{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ARBEDDOOW ","gend":1,"add":"          EVIRD DRAOBKCUB   66                              ","city":"WAYNESBORO                    ","state":"VA","zip":"22980-9244","dob":"1957-04-07","age":"","mstatus":"","insh":"50016653","cliId":"","pno":"4404539297","cno":5404479293,"email":"","ename":"","eno":"","pphy":"SAWYER, RUSSELL C                                           ","ppno":"","pcpadd":"1646 Park Ridge Dr","pcpcity":"Crozet                        ","pcpstate":"VA","pcpzip":229323155,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"APT 116                                                     ","add3":"","madd1":"66   BUCKBOARD DRIVE                                        ","madd2":"APT 116                                                     ","madd3":"","mcity":"WAYNESBORO                    ","mstate":"VA","mzip":"22980-9244","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["D51.8","E53.8","I10","E78.5","E11.40","F41.9","F34.1","K21.9","Z01.84","Z23","R11.0","J45.20","R79.89","J30.89","R10.84","R30.0","R73.03","R10.2","Z01.419","N39.0","G47.9","D22.9","Z12.31","R73.9","F32.9","R14.0","N91.2","N94.10","N95.2","N83.291","N83.292","Z78.0","N94.89","E78.2","R53.83","N85.8","R93.89","J06.9","J40","R31.9","R94.4","E11.9","Z79.4","H25.13","L65.9","E55.9","R80.9","L91.8","E11.69","R31.21","Q82.8","Z80.8","R09.81","R11.2","R11.10","R05","R09.89","B34.9","J45.909","Z79.899","Z79.84","Z88.1","Z88.5","R07.81","J00","J20.9","R53.81","J04.0","F43.21","R63.5","E11.29","H61.22","Z20.828","H43.813","N31.9","N18.32","E83.52","E11.21","J01.00","J02.9","N13.2","R10.9","R55","E11.22","N18.30","R06.00","Z87.891","Z79.82","Z88.2","N23","N20.1","M54.9","J98.9","Z88.8","N20.0","N28.89","N28.0","F32.A","Z87.442","Z82.49","Z98.890","C67.9","N35.92","D62","J44.9","I12.9","G89.29","R31.0","R53.1","C67.4","D41.4","R33.8","G44.52","H53.9"],"date":["2019-11-13","2021-11-24","2021-11-24","2021-10-26","2021-11-24","2021-07-30","2021-11-03","2021-11-24","2019-04-18","2021-11-24","2021-11-24","2021-11-24","2021-05-14","2020-10-09","2019-05-30","2021-09-22","2019-09-25","2019-10-30","2019-07-03","2021-11-24","2019-07-03","2019-07-03","2021-08-03","2019-08-14","2021-10-26","2019-10-04","2019-09-11","2021-01-13","2021-03-19","2019-10-04","2020-01-24","2019-10-04","2019-10-04","2021-11-24","2021-11-03","2019-10-18","2020-01-24","2020-12-24","2019-12-04","2021-11-03","2021-06-11","2021-10-19","2021-10-14","2021-01-04","2020-02-13","2021-09-22","2021-07-27","2020-04-08","2020-03-11","2021-07-27","2020-03-17","2020-03-17","2020-05-04","2020-05-04","2020-05-05","2020-12-10","2020-05-04","2020-05-04","2021-10-19","2021-10-26","2021-10-17","2021-10-19","2021-10-26","2020-05-06","2020-05-06","2020-05-13","2020-05-13","2020-05-13","2021-03-10","2020-12-10","2020-10-09","2020-08-12","2020-12-24","2021-01-04","2021-03-23","2021-11-24","2021-09-22","2021-07-27","2021-09-08","2021-09-08","2021-10-14","2021-11-03","2021-10-14","2021-10-26","2021-10-26","2021-10-14","2021-10-14","2021-10-26","2021-10-26","2021-10-17","2021-11-04","2021-10-17","2021-10-17","2021-10-26","2021-11-03","2021-10-18","2021-10-19","2021-10-19","2021-10-19","2021-10-19","2021-10-26","2021-10-29","2021-10-27","2021-10-27","2021-10-26","2021-10-26","2021-10-26","2021-11-04","2021-10-26","2021-11-04","2021-10-27","2021-10-29","2021-11-24","2021-11-24"],"priorHcc":["",null,null,null,null,"",null,null,"",null,null,null,"","","","","","","",null,"","","","",null,"","","","","","","","",null,null,"","","","",null,"","","","","","","","","","","","","","","","","","","",null,"","",null,"","","","","","","","","","","","",null,"","","","","",null,"",null,null,"","",null,null,null,null,"","",null,null,"","","","","","",null,null,null,null,null,null,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":[["","68645014059","FAMOTIDINE","20MG","60","Select","Select",""],["","16571041210","CIPROFLOXACN","500MG","14","Select","Select",""],["","00169406013","VICTOZA","18MG\/3ML","9","Select","Select",""],["","68382004101","PROMETHAZINE","25MG","30","Select","Select",""],["","00591299239","PHENADOZ","25MG","10","Select","Select",""],["","16571020150","DICLOFENAC","75MG