{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"F W EILRAHCRJ NOSUGRE","gend":0,"add":"AV N 7643EKIP YELL","city":"HARRISONBURG","state":"VA","zip":"22802-1109","dob":"1967-11-05","age":"","mstatus":"","insh":"10116745","cliId":"","pno":"8643473658","cno":9106251666,"email":"","ename":"","eno":"","pphy":"DOMINGUS, JEFF LEWIS","ppno":5404334913,"pcpadd":"339 NEBO SCHOOL RD, ","pcpcity":"NEBO","pcpstate":"NC","pcpzip":287616848,"pcpcounty":"","pcpid":"","pcpname":"HARRISONBURG COMMUNITY HEALTH CENTER","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"N","ano":"","add2":"ROOM 167","add3":"","madd1":"3467 N VALLEY PIKE","madd2":"ROOM 167","madd3":"","mcity":"HARRISONBURG","mstate":"VA","mzip":"22802-1109","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I16.1","I10","N17.9","R79.89","R51.9","R42","R77.8","I25.10","E11.22","I12.9","N18.32","E11.59","E78.2","D50.9","F41.9","F32.9","Z95.1","Z79.82","I65.23","E10.3412","H25.12","Z01.812","Z20.822","R29.898","G43.809","D64.9","E11.49","G47.00","F33.1","Z23","I21.4","I95.1","D63.1","E11.43","K31.84","M62.50","E86.0","K21.00","I48.0","R13.14","R07.2","U07.1","R07.9","I51.7","E78.5","Z79.4","Z86.16","N18.30","E11.21","G90.9","R10.9","R10.32","R11.2","R06.02","R10.13","R93.3","I25.119","I95.9","I50.31","E11.29","K20.90","R13.10","I49.9","E11.9","T18.128A","I95.89","R07.89","G44.89","R06.9","E11.36","H25.812","Z96.1","Z98.41","E10.3411","H01.006","H01.003","H35.031","E10.40","N18.9","E10.22","Z87.891","R94.4","I50.32","I13.0","R13.19","I25.709","N52.9","M54.9","I25.2","I25.9","F14.10","F33.9","F41.1","F11.129","I25.118","E10.9","L98.496","N18.4","E11.42","Z79.2","Z79.02","I16.0","I11.0","I99.8","S22.32XA","R53.1","W01.10XA","S01.01XA","E87.5","Z79.899","M47.812","J32.3","J34.1","J34.89","S00.83XA","R50.9","S01.119A","S09.90XA","W07.XXXA","F14.90","W19.XXXA","S01.81XA","J81.0","L02.211","L97.511","L89.152","L89.142","L89.896","E11.621","L97.509","R10.30","J90","R60.1","A41.89","L02.214","R65.20","N17.8","G90.1","R00.0","R10.12","K59.00","R94.31","R27.9","Z74.3","E10.3413","L03.90","A41.9","R60.0","R80.9","N04.9","M79.89","I50.33","N50.89","E11.311","E83.39","D63.8","N19","E11.40","E11.10","E16.1","E16.2","N18.3","K21.9","Z28.21","I50.9","R09.02","L97.512","R09.89","E13.42","Z59.00","E55.9","N25.81","Z86.79","E11.65","Z95.5","Z72.0","R22.43","L03.115","R79.9","F33.2","M67.00","Z12.5","H25.042","H36","N18.6","I73.9","Z68.42","M19.071","M19.072","M25.571","M25.572","M77.31","Z91.14","R05.9","L97.529","L97.519","R11.0","Z71.89","N18.5","Z01.810","I50.20","Z09"],"date":["2021-12-29","2021-12-21","2021-10-11","2021-12-19","2021-12-21","2021-08-25","2021-12-19","2021-12-21","2021-12-29","2021-12-19","2021-08-19","2022-01-20","2021-12-29","2021-02-08","2021-08-18","2021-08-18","2021-12-21","2021-12-19","2021-01-07","2021-02-19","2021-02-19","2021-01-19","2021-12-19","2022-01-20","2022-01-20","2022-01-20","2022-01-20","2022-01-20","2022-01-20","2022-01-27","2021-12-29","2021-02-21","2021-11-18","2021-02-20","2021-02-04","2021-02-04","2021-02-04","2021-12-29","2021-02-20","2021-02-04","2021-02-04","2021-02-20","2022-02-10","2021-12-20","2021-12-21","2021-12-19","2021-02-21","2021-09-22","2021-12-29","2021-09-21","2021-02-07","2021-02-08","2021-02-12","2022-02-10","2021-02-08","2021-02-08","2021-02-11","2021-02-08","2021-02-08","2021-02-09","2021-02-09","2021-02-12","2021-02-19","2021-12-21","2021-02-09","2021-02-10","2022-02-10","2022-02-10","2022-02-10","2021-02-19","2021-02-19","2021-02-19","2021-02-19","2021-02-19","2021-02-19","2021-02-19","2021-02-19","2021-02-19","2021-12-19","2021-02-19","2021-02-19","2021-02-20","2021-10-19","2021-10-19","2021-02-20","2021-12-19","2021-02-20","2021-02-20","2021-09-21","2021-08-19","2021-02-22","2021-08-03","2021-08-03","2021-08-03","2021-08-19","2021-08-19","2021-08-18","2021-12-21","2021-08-18","2021-08-18","2021-12-19","2021-12-21","2021-09-21","2021-08-19","2021-08-20","2021-09-01","2021-08-24","2021-08-24","2021-09-21","2021-12-19","2021-08-24","2021-08-24","2021-08-24","2021-08-24","2021-08-24","2021-08-24","2021-08-24","2021-08-24","2021-08-24","2021-08-25","2021-08-25","2021-08-25","2021-08-26","2021-