{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"A NORAHSSREGDOR ","gend":1,"add":"        RD ENOTSNEHS 1241                         ","city":"HARRISONBURG             ","state":"VA","zip":"22802-9998","dob":"1941-11-29","age":"","mstatus":"","insh":"10117223","cliId":"","pno":"7440848847","cno":8044774884,"email":"","ename":"","eno":"","pphy":"VON ELTEN, CHRISTOPHER","ppno":8043534000,"pcpadd":"1242 CEDARS CT,","pcpcity":"Charlottesville","pcpstate":"VA","pcpzip":229034800,"pcpcounty":"","pcpid":"","pcpname":"LEGACY CARE LLC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"N","ano":"","add2":"                                                  ","add3":"","madd1":"1421 SHENSTONE DR                                 ","madd2":"                                                  ","madd3":"","mcity":"HARRISONBURG             ","mstate":"VA","mzip":"22802-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z20.9","R07.89","R07.9","R06.9","R06.02","I10","N39.41","M19.011","M25.511","N30.00","R11.0","R35.0","Z88.2","Z88.8","Z86.73","N39.0","E87.1","K44.9","R10.32","R30.0","K58.1","E11.9","E03.9","F41.1","K21.9","G89.4","Z87.440","Z90.49","Z79.899","R39.9","Z71.89","R10.2","K58.2","M54.5","R42","M62.81","R26.2","F41.9","M31.6","M25.50","R35.8","F34.1","F32.9","E78.2","N30.20","I95.9","W19.XXXA","R55","J98.4","N17.9","R40.0","W01.10XA","Z86.79","Z98.890","Z79.890","S49.91XA","Z04.3","F33.9","M48.061","N32.81","R10.31","E03.8","E11.65","N39.44","M41.86","Z98.1","M16.0","M47.816","M51.36","G89.29","F45.42","M54.16","M96.1","M54.51","Z79.891","Z20.822","U07.1","R50.9","H53.8","E04.1","F33.2","G92.9","M54.50","R09.3","N18.31","M48.00","K20.90","K29.70","D64.9","R11.2","R63.5","B37.9","M25.571","R22.41","H04.123","Z96.1","R41.841","F11.20","R60.0","Z12.31","N63.10","M42.06","M54.10","F33.0","Z23","N63.11"," ","F33.1"],"date":["2021-02-08","2021-02-08","2021-02-08","2021-02-08","2022-08-01","2022-08-11","2022-11-08","2020-05-26","2020-10-20","2021-08-10","2022-08-31","2020-05-26","2021-08-06","2021-08-06","2022-09-01","2021-10-01","2021-08-10","2021-08-06","2022-11-25","2021-08-10","2022-11-23","2022-11-25","2022-09-01","2022-12-08","2022-08-29","2022-11-25","2021-08-06","2021-08-06","2022-06-09","2021-08-07","2021-08-06","2022-05-12","2021-08-10","2021-08-10","2022-08-24","2022-09-01","2022-10-17","2022-08-30","2020-09-12","2020-09-12","2020-12-15","2021-09-12","2022-08-30","2021-09-12","2021-09-14","2020-10-20","2022-08-10","2020-10-20","2020-10-20","2020-10-20","2020-10-20","2020-10-20","2020-10-20","2022-07-28","2021-02-08","2020-10-20","2020-10-21","2022-10-31","2022-11-25","2022-07-15","2020-12-15","2020-12-15","2020-12-15","2020-12-15","2020-12-15","2020-12-15","2020-12-15","2020-12-15","2020-12-15","2022-10-31","2022-06-09","2022-06-09","2022-06-09","2022-04-14","2022-06-09","2021-02-08","2021-02-08","2021-02-08","2021-10-01","2022-03-01","2022-10-06","2022-06-09","2022-11-16","2022-08-01","2022-09-06","2022-07-22","2022-08-15","2022-10-12","2022-07-27","2022-09-14","2022-08-19","2022-08-19","2022-08-10","2022-08-10","2022-07-28","2022-07-28","2022-09-01","2022-09-12","2022-10-31","2022-09-07","2022-09-07","2022-10-17","2022-10-17","2022-12-08","2022-09-01","2022-11-16","2022-12-08","2022-11-22"],"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":[["","65862053750","LEVOFLOXACIN","TAB 500MG","14","Select","Select",""],["","00006022131","JANUVIA","TAB 