{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"L   ANDEKCAMOW ","gend":1,"add":"          EUNEVA GNIRPS   6291                              ","city":"SOUTH BOSTON                  ","state":"VA","zip":"24592-1954","dob":"1964-07-11","age":"","mstatus":"","insh":"30019674","cliId":"","pno":"2243486812","cno":4342221868,"email":"","ename":"","eno":"","pphy":"BUCKMAN, PAUL S                                             ","ppno":"","pcpadd":"15210 L P Bailey Memorial Hwy","pcpcity":"Nathalie                      ","pcpstate":"VA","pcpzip":245773304,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"1926   SPRING AVENUE                                        ","madd2":"                                                            ","madd3":"","mcity":"SOUTH BOSTON                  ","mstate":"VA","mzip":"24592-1954","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["C50.912","M62.830","K58.0","Z91.018","H02.831","H02.832","H02.834","H02.835","E11.9","H25.13","E78.2","I10","I83.813","I73.89","R10.9","Z85.3","K21.9","F41.1","R07.81","J00","H61.21","K30","C50.919","J39.2","R68.2","R09.82","E11.69","E55.9","G47.09","E66.9","R63.4","R11.0","E11.65","Z23","L90.5","Z80.3","Z80.41","Z01.89","Z01.810","Z01.812","F17.200","R94.31","Z20.822","K22.2","R10.84","R12","K29.00","K44.9","K29.50","B96.81","F17.210","Z88.8","Z79.84","Z79.899","K29.70","K31.89","K29.60","R06.00","I73.9","I87.2","I83.893","I78.1","M79.669","Z91.014","R92.1","R06.09"],"date":["2020-05-05","2019-02-14","2021-10-06","2021-04-14","2019-04-10","2019-04-10","2019-04-10","2019-04-10","2021-04-29","2019-04-10","2021-11-18","2021-11-18","2019-07-24","2020-10-29","2021-03-15","2021-10-18","2020-05-05","2020-05-05","2019-12-04","2019-12-13","2019-12-26","2020-08-17","2020-02-19","2020-04-02","2020-04-02","2020-04-02","2020-05-06","2020-05-06","2020-05-05","2021-04-14","2020-08-17","2021-04-14","2020-09-14","2020-10-08","2020-10-16","2021-10-18","2021-10-18","2021-03-15","2021-04-09","2021-04-09","2021-10-06","2021-04-09","2021-04-09","2021-04-14","2021-04-14","2021-04-14","2021-04-14","2021-10-06","2021-04-14","2021-10-06","2021-04-14","2021-04-14","2021-04-14","2021-04-14","2021-04-22","2021-04-14","2021-10-06","2021-04-29","2021-11-18","2021-08-19","2021-09-28","2021-09-28","2021-09-28","2021-10-06","2021-10-18","2021-11-18"],"priorHcc":["","","","","","","","","","",null,null,"","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",null,"",null,null,null,"","",null]}},{"a":[]}]},{"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":[]}]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","63868033860","ANTI-DIARRHE","2MG","60","Select","Select",""],["","23155000810","HYDROCHLOROT","25MG","45","Select","Select",""],["","13668000810","ZOLPIDEM","10MG","30","Select","Select",""],["","43199001201","HYOSCYAMINE","0.125MG","120","Select","Select",""],["","45802091987","CETIRIZINE","10MG","30","Select","Select",""],["","68462047205","POT CL MICRO","20MEQ ER","60","Select","Select",""],["","62175013643","OMEPRAZOLE","40MG","30","Select","Select",""],["","45802005911","NYSTATIN","100000","30","Select","Select",""],["","13668011590","LOSARTAN","100MG","30","Select","Select",""],["","69452015120","VITAMIN","50000UNT","8","Select","Select",""],["","16729000316","GLIMEPIRIDE","4MG","60","Select","Select",""],["","79854001156","ACIDOPHILUS","","60","Select","Select",""],["","65862018730","ONDANSETRON","4MG","20","Select","Select",""],["","10702000201","PROMETHAZINE","12.5MG","20","Select","Select",""],["","57237000511","FLUCONAZOLE","150MG","1","Select","Select",""],["","65862056099","PANTOPRAZOLE","40MG","30","Select","Select",""],["","00193731025","CONTOUR","NEXT","50","Select","Select",""],["","08484081028","PRODIGY","28G","100","Select","Select",""],["","00603533715","PREDNISONE","5MG","21","Select","Select",""],["","23155065205","METRONIDAZOL","500MG","42","Select","Select",""],["","62135062605","DOXYCYCL","100MG","28","Select","Select",""],["","63868098930","PINK","262MG","84","Select","Select",""],["","63868033860","ANTI-DIARRHE ","TAB 2MG","60","Select","Select",""],["","23155000810","HYDROCHLOROT ","TAB 25MG","45","Select","Select",""],["","13668000810","ZOLPIDEM ","TAB 10MG","30","Select","Select",""],["","43199001201","HYOSCYAMINE ","TAB 0.125MG","120","Select","Select",""],["","45802091987","CETIRIZINE ","TAB 10MG","30","Select","Select",""],["","68462047205","POT  CL MICRO","TAB 20MEQ ER","60","Select","Select",""],["","62175013643","OMEPRAZOLE ","CAP 40MG","30","Select","Select",""],["","45802005911","NYSTATIN ","CRE 100000","30","Select","Select",""],["","13668011590","LOSARTAN ","TAB 100MG","30","Select","Select",""],["","69452015120","VITAMIN ","CAP 50000UNT","8","Select","Select",""],["","16729000316","GLIMEPIRIDE ","TAB 4MG","60","Select","Select",""],["","79854001156","ACIDOPHILUS ","CHW ","60","Select","Select",""],["","65862018730","ONDANSETRON ","TAB 4MG","20","Select","Select",""],["","10702000201","PROMETHAZINE ","TAB 12.5MG","20","Select","Select",""],["","57237000511","FLUCONAZOLE ","TAB 150MG","1","Select","Select",""],["","65862056099","PANTOPRAZOLE ","TAB 40MG","30","Select","Select",""],["","00193731025","CONTOUR ","TES NEXT","50","Select","Select",""],["","08484081028","PRODIGY ","MIS 28G","100","Select","Select",""],["","00603533715","PREDNISONE ","PAK 5MG","21","Select","Select",""],["","23155065205","METRONIDAZOL ","TAB 500MG","42","Select","Select",""],["","62135062605","DOXYCYCL ","TAB 100MG","28","Select","Select",""],["","63868098930","PINK ","CHW 262MG","84","Select","Select",""]]}},{"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":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[[["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""]]]},{"t":"Mini-Cog","q":[{"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":""}]}]}