{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"M   ANITSNIKNEJ ","gend":1,"add":"AWHGIH SU 424YAWHGIH 043 Y","city":"LURAY","state":"VA","zip":"22835-4846","dob":"1962-10-14","age":"","mstatus":"","insh":"60017591","cliId":"","pno":"4704509932","cno":5407423990,"email":"","ename":"","eno":"","pphy":"JAMES G DALE","ppno":5407436558,"pcpadd":"250 Memorial Dr, Ste D","pcpcity":"Luray","pcpstate":"VA","pcpzip":228351000,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"NORTHERN\/ WINCHESTER","aligned":"","ano":"","add2":"APT G53","add3":"","madd1":"424 US HIGHWAY 340 HIGHWAY","madd2":"APT G53","madd3":"","mcity":"LURAY","mstate":"VA","mzip":"22835-4846","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I10","I48.91","I48.0","K21.9","A41.51","A41.9","R65.21","N10","D69.59","J44.9","F17.210","Z88.5","Z88.7","Z88.8","Z79.899","Z83.3","Z80.0","R65.20","D72.825","F41.9","R04.2","G89.4","Z91.19","R05","Z23","Z12.31","Z12.11","R00.2","G43.C0","H04.123","H52.4","N12","R50.9","Z79.01","M19.90","Z98.51","Z80.7","Z82.5","J43.2","J20.9","J44.1","N30.90","R16.0","Z74.3","R07.81","X50.1XXA","M51.37","M41.9","M54.31","R68.89","E78.5","R07.89","R06.02","Z20.828","Z72.0"],"date":["2020-11-27","2019-05-25","2020-11-27","2019-05-25","2019-05-25","2019-05-25","2019-05-25","2019-05-26","2019-05-25","2020-11-27","2020-11-27","2019-05-25","2019-05-25","2019-05-25","2019-05-25","2019-05-25","2019-05-25","2019-05-25","2019-05-25","2020-11-20","2020-11-27","2020-11-27","2020-11-27","2021-04-01","2019-11-05","2019-01-17","2019-01-09","2019-04-17","2019-04-08","2019-04-08","2019-04-08","2019-05-24","2020-09-24","2019-05-24","2019-05-24","2019-05-24","2019-05-24","2019-05-24","2019-11-05","2021-04-01","2021-04-01","2019-05-24","2019-05-24","2019-05-25","2019-10-21","2019-10-21","2020-08-12","2020-08-12","2020-08-12","2019-05-29","2019-01-09","2019-01-15","2019-01-15","2020-12-29","2020-06-17"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}},{"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":[["","68382002401","ATENOLOL ","TAB 100MG","30","Select","Select",""],["","64380080307","RANITIDINE ","TAB 150MG","30","Select","Select",""],["","68180072103","AMLODIPINE ","TAB 10MG","30","Select","Select",""],["","68180098103","LISINOPRIL ","TAB 20MG","30","Select","Select",""],["","55111015810","OMEPRAZOLE ","CAP 20MG","30","Select","Select",""],["","00093742698","MONTELUKAST ","TAB 10MG","30","Select","Select",""],["","70377002711","ATORVASTATIN ","TAB 10MG","30","Select","Select",""],["","00378967130","IPRATROPIUM\/ ","SOL ALBUTER","90","Select","Select",""],["","00116200116","CHLORHEX ","SOL 0.0012","473","Select","Select",""],["","00597007541","SPIRIVA ","CAP HANDIHLR","30","Select","Select",""],["","69097094312","GABAPENTIN ","CAP 300MG","90","Select","Select",""],["","00378932232","WIXELA ","AER 500\/50","60","Select","Select",""],["","57664050183","MIRTAZAPINE ","TAB 45MG","30","Select","Select",""],["","33332032001","AFLURIA ","INJ 2020-21","0.5","Select","Select",""],["","69097014260","ALBUTEROL ","AER HFA","6.7","Select","Select",""],["","00085113204","PROVENTIL ","AER HFA","6.7","Select","Select",""],["","00093310905","AMOXICILLIN ","CAP 500MG","28","Select","Select",""],["","00591565810","CYCLOBENZAPR ","TAB 10MG","30","Select","Select",""],["","65162019050","NAPROXEN ","TAB 500MG","20","Select","Select",""],["","00003089421","ELIQUIS ","TAB 5MG","60","Select","Select",""],["","68180016013","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","53489011905","DOXYCYCL ","CAP 100MG","20","Select","Select",""],["","58160082311","SHINGRIX ","INJ 50\/0.5ML","1","Select","Select",""],["","67877021620","CEFUROXIME ","TAB 500MG","12","Select","Select",""],["","00173069700","ADVAIR ","AER 500\/50","60","Select","Select",""],["","17478071130","LIDOCAINE ","GEL 2% JELLY","30","Select","Select",""],["","50458057990","XARELTO ","TAB 20MG","30","Select","Select",""],["","00378064110","PREDNISONE ","TAB 10MG","30","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":[[["No","Select","","","","","Select","",""],["No","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":""}]}]}