{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" YDNICNADROJ","gend":1,"add":"      DAOR YRREF DLO 0512                         ","city":"HUDGINS                  ","state":"VA","zip":"23076-9998","dob":"1978-10-02","age":"","mstatus":"","insh":"10114432","cliId":"","pno":"0540843615","cno":8049484806,"email":"","ename":"","eno":"","pphy":"HUSEN, SRIE","ppno":7577363725,"pcpadd":"100 ENTERPRISE DR,","pcpcity":"Yorktown","pcpstate":"VA","pcpzip":236923190,"pcpcounty":"","pcpid":"","pcpname":"SENTARA FAMILY & INTERNAL MEDICINE PHYSICIANS","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"                                                  ","add3":"","madd1":"2150 OLD FERRY ROAD                               ","madd2":"                                                  ","madd3":"","mcity":"HUDGINS                  ","mstate":"VA","mzip":"23076-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M48.07","M51.36","M47.816","M70.71","F25.0","F41.0","F90.2","F41.1","F51.01","R56.9","F41.9","F98.8","E22.1","M47.896","G40.909","F20.0","K50.919","R51.9","R19.5","K21.9","F31.9","K58.9","Z87.19","F17.210","Z79.899","R00.2","R05","Z20.822","N64.3","E66.01","Z68.42","S00.11XA","W22.09XA","Y92.031","M46.1","R50.9","R06.02","J02.9","M79.7","G89.4","K11.7","F80.81","R13.12","H54.7","K22.719","G81.94","G47.33","M79.644","M79.89","R25.1","R47.01","R73.9","L73.9","R06.2","M25.559","M25.561","M25.562","G89.29","R20.2","M54.5","R29.818","K76.9","R05.9","Z12.31","D35.2","Z68.41","R69","R06.00","Z86.39","Z76.0","Z90.49","Z90.710","R53.83","R40.0","M79.10","M62.81","F90.1","D44.3","L08.9","R63.5","L03.012","R60.1","R14.0","R06.83","R26.89","G25.81","Z85.3","M25.661","R41.82","R60.9","E66.9","H16.223","H25.13","H35.373","N60.11","Z68.32","F32.9","I10","N95.1","I49.3","I49.1","K76.89","J02.0","R22.1","R13.11","R13.14","K59.04","K44.9","Z87.11","F44.5","K50.90","F42.9","F17.200","E55.9","F43.10"," ","F44.9"],"date":["2022-07-27","2022-07-27","2022-07-27","2022-05-12","2020-08-27","2020-08-27","2022-11-03","2020-08-27","2020-08-27","2022-10-12","2022-11-03","2022-11-03","2022-07-14","2021-07-26","2022-08-01","2022-11-03","2021-09-07","2021-09-07","2022-09-06","2022-08-01","2022-10-11","2022-08-01","2022-08-01","2022-08-01","2022-08-01","2020-07-02","2021-08-20","2022-10-11","2022-07-14","2022-10-11","2022-10-11","2021-08-08","2021-08-08","2021-08-08","2022-07-27","2022-09-06","2020-07-13","2020-07-13","2022-06-15","2022-06-15","2021-09-07","2021-09-07","2021-09-07","2021-04-23","2021-04-23","2021-04-23","2022-10-11","2020-12-17","2020-11-16","2022-06-15","2022-06-15","2022-07-07","2021-04-15","2022-05-06","2021-06-08","2021-06-08","2021-06-08","2022-10-11","2021-04-23","2021-02-26","2022-08-02","2020-07-01","2022-05-06","2022-08-17","2022-11-03","2021-07-28","2021-04-28","2021-04-23","2021-09-28","2021-05-05","2021-01-20","2021-01-20","2020-05-07","2020-05-07","2020-05-07","2020-05-07","2021-01-28","2021-05-07","2020-12-17","2021-09-28","2020-06-15","2020-06-15","2020-06-15","2020-11-16","2021-04-23","2022-10-11","2022-08-17","2021-06-18","2022-08-01","2021-04-08","2021-01-20","2021-03-24","2021-03-24","2021-03-24","2021-01-26","2021-01-26","2021-01-26","2021-08-05","2021-01-26","2020-07-03","2020-07-03","2020-07-01","2020-07-20","2020-07-20","2020-07-20","2021-01-04","2021-01-04","2021-01-04","2021-01-20","2022-10-11","2022-10-11","2022-10-11","2022-10-11","2022-10-11","2022-10-11","2022-11-03","2022-11-03"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}}]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"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":[["","00555097402","AMPHET\/DEXTR","TAB 30MG","60","Select","Select",""],["","50474047066","BRIVIACT","TAB 25MG","120","Select","Select",""],["","29300012510","MELOXICAM","TAB 15MG","30","Select","Select",""],["","55111015330","ONDANSETRON","TAB 4MG","60","Select","Select",""],["","00832046515","NYAMYC","POW 100000","60","Select","Select",""],["","43547040211","FUROSEMIDE","TAB 40MG","30","Select","Select",""],["","75834021930","VENLAFAXINE","TAB 225MG ER","30","Select","Select",""],["","00832532511","POT  CL MICRO","TAB 20MEQ ER","30","Select","Select",""],["","00143122701","DICYCLOMINE","TAB 20MG","90","Select","Select",""],["","59310057922","PROAIR","AER ","8.5","Select","Select",""],["","16729017217","AMITRIPTYLIN","TAB 25MG","30","Select","Select",""],["","16729013716","CLONAZEPAM","TAB 1MG","60","Select","Select",""],["","00093317431","ALBUTEROL","FAT E","8.5","Select","Select",""],["","68382032010","POT  CHLORIDE","TAB 10MEQ ER","30","Select","Select",""],["","52817033010","CYCLOBENZAPR","TAB 5MG","60","Select","Select",""],["","55111018015","TIZANIDINE","TAB 4MG","60","Select","Select",""],["","70710113908","FLUCONAZOLE","TAB 150MG","2","Select","Select",""],["","59746011506","PROCHLORPER","TAB 10MG","20","Select","Select",""],["","53885039310","ONETOUCH","MIS LANCETS","100","Select","Select",""],["","42806040021","METHYLPRED","TAB 4MG","21","Select","Select",""],["","50458060901","INVEGA","INJ 819MG","2.63","Select","Select",""],["","53489011905","DOXYCYCL","CAP 100MG","20","Select","Select",""],["","00093101042","MUPIROCIN","OIN 0.02","22","Select","Select",""],["","65862050320","AMOX\/K","TAB 875-125","20","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","15","Select","Select",""],["","68645056354","IBUPROFEN","TAB 800MG","28","Select","Select",""],["","00781261305","AMOXICILLIN","CAP 500MG","30","Select","Select",""],["","50742011808","CABERGOLINE","TAB 0.5MG","24","Select","Select",""],["","67877056105","METFORMIN","TAB 500MG","30","Select","Select",""],["","63304069205","CLINDAMYCIN","CAP 150MG","30","Select","Select",""],["","00781808926","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","99073013001","FREESTYLE    MIS LANCETS","MIS LANCETS","100","Select","Select",""],["","66758019001","KLOR-CON","TAB 20MEQ ER","30","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","40","Select","Select",""],["","70954001910","PRAZOSIN","CAP 1MG","60","Select","Select",""],["","68462025601","ROPINIROLE","TAB 2MG","30","Select","Select",""],["","65162028203","PALIPERIDONE","TAB ER 6MG","30","Select","Select",""],["","00093031101","LOPERAMIDE","CAP 2MG","16","Select","Select",""],["","31722053705","LEVETIRACETA","TAB 500MG","60","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":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"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":""}]}]}