{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"  REFINNEJRETRAC M ","gend":1,"add":"SREFFEJ 72TEERTS NO","city":"VERONA","state":"VA","zip":"24482-2526","dob":"1977-05-03","age":"","mstatus":"","insh":"50019421","cliId":"","pno":"4204501948","cno":"","email":"","ename":"","eno":"","pphy":"LAGRUA, JAMES C","ppno":5402483413,"pcpadd":"1371 LEE HIGHWAY, ","pcpcity":"VERONA","pcpstate":"VA","pcpzip":244820001,"pcpcounty":"","pcpid":"","pcpname":"CARILION FAMILY MEDICINE FORT DEFIANCE","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"","add3":"","madd1":"27 JEFFERSON STREET","madd2":"","madd3":"","mcity":"VERONA","mstate":"VA","mzip":"24482-2526","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G40.909","E03.9","E78.5","G40.209","Z30.09","N92.1","S06.9X0A","X58.XXXA","Z98.2","G93.1","Z00.01","S06.890A","E23.0","E78.49","S09.92XA","S00.31XA","S06.9X0S","X58.XXXS","Z12.39","Z79.890","Z53.9","Z20.822","E78.00","Z45.41","F72","B37.0","D64.9","N20.0","N39.0","R32","J44.9","N28.1","R53.1","N30.00","K68.11","A40.9","D62","N15.1","K68.19","E44.1","E88.09","I31.3","I69.398","N13.5","R59.1","A41.9","D72.829","R00.0","Z86.73","F79","Z87.820","R50.9","R91.8","J96.21","R93.5","R59.0","B96.4","Z78.1","R19.09","I63.9","N28.9","K65.1","R18.8","N10","B95.4","R94.31","B95.2","Z86.79","R41.0","R45.1","Z93.6","Z79.2","A49.9","Z79.899","J90","A49.8","D50.0","E46","I63.411","Z43.6","I63.511","R21","N12","D61.9","M25.561","T14.90XA","S83.91XA","S89.91XA","R41.82","M25.461","Y93.01","F03.90","K21.9","M79.604","M79.661","Z03.89","R29.898","N11.8","G40.802","I10","G89.29","K59.09","F50.89","R56.9","S09.90XA","G40.409","Z01.810","Z13.9","K05.6","K06.9","K02.9","Z68.33","Z51.81","S06.2X9A"],"date":["2022-01-27","2022-02-09","2021-11-16","2021-10-12","2021-06-29","2020-07-28","2020-09-24","2022-01-27","2020-09-30","2022-01-27","2020-12-30","2020-12-30","2020-12-30","2020-12-30","2021-05-08","2021-05-08","2021-09-08","2021-09-08","2021-09-08","2022-02-09","2021-09-08","2021-11-13","2022-01-27","2021-10-06","2021-12-07","2021-10-29","2021-11-14","2022-02-23","2021-11-14","2021-11-13","2021-11-13","2021-11-23","2021-11-13","2021-11-13","2021-11-13","2021-11-14","2021-12-29","2022-01-27","2021-11-24","2021-11-14","2021-11-14","2021-12-30","2021-11-14","2021-11-14","2021-11-14","2021-12-29","2021-11-15","2021-11-23","2021-12-01","2021-12-08","2021-12-22","2021-11-15","2021-11-15","2021-11-15","2021-11-17","2021-11-23","2021-12-15","2021-11-17","2021-11-18","2021-12-22","2021-11-18","2021-11-18","2021-12-13","2021-12-15","2021-11-23","2021-11-23","2021-11-24","2021-12-22","2021-11-29","2021-11-29","2021-12-02","2022-01-03","2021-12-08","2022-01-03","2021-12-08","2022-01-03","2021-12-15","2021-12-15","2021-12-15","2021-12-16","2021-12-29","2021-12-29","2022-01-02","2022-01-27","2022-02-28","2022-01-27","2022-01-27","2022-01-27","2022-01-27","2022-01-27","2022-01-27","2022-01-27","2022-02-09","2022-02-09","2022-02-09","2022-02-09","2022-02-09","2022-02-23","2019-02-07","2019-02-07","2019-02-07","2019-02-07","2019-05-29","2019-02-08","2019-02-07","2019-02-08","2019-05-06","2019-05-06","2019-05-29","2019-05-29","2019-05-29","2019-05-29","2019-10-07","2019-10-07"],"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":[["","68180096803","LEVOTHYROXIN","TAB 88MCG","31","Select","Select",""],["","31722053705","LEVETIRACETA","TAB 500MG","62","Select","Select",""],["","69097082112","GEMFIBROZIL","TAB 600MG","62","Select","Select",""],["","67877022410","GABAPENTIN","CAP 400MG","62","Select","Select",""],["","60505257908","ATORVASTATIN","TAB 20MG","28","Select","Select",""],["","40985027495","CALCIUM+D3","TAB 315-250","62","Select","Select",""],["","00904699880","DOCUSATE","CAP 100MG","56","Select","Select",""],["","29300012510","MELOXICAM","TAB 15MG","21.00","Select","Select",""],["","67877024810","QUETIAPINE","TAB 400MG","56","Select","Select",""],["","64380080308","RANITIDINE","TAB 150MG","30","Select","Select",""],["","00904645780","DOK","CAP 100MG","62","Select","Select",""],["","37864073406","CA","TAB 315\/250","62","Select","Select",""],["","00904673080","ACETAMIN","TAB 500MG","30","Select","Select",""],["","00904672580","SENNA","TAB 8.6MG","60","Select","Select",""],["","59762453701","MEDROXYPR","INJ 150MG\/ML","1","Select","Select",""],["","57896045401","GERI-KOT","TAB 8.6MG","60","Select","Select",""],["","68682065220","DIAZEPAM","GEL 10MG","1","Select","Select",""],["","61442010201","DICLOFENAC","TAB 50MG DR","30","Select","Select",""],["","40985021501","CALCIUM","TAB ","60","Select","Select",""],["","57664037718","TRAMADOL","TAB 50MG","30.00","Select","Select",""],["","57237023305","SMZ-TMP","TAB 800-160","14.00","Select","Select",""],["","00527512170","NYSTATIN","SUS 100000","120","Select","Select",""],["","57237000511","FLUCONAZOLE","TAB 150MG","3","Select","Select",""],["","00904527260","CALCITRATE","TAB ","62","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","6","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","28","Select","Select",""],["","33332031901","AFLURIA","INJ 2019-20","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":""}]}]}