25MG","90","Select","Select",""],["","00469260190","MYRBETRIQ","TAB 25MG","90","Select","Select",""],["","00378210005","LOPERAMIDE","CAP 2MG","30.00","Select","Select",""],["","64764008060","AMITIZA","CAP 8MCG","180","Select","Select",""],["","10702005601","OXYCODONE","TAB 10MG","90","Select","Select",""],["","43386016006","MISOPROSTOL","TAB 100MCG","15","Select","Select",""],["","59385002160","BELBUCA","MIS 75MCG","60.00","Select","Select",""],["","62175011843","OMEPRAZOLE","CAP 20MG","180","Select","Select",""],["","00781518110","LEVOTHYROXIN","TAB 50MCG","90","Select","Select",""],["","00115166101","PROPRANOLOL","TAB 40MG","180","Select","Select",""],["","43547035611","LISINOPRIL","TAB 40MG","90","Select","Select",""],["","00254302802","LUBIPROSTONE","CAP 8MCG","60","Select","Select",""],["","62175027037","OXYBUTYNIN","TAB 5MG ER","14","Select","Select",""],["","29300024405","BUSPIRONE","TAB 5MG","60","Select","Select",""],["","00115164501","NITROFUR","CAP 100MG","90","Select","Select",""],["","50111064801","FLUOXETINE","CAP 20MG","90","Select","Select",""],["","16729044416","BUPROPN","TAB 300MG XL","90","Select","Select",""],["","68180098430","BUDESONIDE","SUS 0.5MG\/2","60","Select","Select",""],["","50383092493","BUPRENORPHIN","SUB 2MG","30","Select","Select",""],["","70461012003","FLUAD","INJ 0.5ML","0.5","Select","Select",""],["","58160082311","SHINGRIX","INJ 50\/0.5ML","1","Select","Select",""],["","31722052101","HYDRALAZINE","TAB 50MG","180","Select","Select",""],["","67877019805","AMLODIPINE","TAB 5MG","90","Select","Select",""],["","68462015713","ONDANSETRON","TAB 4MG ODT","30","Select","Select",""],["","65162006205","SUCRALFATE","SUS 1GM\/10ML","420","Select","Select",""],["","72205001390","PREGABALIN","CAP 75MG","90.00","Select","Select",""],["","67877022310","GABAPENTIN","CAP 300MG","360","Select","Select",""],["","00406051205","OXYCOD\/APAP","TAB 5-325MG","84","Select","Select",""],["","00781107710","ALPRAZOLAM","TAB 0.5MG","60","Select","Select",""],["","59651036105","IBUPROFEN","TAB 600MG","90","Select","Select",""],["","00187073130","WELLBUTRIN","TAB XL 300MG","90","Select","Select",""],["","00093216568","NALOXONE","SPR 4MG","2","Select","Select",""],["","69315090505","LORAZEPAM","TAB 1MG","30.00","Select","Select",""],["","57237005920","CEFUROXIME","TAB 500MG","20","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","65862056099","PANTOPRAZOLE","TAB 40MG","15","Select","Select",""],["","69315011610","FUROSEMIDE","TAB 20MG","7","Select","Select",""],["","59746000106","METHYLPRED","TAB 4MG","63","Select","Select",""],["","70710113801","FLUCONAZOLE","TAB 100MG","2","Select","Select",""],["","43386048024","ORPHENADRINE","TAB 100MG ER","14","Select","Select",""],["","00093224001","CEPHALEXIN","TAB 500MG","15","Select","Select",""],["","16571020150","DICLOFENAC","TAB 75MG DR","14","Select","Select",""],["","00054418425","DEXAMETHASON","TAB 4MG","6","Select","Select",""],["","00781809003","AZITHROMYCIN","TAB 500MG","3","Select","Select",""],["","49281012165","FLUZONE","INJ 2021-22","0.7","Select","Select",""],["","67877054360","CEFDINIR","CAP 300MG","14","Select","Select",""],["","60758077305","KETOROLAC","SOL 0.004","5","Select","Select",""],["","00143992801","CIPROFLOXACN","TAB 500MG","4","Select","Select",""],["","00185013005","BUMETANIDE","TAB 2MG","6","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":""}]}]}