpzip":245024272,"pcpcounty":"","pcpid":"","pcpname":"CENTRA MEDICAL GROUP LLC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"","add2":"APT B2                                            ","add3":"","madd1":"830   V E S  ROAD                                 ","madd2":"APT B2                                            ","madd3":"","mcity":"LYNCHBURG                ","mstate":"VA","mzip":"24503-1237","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F33.3","G10","R19.7","K21.9","R06.81","R94.31","I10","M18.11","M25.341","S92.352A","M79.672","Z00.00","Z12.31","N95.8","Z13.1","Z68.38","E78.2","F32.9","Z98.890","Z96.1","G43.909","Z79.899","F33.2","H25.13","S92.352D","R51.9","G31.9","E78.5","D50.9","Z47.1","Z98.1","N95.1","R23.2","I71.2","R92.8","H25.043","Z20.822","Z00.01","E87.6","R13.10","M54.16","S92.302A","N60.19","D64.9","Z48.810","Z51.81","M53.3","M54.9","G89.29","B36.9","F32.A","F41.9","F43.10","G24.01","G47.33","J31.2","M24.841","N60.02","N39.41","Z48.89","S22.41XA","V89.2XXA","M79.89","Z23","S19.9XXA","R07.81","V49.9XXA","Y92.410","I31.3","I77.819","Z79.82","K58.9","F41.8","M19.041","R92.1","Z80.8","Z04.1","Z02.4","M79.604","M79.661","M79.662","G25.81","M79.641","J30.2","R39.198","R39.9","M65.341","S69.91XA","H04.123","R21","S90.859A"," "],"date":["2022-11-07","2022-07-21","2020-04-18","2022-04-25","2021-04-22","2019-05-03","2022-04-28","2019-05-24","2019-05-09","2019-07-17","2019-09-17","2019-11-04","2019-11-04","2019-11-04","2019-11-04","2019-11-04","2019-11-04","2021-11-24","2021-12-14","2021-11-22","2019-11-21","2021-05-21","2019-11-04","2021-11-16","2019-09-17","2020-11-11","2020-11-10","2022-04-28","2022-04-25","2019-08-02","2019-08-02","2020-10-20","2021-04-02","2022-04-28","2020-10-20","2021-11-16","2021-11-16","2020-01-30","2020-05-08","2021-05-20","2019-08-21","2019-08-21","2019-08-21","2020-10-19","2021-12-14","2020-10-16","2020-11-11","2020-11-11","2020-11-11","2021-11-24","2021-11-24","2021-11-24","2021-11-24","2021-11-24","2022-04-25","2021-04-02","2019-04-12","2019-07-16","2019-04-25","2019-08-02","2019-12-14","2019-12-14","2019-05-24","2022-09-26","2019-12-14","2019-12-14","2019-12-14","2019-12-14","2019-12-14","2019-12-14","2019-12-14","2020-03-02","2020-03-02","2019-06-18","2020-11-25","2020-11-25","2019-12-14","2021-12-23","2022-03-17","2022-03-17","2022-03-17","2022-04-25","2022-05-18","2022-05-18","2022-08-01","2022-08-01","2022-07-07","2022-07-07","2022-07-25","2022-09-26","2022-09-26","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":[["","68462020113","TELMISARTAN","TAB 80MG","90","Select","Select",""],["","43598051030","ESOMEPRA","CAP 40MG DR","180","Select","Select",""],["","65862069730","VENLAFAXINE","CAP 150MG ER","30","Select","Select",""],["","00713067831","NYSTATIN","CRE 100000","30","Select","Select",""],["","68180072003","AMLODIPINE","TAB 5MG","90","Select","Select",""],["","31722061190","PREGABALIN","CAP 50MG","60.00","Select","Select",""],["","33342010511","QUETIAPINE","TAB 400MG","30","Select","Select",""],["","68382011614","RISPERIDONE","TAB 3MG","60","Select","Select",""],["","69097094312","GABAPENTIN","CAP 300MG","120","Select","Select",""],["","00555088602","ESTRADIOL","TAB 1MG","90","Select","Select",""],["","00093506101","HYDROXYZ","TAB 25MG","240","Select","Select",""],["","68180063809","ATORVASTATIN","TAB 80MG","90","Select","Select",""],["","59148003613","REXULTI","TAB 0.5MG","30","Select","Select",""],["","00527058601","DICYCLOMINE","CAP 10MG","180","Select","Select",""],["","68546017260","AUSTEDO","TAB 12MG","180.00","Select","Select",""],["","57237007530","ONDANSETRON","TAB 4MG","15","Select","Select",""],["","49281072010","FLUBLOK","INJ 2020-21","0.5","Select","Select",""],["","65162019010","NAPROXEN","TAB 500MG","20","Select","Select",""],["","00378415105","TRAMADOL","TAB 50MG","20","Select","Select",""],["","61314063705","PREDNISOLONE","SUS 1% OP","15","Select","Select",""],["","51672131200","MUPIROCIN","OIN 0.02","22","Select","Select",""],["","51672127502","CLOTRIMAZOLE","CRE 0.01","60","Select","Select",""],["","69315030805","CIPROFLOXACN","SOL 0.3% OP","5","Select","Select",""],["","00406012401","HYDROCO\/APAP","TAB 7.5-325","12","Select","Select",""],["","00093406801","PRAZOSIN","CAP 2MG","30","Select","Select",""],["","00469260130","MYRBETRIQ","TAB 25MG","30","Select","Select",""],["","00069024430","TOVIAZ","TAB 8MG","30","Select","Select",""],["","10702001801","OXYCODONE","TAB 5MG","40","Select","Select",""],["","16729020312","BUSPIRONE","TAB 15MG","120","Select","Select",""],["","65862020390","LOSARTAN","TAB 100MG","90","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":""}]}]}