{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ENILEUQCAJATLAREP R ","gend":1,"add":"RAP   1031EUNEVA  K","city":"LYNCHBURG","state":"VA","zip":24501,"dob":"1970-08-25","age":"","mstatus":"","insh":"12016729","cliId":"","pno":"9512369294","cno":"","email":"","ename":"","eno":"","pphy":"ISAACS, ROSS B","ppno":3215949296,"pcpadd":"800 5TH ST,MARTIN LUTHER KING JR BLVD","pcpcity":"LYNCHBURG","pcpstate":"VA","pcpzip":24504,"pcpcounty":"","pcpid":"","pcpname":"COMMUNITY ACCESS NETWORK INC","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"WESTERN\/CHARLOTTESVILLE","aligned":"","ano":"","add2":"APT 103","add3":"","madd1":"1301 PARK AVENUE","madd2":"APT 103","madd3":"","mcity":"LYNCHBURG","mstate":"VA","mzip":"24501-1885","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G81.91","R27.0","R27.8","G40.89","R47.1","R41.841","I10","D32.9","Z09","R00.0","D72.829","E11.42","E78.2","M79.605","R68.89","M62.81","R26.2","B37.9","K21.9","F39","K59.04","E66.01","Z68.42","E11.9","G47.8","K46.9","R22.0","D32.0","R51","G40.109","M54.2","Z71.3","E11.8","I97.3","F51.01","E55.9","M79.604","M48.061","R56.9","F31.9","F41.1","F50.89","M79.651","M54.16","N92.1","M47.816","M51.36","M54.5","Z11.59","K21.0","K29.50","K31.7","K22.8","R01.1","E11.40","Z79.4","M79.7","F32.9","Z82.49","Z83.3","N30.01","N92.0","G89.29","R53.83","Z13.220","Z13.228","Z11.4","Z86.018","M43.19","M51.37","M46.87","M48.062","Z01.818","R52","Z20.828","J02.9","J06.9","D72.828","G47.33","H11.32","Z79.899","R39.9","R81","I72.9","R20.0","R47.81","I50.9","R60.0","Z82.3","Z01.810","G47.9","I72.0","F31.32","Z63.8","R74.8","Z91.09","R51.9","K76.0","R07.9","I11.0","E78.5","R94.39","I67.1","Z20.822","Z68.43","F31.4","M79.18","Z79.82","Z91.041","I51.7","R79.89","R05","Z12.31","Z23","R29.810","R30.0","B37.3","L30.9","H57.12","H04.123","H54.7","Q15.9","R23.9","N95.9","Z12.4","Z11.51","K42.9","R93.41","R59.9","K43.2","M54.42","M54.41","R40.4","R91.8","I31.3","R06.02","I16.1","I21.A1","J96.02","J96.01","R65.10","I50.31","E11.21","E87.2","E11.65","R19.7","J80","R06.9","R09.02","J81.0","J96.90","J98.4","Z46.82","G62.9","G40.909","I25.10","R06.03","E11.22","N18.9","R80.9","D63.1","N18.31","I25.2","E21.3","R60.1","R77.9","R53.1","R11.0","R11.11","R53.81","R11.2","R10.9","R93.5","K43.9","K52.9","N32.81","R94.8","R10.84","B16.9","R94.5","D73.89","R93.2","N88.8","L98.9"],"date":["2020-05-14","2020-04-16","2020-04-16","2021-09-01","2020-06-02","2020-06-02","2022-03-16","2022-03-16","2021-09-14","2021-09-20","2020-01-08","2022-03-16","2021-10-20","2020-01-24","2020-06-04","2020-05-14","2020-05-14","2021-03-24","2022-03-16","2020-04-15","2020-02-06","2022-03-11","2021-08-22","2022-03-11","2020-08-21","2021-06-24","2021-08-22","2021-09-14","2020-09-11","2020-03-19","2020-03-27","2022-03-11","2020-09-01","2020-07-14","2021-02-08","2022-03-16","2020-04-15","2021-02-08","2021-07-14","2021-10-26","2022-03-16","2020-04-30","2020-05-08","2021-02-24","2021-06-24","2021-02-24","2021-02-24","2020-07-28","2020-07-15","2020-06-24","2020-06-24","2020-06-24","2020-06-24","2020-06-24","2020-08-25","2021-09-01","2020-08-25","2021-08-22","2020-11-12","2020-06-24","2020-07-02","2020-07-02","2021-08-16","2021-11-02","2020-07-15","2020-07-15","2020-07-15","2021-05-20","2020-07-27","2020-07-27","2020-07-27","2021-02-24","2020-09-01","2020-08-05","2020-08-05","2020-08-05","2020-08-05","2020-08-14","2022-01-26","2020-08-25","2021-09-20","2020-09-01","2020-09-01","2021-08-23","2020-09-11","2021-07-14","2021-01-22","2021-01-18","2021-01-22","2021-01-18","2021-01-22","2021-09-01","2022-03-16","2021-11-08","2022-03-16","2022-03-16","2021-07-14","2021-11-16","2021-03-02","2021-08-22","2022-03-16","2021-01-29","2021-10-15","2021-08-22","2022-03-11","2021-03-30","2021-03-02","2021-03-02","2021-08-22","2021-08-22","2021-03-24","2021-04-03","2021-04-15","2022-02-17","2021-07-14","2021-05-03","2021-05-03","2021-05-03","2021-05-20","2021-05-20","2021-05-19","2021-06-14","2021-06-14","2021-06-24","2021-06-24","2021-06-24","2021-09-20","2021-07-20","2021-07-20","2021-07-29","2022-03-16","2021-08-16","2021-08-22","2021-08-23","2021-08-22","2021-08-22","2021-08-25","2021-09-01","2021-08-22","2021-08-25","2021-08-25","2021-08-22","2021-08-22","2021-08-22","2022-02-21","2021-08-22","2021-08-22","2021-08-22","2021-08-22","2021-08-25","2021-08-23","2021-08-22","2021-08-22","2021-08-23","2021-08-23","2022-01-26","2021-08-23","2021-08-26","2021-08-26","2021-08-26","2021-08-31","2021-08-31","2021-09-14","2022-03-16","2021-09-14","2021-09-14","2021-09-14","2021-09-20","2021-09-20","2021-09-20","2021-09-20","2021-09-20","2021-09-20","2021-09-20","2021-09-29","2021-09-29","2021-11-16","2021-11-02","2021-11-02","2021-11-10","2021-11-16","2021-11-16","2021-11-16","2022-02-09"],"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":{"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":[["","57599080000","FREESTY","57599080000 