{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" R NNASPPIHC","gend":1,"add":"       DAOR NOTSTTIP 6042                         ","city":"FREDERICKSBURG           ","state":"VA","zip":"22408-0282","dob":"1985-02-02","age":"","mstatus":"","insh":"10115752","cliId":"","pno":"0743402269","cno":4346888585,"email":"","ename":"","eno":"","pphy":"FARMER, EMILY","ppno":5407101086,"pcpadd":"10620 SPOTSYLVANIA AVE,","pcpcity":"Fredericksburg","pcpstate":"VA","pcpzip":224082637,"pcpcounty":"","pcpid":"","pcpname":"MARY WASHINGTON HEALTHCARE PHYSICIANS","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"                                                  ","add3":"","madd1":"2406 PITTSTON ROAD                                ","madd2":"                                                  ","madd3":"","mcity":"FREDERICKSBURG           ","mstate":"VA","mzip":"22408-0282","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E16.2","E16.1","R56.9","R41.0","R00.0","G40.409","R05","R51.9","F17.200","W19.XXXA","G40.909","R52","T85.698A","S16.1XXA","R07.89","M79.2","X58.XXXA","S29.011A","Z03.89","G40.309","Z01.419","Z12.4","N39.490","R15.9","W10.9XXA","N39.46","G40.89","F32.9","K21.9","L03.818","S90.869A","M54.5","W57.XXXA","S90.862A","S90.861A","Z88.8","F17.210","L03.115","E87.1","S09.90XA","G40.109","Z96.89","Z72.51","M25.50","R11.2","I10","E78.5","J45.909","M21.619","B88.0","F12.10","E78.00","Z87.820","K12.2","R09.02","I95.9","F10.929","G40.509","R07.81","M25.512","Z76.0","Z20.828","N39.0","R47.01","E87.6","E83.42","E11.9","E55.9","E53.8","Z79.84","G40.919","G93.40","F05","S06.2X9D","G93.41","R41.82","F31.2","F07.0","J44.9","F32.3","R07.0","R07.9","F29","R69","F33.2","G40.501","F33.9","R35.0","R11.0","J45.20","E28.2","F31.9","E78.2","E22.2","E53.9","Z79.899","F63.89","G40.911","F33.1","Z09","R42","Z53.29","Z82.49","R40.4","R40.2411","G44.89","D64.9","L68.0","N92.0","J98.9","R05.9","R06.02","R06.2","Z20.822","G93.89","J06.9","N30.01","G40.804","R05.3","J45.41","G47.10","R06.83","A09","E86.0","R10.84","R68.82","J43.9","G47.33"," ","F41.9","L03.011","J44.1","I49.3"],"date":["2021-01-12","2021-01-12","2022-06-14","2021-10-27","2021-01-08","2021-01-08","2021-01-08","2021-11-18","2022-11-10","2021-06-04","2021-11-18","2021-01-12","2021-01-12","2021-01-12","2021-01-12","2021-01-12","2021-01-12","2021-01-12","2021-01-12","2021-01-26","2020-04-03","2020-04-03","2022-02-19","2022-02-19","2021-05-14","2020-09-29","2020-11-05","2021-04-02","2020-10-22","2020-06-03","2020-06-03","2020-06-03","2020-06-03","2020-06-03","2020-06-03","2020-10-13","2021-10-27","2020-06-03","2021-06-04","2021-06-04","2020-06-11","2020-06-11","2020-06-19","2020-06-19","2022-07-01","2021-11-16","2021-10-27","2021-11-16","2021-07-07","2021-07-07","2022-11-10","2020-09-26","2020-10-13","2020-10-13","2020-08-03","2020-08-03","2020-08-03","2020-09-23","2020-08-26","2020-08-26","2021-09-06","2020-10-13","2020-09-24","2020-09-24","2020-09-24","2021-10-27","2021-10-27","2020-10-22","2020-09-24","2021-10-27","2020-09-24","2020-09-24","2020-09-24","2020-09-24","2020-09-25","2020-09-24","2020-09-26","2020-09-26","2022-11-23","2020-09-26","2020-09-26","2020-09-26","2020-09-26","2020-09-26","2020-10-14","2022-08-10","2022-04-10","2020-10-12","2022-07-01","2020-10-22","2020-10-22","2020-10-22","2020-10-22","2020-10-13","2020-10-13","2021-11-16","2020-10-14","2020-10-15","2020-10-15","2020-10-22","2021-10