{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" LORACEKNIF","gend":1,"add":"         RD HTROWTIHW 722                         ","city":"CULPEPER                 ","state":"VA","zip":"22701-9998","dob":"1973-06-21","age":"","mstatus":"","insh":"10118782","cliId":"","pno":"2804598695","cno":5408253366,"email":"","ename":"","eno":"","pphy":"KILEY, SUSAN","ppno":4349333318,"pcpadd":"300 E MAIN ST STE 200,","pcpcity":"Charlottesville","pcpstate":"VA","pcpzip":229025219,"pcpcounty":"","pcpid":"","pcpname":"HEALTH AND WELLNESS MEDICAL SERVICES LLC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"NORTHERN & WINCHESTER","aligned":"N","ano":"","add2":"                                                  ","add3":"","madd1":"227 WHITWORTH DR                                  ","madd2":"                                                  ","madd3":"","mcity":"CULPEPER                 ","mstate":"VA","mzip":"22701-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F25.0","R25.1","R68.2","R76.8","R26.9","Z12.31","E53.9","E55.9","G95.9","F31.9","G25.1","G95.89","M48.02","Z98.1","R27.0","F31.2","F31.0","F25.9","S61.215A","W27.2XXA","Z88.0","Z88.5","Z79.890","Z79.899","E03.9","Z98.51","R29.6","F31.60","R26.89","F32.9","Z23","F41.9","W19.XXXA","F31.73","M54.5","B35.1","G89.29","M54.32","M62.838","G25.0","R79.89","K59.01","F31.75","Z11.1","H25.13","H43.813","H35.431","H52.4","Z71.89","E66.09","Z68.35","R68.89","J06.9","M47.12","R22.0","D51.9","E11.9","R94.6","Z13.220","R79.9","M19.011","M75.31","M54.40","M41.9","S06.9X9A","F84.0","S06.9X1A","S01.81XA","W07.XXXA","R58","R40.20","R06.9","R52","E87.8","N28.9","E78.5","Z13.6","E06.9","E78.2"," ","J01.90","H69.90","H92.02","R60.0","M75.51","K12.0"],"date":["2021-08-18","2021-02-25","2021-02-25","2021-02-25","2021-02-25","2022-03-23","2021-03-11","2022-05-01","2021-05-19","2022-06-21","2021-05-19","2021-04-07","2021-04-07","2021-04-07","2021-05-19","2020-11-24","2021-04-29","2021-05-19","2021-08-20","2021-08-20","2021-08-20","2021-08-20","2021-08-20","2021-08-20","2022-10-18","2021-08-20","2020-09-04","2020-09-04","2020-09-08","2020-09-08","2021-11-11","2020-09-08","2022-05-04","2020-09-08","2020-12-03","2020-10-01","2020-12-03","2020-12-23","2020-12-23","2020-10-16","2020-10-23","2020-10-23","2021-10-28","2021-10-28","2020-10-29","2020-10-29","2020-10-29","2020-10-29","2021-11-11","2021-11-11","2021-11-11","2020-12-01","2021-12-14","2020-12-23","2022-03-14","2022-03-28","2022-03-28","2022-03-28","2022-03-28","2022-03-28","2022-04-09","2022-05-01","2022-05-01","2022-05-01","2022-05-04","2022-05-02","2022-05-04","2022-05-04","2022-05-04","2022-05-04","2022-05-04","2022-05-04","2022-05-04","2022-06-21","2022-06-21","2022-06-21","2022-06-21","2022-06-21","2022-10-18","2022-10-18","2022-06-21","2022-06-21","2022-06-21","2022-06-21","2022-04-12","2022-06-14"],"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":[["","29300011210","LAMOTRIGINE","TAB 100MG","31","Select","Select",""],["","65162075750","DIVALPROEX","TAB 500MG ER","60","Select","Select",""],["","68180096701","LEVOTHYROXIN","TAB 75MCG","30","Select","Select",""],["","60505257908","ATORVASTATIN","TAB 20MG","31","Select","Select",""],["","69315011610","FUROSEMIDE","TAB 20MG","16","Select","Select",""],["","65162054410","PRIMIDONE","TAB 50MG","90","Select","Select",""],["","67877024760","QUETIAPINE","TAB 300MG","60","Select","Select",""],["","65862019401","FLUOXETINE","CAP 40MG","56","Select","Select",""],["","10702000601","CYCLOBENZAPR","TAB 5MG","30","Select","Select",""],["","50111056002","TRAZODONE","TAB 50MG","28","Select","Select",""],["","68382013814","TOPIRAMATE","TAB 25MG","56","Select","Select",""],["","00781261301","AMOXICILLIN","CAP 500MG","21","Select","Select",""],["","67877032101","IBUPROFEN","TAB 800MG","12","Select","Select",""],["","00115165901","PROPRANOLOL","TAB 10MG","60","Select","Select",""],["","65862018601","CLINDAMYCIN","CAP 300MG","28","Select","Select",""],["","69315013610","BENZTROPINE","TAB 0.5MG","56","Select","Select",""],["","00093227534","AMOX\/K","TAB 875-125","20","Select","Select",""],["","65862064163","AZITHROMYCIN","TAB 250MG","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":""}]}]}