08-26","2021-12-19","2021-08-26","2021-08-26","2021-08-26","2021-12-19","2021-08-26","2021-08-26","2021-08-26","2021-09-20","2021-08-27","2021-09-07","2021-09-07","2021-08-27","2021-08-27","2021-12-19","2021-08-29","2021-08-29","2021-08-30","2021-09-01","2021-09-01","2020-10-19","2021-09-03","2021-09-07","2021-09-24","2021-09-19","2021-09-19","2021-09-19","2021-10-11","2021-09-21","2021-10-19","2021-09-26","2021-09-21","2021-12-21","2021-12-09","2021-10-19","2021-12-19","2021-12-19","2020-09-22","2020-12-02","2020-09-22","2020-12-02","2020-09-22","2021-09-22","2021-09-24","2021-10-10","2021-10-19","2021-10-19","2021-10-19","2021-10-19","2021-12-19","2021-11-12","2021-11-12","2021-11-12","2021-11-12","2020-11-17","2020-11-17","2020-11-17","2020-11-17","2020-11-23","2020-12-02","2020-12-02","2020-12-02","2020-12-02","2021-12-19","2021-12-19","2020-12-17","2020-12-17","2020-12-17","2021-12-29","2021-12-19","2021-12-19","2021-12-19","2021-12-19","2021-12-19","2021-12-21","2020-12-24","2021-12-29","2021-12-29"],"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":[["","31722052201","HYDRALAZINE","TAB 100MG","90","Select","Select",""],["","68462063945","NITROGLYCERN","SUB 0.4MG","25","Select","Select",""],["","13668010401","ISOSORB","TAB 30MG ER","90","Select","Select",""],["","68180044501","QUETIAPINE","TAB 25MG","30","Select","Select",""],["","00024592505","ADMELOG","INJ 100U\/ML","3","Select","Select",""],["","65162010211","GABAPENTIN","CAP 300MG","30","Select","Select",""],["","00548585000","GLUCAGON","KIT 1MG","1","Select","Select",""],["","08290320550","BD  PEN NEEDL","MIS 32GX5\/32","600","Select","Select",""],["","08627001601","DEXCOM","MIS TRANSMIT","1","Select","Select",""],["","68645051554","AMLODIPINE","TAB 5MG","90","Select","Select",""],["","69315011710","FUROSEMIDE","TAB 40MG","30","Select","Select",""],["","31722071390","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","69315030660","NYSTATIN","POW 100000","60","Select","Select",""],["","99073070827","FREESTYLE    TES LITE","TES LITE","600","Select","Select",""],["","00093505798","ATORVASTATIN","TAB 80MG","30","Select","Select",""],["","69238115403","EZETIMIBE","TAB 10MG","90","Select","Select",""],["","00002771559","BASAGLAR","INJ 100UNIT","3","Select","Select",""],["","00093506110","HYDROXYZ","TAB 25MG","30","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","14","Select","Select",""],["","50742061510","METOPROL","TAB 25MG ER","90","Select","Select",""],["","00169266015","TRESIBA","INJ 100UNIT","60","Select","Select",""],["","42799012001","BUMETANIDE","TAB 1MG","42","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","65862035705","CLOPIDOGREL","TAB 75MG","30","Select","Select",""],["","62332053331","METOLAZONE","TAB 5MG","30","Select","Select",""],["","73070010315","INSULIN","INJ FLEXPEN","45","Select","Select",""],["","60758011905","PREDNISOLONE","SUS 1% OP","10","Select","Select",""],["","00169300315","NOVOLIN","INJ 100 UNIT","3","Select","Select",""],["","71930001730","ONDANSETRON","TAB 4MG","14","Select","Select",""],["","00169633910","NOVOLOG","INJ FLEXPEN","3","Select","Select",""],["","68382004101","PROMETHAZINE","TAB 25MG","10","Select","Select",""],["","00527169501","BUT\/APAP\/CAF","TAB ","10","Select","Select",""],["","65862084003","MOXIFLOXACIN","SOL HCL 0.5%","3","Select","Select",""],["","00143924920","AMOX\/K","TAB 875-125","20","Select","Select",""],["","99073070805","FREESTYLE    MIS LITE","MIS LITE","1","Select","Select",""],["","99073013001","FREESTYLE    MIS LANCETS","MIS LANCETS","500","Select","Select",""],["","16729022616","SPIRONOLACT","TAB 50MG","30","Select","Select",""],["","24979018646","SEVELAMER","TAB 800MG","90","Select","Select",""],["","00245021311","MIDODRINE","TAB 10MG","90","Select","Select",""],["","00088221905","LANTUS","INJ 100\/ML","3","Select","Select",""],["","00781286810","OMEPRAZOLE","CAP 20MG","30","Select","Select",""],["","00574200802","NYSTOP","POW 100000","60","Select","Select",""],["","31722099601","HYDROCO\/APAP","TAB 5-325MG","12","Select","Select",""],["","72618300002","NURTEC","TAB 75MG ODT","8","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":""}]}]}