-27","2021-11-18","2021-10-27","2021-10-27","2021-10-27","2021-10-27","2021-11-16","2021-11-16","2021-11-16","2021-11-18","2022-05-20","2022-11-10","2022-05-20","2021-12-13","2020-12-05","2021-12-13","2022-02-26","2022-11-08","2022-11-10","2022-11-10","2022-11-10","2022-11-10","2022-07-03","2022-07-03","2022-07-01","2022-06-14","2022-07-01","2022-11-10","2022-11-23","2021-04-02","2021-04-02","2022-11-10","2022-11-10"],"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":[["","65862057490","MONTELUKAST","TAB 10MG","30","Select","Select",""],["","67877019705","AMLODIPINE","TAB 2.5MG","30","Select","Select",""],["","23155010205","METFORMIN","TAB 500MG","60","Select","Select",""],["","65862052890","VENLAFAXINE","CAP 75MG ER","30","Select","Select",""],["","43547035611","LISINOPRIL","TAB 40MG","30","Select","Select",""],["","16714035502","LEVETIRACETA","TAB 500MG","180","Select","Select",""],["","64764017130","DEXILANT","CAP 30MG DR","30","Select","Select",""],["","16714087603","ATORVASTATIN","TAB 40MG","30","Select","Select",""],["","00131248035","VIMPAT","TAB 200MG","60","Select","Select",""],["","16729018217","HYDROCHLOROT","TAB 12.5MG","30","Select","Select",""],["","00173085910","BREO","INH 100-25","60","Select","Select",""],["","59310057922","PROAIR","AER ","8.5","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","16714088801","CLOBAZAM","TAB 20MG","60","Select","Select",""],["","51672400501","CARBAMAZEPIN","TAB 200MG","240","Select","Select",""],["","53746051101","SPIRONOLACT","TAB 25MG","90","Select","Select",""],["","51991029301","OXCARBAZEPIN","TAB 300MG","180","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","Select","Select",""],["","43547034250","RISPERIDONE","TAB 2MG","180","Select","Select",""],["","68462068160","LACOSAMIDE","TAB 200MG","180","Select","Select",""],["","13811071910","NITROFURANTN","CAP 100MG","2","Select","Select",""],["","65862018730","ONDANSETRON","TAB 4MG","9","Select","Select",""],["","00143122701","DICYCLOMINE","TAB 20MG","20","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","48","Select","Select",""],["","24979070306","DEXLANSOPRAZ","CAP 30MG DR","90","Select","Select",""],["","42858010201","OXYCOD\/APAP","TAB 5-325MG","12","Select","Select",""],["","00093310905","AMOXICILLIN","CAP 500MG","21","Select","Select",""],["","49483060450","IBUPROFEN","TAB 800MG","21","Select","Select",""],["","00116200116","CHLORHEX","SOL 0.0012","473","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","20.00","Select","Select",""],["","70710113908","FLUCONAZOLE","TAB 150MG","1.00","Select","Select",""],["","68462013001","ZONISAMIDE","CAP 100MG","60","Select","Select",""],["","00603533715","PREDNISONE","PAK 5MG","21","Select","Select",""],["","62756079813","DIVALPROEX","TAB 500MG DR","60","Select","Select",""],["","55111028130","LEVOFLOXACIN","TAB 750MG","5","Select","Select",""],["","00143211205","DOXYCYCL","TAB 100MG","20","Select","Select",""],["","00173089310","TRELEGY","AER ELLIPTA","60","Select","Select",""],["","59651021430","AZELASTINE","SPR 0.001","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":["",""]}},{"a":{"indx":["1",""],"comment":["",""],"sub":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["1",""],"comment":["",""],"sub":{"indx":[["","",""],[""],[""],[""],[""]],"comment":[["","",""],[""],[""],[""],[""]],"sub":[]}}},{"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":""}]}]}