{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" R ECYOJDNALWOR","gend":1,"add":"ENIP 632TEERTS ","city":"Wakefield","state":"VA","zip":"23888-2900","dob":"1957-12-22","age":"","mstatus":"","insh":"10112545","cliId":"","pno":"5775706848","cno":7572175364,"email":"","ename":"","eno":"","pphy":"VAUGHN, LINDSAY D","ppno":7573128730,"pcpadd":"109 RAILROAD AVE,","pcpcity":"Wakefield","pcpstate":"VA","pcpzip":"23888-9998","pcpcounty":"","pcpid":"","pcpname":"SENTARA FAMILY MEDICINE PHYSICIANS","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"N","ano":"","add2":"","add3":"","madd1":"236 PINE STREET","madd2":"","madd3":"","mcity":"Wakefield","mstate":"VA","mzip":"23888-2900","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11.9","E08.9","I10","E11.3312","E11.3311","H40.9","H25.11","H25.12","E11.3391","R06.00","I37.1","E11.65","Z12.39","R06.02","Z71.3","Z68.35","D50.8","H40.1131","N18.32","G47.33","E78.5","F41.9","U07.1","R51.9","Z68.36","I12.9","E11.22","E66.9","I63.312","D72.829","Z20.822","Z11.52","R07.9","Z86.16","Z68.33","R51","R60.0","Z23","Z68.32","Z12.31","Z71.9","J10.1","R05.1","J02.9","R03.0","Z68.34","Z82.49","Z92.89","Z86.73","R79.89","N17.9","I20.0","J12.81","R06.81","N18.30","R06.09","E11.69","Z79.4","E11.39","N18.31","E66.8","R92.8","N64.89","Z12.4","M54.2","E11.8","R07.2","R20.0","R53.1","R06.83","R94.4","D64.9","I08.3","D50.9","Z78.9","E55.9","J96.01","J12.82","E87.2","E87.1","E66.01","Z68.37","R77.8","I13.0","J44.9","E11.36","E11.59","I50.32","E11.3313","H25.013","H25.13","H50.10","H18.413","M79.18","I77.1","Z68.38","Z97.8"],"date":["2023-03-31","2022-08-26","2023-04-02","2023-03-09","2023-03-09","2022-06-30","2022-06-30","2022-06-30","2021-05-13","2021-01-05","2021-01-05","2021-09-29","2020-11-27","2021-09-29","2023-01-11","2022-11-29","2023-01-11","2021-10-20","2023-03-03","2021-11-09","2023-01-11","2021-04-20","2022-03-07","2023-02-06","2021-04-20","2023-03-03","2023-03-03","2023-03-03","2021-05-14","2021-05-18","2021-09-15","2022-12-08","2021-04-29","2021-04-28","2022-03-07","2021-09-29","2021-09-29","2021-09-29","2022-06-07","2023-03-27","2022-06-09","2022-12-08","2022-12-08","2022-12-08","2022-12-08","2022-12-08","2021-04-29","2021-04-29","2023-01-11","2021-04-29","2021-04-29","2021-04-28","2020-12-09","2021-05-14","2021-04-28","2021-03-29","2022-11-29","2022-11-29","2022-11-29","2022-11-29","2022-11-29","2021-12-07","2021-12-07","2021-01-19","2021-01-19","2021-09-29","2021-04-28","2021-01-28","2023-01-11","2021-01-28","2021-01-28","2021-01-28","2021-01-05","2021-02-04","2021-02-04","2021-02-04","2021-02-04","2021-02-04","2021-02-04","2021-02-04","2021-04-28","2021-02-04","2021-02-04","2021-10-20","2021-10-20","2021-10-20","2021-10-20","2021-10-20","2021-10-14","2021-10-14","2021-10-14","2021-10-14","2021-10-14","2021-01-28","2021-04-28","2021-04-28","2023-01-11"],"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":[["","00169368712","LEVEMIR","INJ ","50","Select","Select",""],["","00093317431","ALBUTEROL SUL","FAT E","8.5","Select","Select",""],["","29300039710","AMLODIPINE","TAB 5MG","30","Select","Select",""],["","68180096301","ALBUTEROL","AER HFA","8.5","Select","Select",""],["","00173085910","BREO ELLIPTA","INH 100-25","60","Select","Select",""],["","00597015330","JARDIANCE","TAB 25MG","30","Select","Select",""],["","42571014726","DORZOL\/TIMOL","SOL 22.3-6.8","10","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8.5","Select","Select",""],["","73070010011","INSULIN ASPA","INJ 100\/ML","30","Select","Select",""],["","00169750111","NOVOLOG","INJ 100\/ML","30","Select","Select",""],["","16729018201","HYDROCHLOROT","TAB 12.5MG","36","Select","Select",""],["","00002318280","TRULICITY","INJ 4.5\/0.5","2","Select","Select",""],["","57599080000","FREESTY LIBR","KIT 2 SENSOR","6","Select","Select",""],["","16714017303","ATORVASTATIN","TAB 10MG","30","Select","Select",""],["","00310653004","BYDUREON PEN","INJ 2MG","4","Select","Select",""],["","08290328418","INSULIN SYRG","MIS 1ML\/31G","270","Select","Select",""],["","08290320119","BD PEN NEEDL","MIS 31GX5MM","100","Select","Select",""],["","80777027399","MODERNA VAC","INJ COVID-19","0.5","Select","Select",""],["","31722063231","OSELTAMIVIR","CAP 75MG","10","Select","Select",""],["","68645058259","METFORMIN","TAB 500MG","30","Select","Select",""],["","00173085910","BREO","INH 100-25","60","Select","Select",""],["","59310057922","PROAIR","AER ","8.5","Select","Select",""],["","73070010011","INSULIN","INJ 100\/ML","30","Select","Select",""],["","57599080000","FREESTY","KIT 2 SENSOR","6","Select","Select",""],["","00310653004","BYDUREON","INJ 2MG","4","Select","Select",""],["","08290320119","BD  PEN NEEDL","MIS 31GX5MM","100","Select","Select",""],["","80777027399","MODERNA","INJ COVID-19","0.5","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":""}]}]}