DR","30","Select","Select",""],["","99073012050","FREESTYLE TES","","50","Select","Select",""],["","45802065078","LORATADINE","10MG","90","Select","Select",""],["","72205000490","ROSUVASTATIN","20MG","30","Select","Select",""],["","62332002431","FLUOXETINE","40MG","30","Select","Select",""],["","00781286810","OMEPRAZOLE","20MG","30","Select","Select",""],["","31722070090","LOSARTAN","25MG","30","Select","Select",""],["","29300022019","MONTELUKAST","10MG","30","Select","Select",""],["","42806071401","BENZONATATE","100MG","30","Select","Select",""],["","00781261305","AMOXICILLIN","500MG","30","Select","Select",""],["","59267100001","PFIZER","COVID-19","0.3","Select","Select",""],["","00093081001","NORTRIPTYLIN","10MG","60","Select","Select",""],["","08290320550","BD PEN NEEDL","32GX5\/32","100","Select","Select",""],["","65862070060","CEFUROXIME","500MG","20","Select","Select",""],["","59746017310","PREDNISONE","10MG","20","Select","Select",""],["","29300011516","TOPIRAMATE","25MG","180","Select","Select",""],["","45963014205","BUPROPN","300MG XL","30","Select","Select",""],["","70069000510","CYANOCOBALAM","1000MCG","4","Select","Select",""],["","16729013616","CLONAZEPAM","0.5MG","20","Select","Select",""],["","67877021905","CEPHALEXIN","500MG","21","Select","Select",""],["","64380073706","VITAMIN","50000UNT","4","Select","Select",""],["","65162022621","YUVAFEM","10MCG","30","Select","Select",""],["","00046087221","PREMARIN","0.625MG","30","Select","Select",""],["","49035061265","ALLERGY","10MG","30","Select","Select",""],["","66993001968","ALBUTEROL","HFA","18","Select","Select",""],["","68645014059","FAMOTIDINE ","TAB 20MG","60","Select","Select",""],["","16571041210","CIPROFLOXACN ","TAB 500MG","14","Select","Select",""],["","00169406013","VICTOZA ","INJ 18MG\/3ML","9","Select","Select",""],["","68382004101","PROMETHAZINE ","TAB 25MG","30","Select","Select",""],["","00591299239","PHENADOZ ","SUP 25MG","10","Select","Select",""],["","16571020150","DICLOFENAC ","TAB 75MG DR","30","Select","Select",""],["","99073012050","FREESTYLE    TES","TES ","50","Select","Select",""],["","45802065078","LORATADINE ","TAB 10MG","90","Select","Select",""],["","72205000490","ROSUVASTATIN ","TAB 20MG","30","Select","Select",""],["","62332002431","FLUOXETINE ","CAP 40MG","30","Select","Select",""],["","00781286810","OMEPRAZOLE ","CAP 20MG","30","Select","Select",""],["","31722070090","LOSARTAN ","TAB 25MG","30","Select","Select",""],["","49035061246","ALLERGY ","TAB 10MG","34","Select","Select",""],["","29300022019","MONTELUKAST ","TAB 10MG","30","Select","Select",""],["","42806071401","BENZONATATE ","CAP 100MG","30","Select","Select",""],["","00781261305","AMOXICILLIN ","CAP 500MG","30","Select","Select",""],["","59267100001","PFIZER ","INJ COVID-19","0.3","Select","Select",""],["","00093081001","NORTRIPTYLIN ","CAP 10MG","60","Select","Select",""],["","00093083201","CLONAZEPAM ","TAB 0.5MG","20","Select","Select",""],["","70069000510","CYANOCOBALAM ","INJ 1000MCG","1","Select","Select",""],["","08290320550","BD  PEN NEEDL","MIS 32GX5\/32","100","Select","Select",""],["","65862070060","CEFUROXIME ","TAB 500MG","20","Select","Select",""],["","59746017310","PREDNISONE ","TAB 10MG","20","Select","Select",""],["","29300011516","TOPIRAMATE ","TAB 25MG","180","Select","Select",""],["","45963014205","BUPROPN ","TAB 300MG XL","30","Select","Select",""],["","68382013201","TAMSULOSIN ","CAP 0.4MG","7","Select","Select",""],["","65162068210","PHENAZOPYRID ","TAB 200MG","6","Select","Select",""],["","10702020101","OXYBUTYNIN ","TAB 5MG","14","Select","Select",""],["","68645056259","IBUPROFEN ","TAB 600MG","21","Select","Select",""],["","57664037713","TRAMADOL ","TAB 50MG","25","Select","Select",""],["","17478007035","ERYTHROMYCIN ","OIN 5MG\/GM","3.5","Select","Select",""],["","67877021905","CEPHALEXIN ","CAP 500MG","21","Select","Select",""],["","64380073706","VITAMIN ","CAP 50000UNT","4","Select","Select",""],["","65162022621","YUVAFEM ","TAB 10MCG","30","Select","Select",""],["","00046087221","PREMARIN ","CRE 0.625MG","30","Select","Select",""],["","66993001968","ALBUTEROL ","AER HFA","18","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":""}]}]}