FREESTY ","2","Select","Select",""],["","00088221905","LANTUS","00088221905 LANTUS ","15","Select","Select",""],["","57237001930","DULOXETINE","57237001930 DULOXETINE ","60","Select","Select",""],["","73070010315","INSULIN","73070010315 INSULIN ","15","Select","Select",""],["","52817036100","METOPROL","52817036100 METOPROL ","60","Select","Select",""],["","16714035502","LEVETIRACETA","16714035502 LEVETIRACETA ","60","Select","Select",""],["","00193731150","CONTOUR","TES NEXT","50.00","Select","Select",""],["","70954000520","OXYBUTYNIN","70954000520 OXYBUTYNIN ","60","Select","Select",""],["","68645051054","HYDROCHLOROT","68645051054 HYDROCHLOROT ","30","Select","Select",""],["","64380073706","VITAMIN","CAP 50000UNT","1","Select","Select",""],["","29300011516","TOPIRAMATE","29300011516 TOPIRAMATE ","90","Select","Select",""],["","00555077902","MEDROXYPR","TAB 10MG","60","Select","Select",""],["","16714048501","DIVALPROEX","16714048501 DIVALPROEX ","30","Select","Select",""],["","50458014130","INVOKANA","50458014130 INVOKANA ","90","Select","Select",""],["","00169633910","NOVOLOG","INJ FLEXPEN","15","Select","Select",""],["","43547040111","FUROSEMIDE","43547040111 FUROSEMIDE ","90","Select","Select",""],["","75834011001","CHLORTHALID","75834011001 CHLORTHALID ","30","Select","Select",""],["","65862019105","CYCLOBENZAPR","65862019105 CYCLOBENZAPR ","60","Select","Select",""],["","68180051703","LISINOPRIL","68180051703 LISINOPRIL ","30","Select","Select",""],["","00093505698","ATORVASTATIN","00093505698 ATORVASTATIN ","30","Select","Select",""],["","68180044501","QUETIAPINE","TAB 25MG","60","Select","Select",""],["","31722052101","HYDRALAZINE","31722052101 HYDRALAZINE ","90","Select","Select",""],["","16714012303","OMEPRAZOLE","16714012303 OMEPRAZOLE ","30","Select","Select",""],["","63402030430","LATUDA","63402030430 LATUDA ","30","Select","Select",""],["","68645051654","AMLODIPINE","68645051654 AMLODIPINE ","90","Select","Select",""],["","45802005911","NYSTATIN","45802005911 NYSTATIN ","30","Select","Select",""],["","70710113803","FLUCONAZOLE","70710113803 FLUCONAZOLE ","5","Select","Select",""],["","00172392570","DIAZEPAM","00172392570 DIAZEPAM ","2","Select","Select",""],["","50228017801","GABAPENTIN","50228017801 GABAPENTIN ","90","Select","Select",""],["","57896040110","DOCUSATE","CAP 100MG","30","Select","Select",""],["","00781261305","AMOXICILLIN","00781261305 AMOXICILLIN ","20","Select","Select",""],["","65862044930","VALACYCLOVIR","65862044930 VALACYCLOVIR ","21","Select","Select",""],["","57599000101","FREESTYLE    KIT SENSOR","57599000101 FREESTYLE    KIT SENSOR","2","Select","Select",""],["","68382004101","PROMETHAZINE","68382004101 PROMETHAZINE ","10","Select","Select",""],["","68462015713","ONDANSETRON","68462015713 ONDANSETRON ","10","Select","Select",""],["","00169406012","VICTOZA","INJ 18MG\/3ML","6.00","Select","Select",""],["","57599000021","FREESTYLE    MIS READER","57599000021 FREESTYLE    MIS READER","1","Select","Select",""],["","00904645780","DOK","CAP 100MG","30","Select","Select",""],["","49281042150","FLUZONE","49281042150 FLUZONE ","0.5","Select","Select",""],["","67877041401","METFORMIN","TAB 750MG ER","45.00","Select","Select",""],["","00406012301","HYDROCO\/APAP","TAB 5-325MG","21","Select","Select",""],["","81131038681","RELION","81131038681 RELION ","100","Select","Select",""],["","08290320109","BD  PEN NEEDL","08290320109 BD  PEN NEEDL","100","Select","Select",""],["","51293081101","PHENAZOPYRID","TAB 200MG","9","Select","Select",""],["","65162047810","NITROFURANTN","CAP 100MG","10","Select","Select",""],["","00169280015","SAXENDA","INJ 18MG\/3ML","15.00","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":{"indx":[["","",""],[""],[""],[""],[""]],"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":""}]}]}