{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LLESSURYESSUH ","gend":0,"add":" EGROEG 6921DAOR SNOTLAW","city":"MOUNT SOLON","state":"VA","zip":"22843-2400","dob":"1967-07-04","age":"","mstatus":"","insh":"0844050","cliId":"","pno":"3404561610","cno":"","email":"","ename":"","eno":"","pphy":"GREENBERG, TIFFANY","ppno":"","pcpadd":"2927 STUARTS DRAFT HWY STE 101,","pcpcity":"Stuarts Draft","pcpstate":"VA","pcpzip":"24477-2796","pcpcounty":"","pcpid":"","pcpname":"AUGUSTA HEALTH FAMILY PRACTICE STUARTS DRAFT","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"1296 GEORGE WALTONS ROAD","add3":"","madd1":"1296 GEORGE WALTONS ROAD","madd2":"","madd3":"","mcity":"MOUNT SOLON","mstate":"VA","mzip":"22843-2400","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I20.9","R07.9","I24.9","E03.9","I10","I50.32","I25.110","E78.5","E11.9","I11.0","Z95.5","Z79.02","Z79.82","Z79.890","Z88.1","Z88.0","I25.119","Z82.49","I25.10","T82.855A","T82.897A","K21.9","E66.9","R11.0","R00.1","Z20.822","Z03.818","I20.0","I21.4","I25.83","N20.0","I50.22","R10.31","R10.11","I50.9","Z87.442","Z90.49","Z79.899","R60.0","R09.89","Z01.810","I49.3","R94.39","E03.8","Z83.49","T14.8XXA","W57.XXXA","I69.351","I11.9","G89.29","I69.398","H53.9","I25.2","Z68.36","T82.855D","Z87.891","Z86.73","I51.7","R93.89","Z68.35","Z72.89","I34.0","E78.00","R03.0","Z88.8","E78.2","Z18.32","R06.09","E11.65","R59.0","H10.45","F43.23","D36.0","I50.30","F19.11","J22","R06.02","R05.9","U07.1","J12.82","R09.81","R06.00","R94.2","R05.1","R20.2","R60.9","Z98.61","I25.84","I27.20","G47.33","Z86.16","M79.601","M79.602","M47.817","M54.16","M51.36","M48.061","M51.16","M75.51","S30.1XXA","D72.829","W22.8XXA","Y93.89","R10.32","Y92.59","S39.91XA","M75.52","I16.0","E87.6","I49.5","I45.5","R51.9","M54.9","I25.9","R07.89","M54.6","Z95.0","R55","M79.662","R42","Z79.84","Z00.00","I95.9","Z12.11","Z12.5","Z11.3","N17.9","Z45.018","R00.2","R25.2","Z76.0","Z68.37","Z87.19","J01.90","R22.33","S80.12XA","M79.89","S89.92XA","J06.9","I16.1","J18.9","Y83.1","E66.01","D64.9","R73.9","I37.1","E87.1","I25.118","I50.33","I49.1","R94.31","Z13.31","G47.09","Z91.89","R06.2","D86.2","C85.28","Z68.33"],"date":["2022-09-21","2023-04-19","2021-01-22","2023-04-21","2023-04-21","2023-04-21","2021-07-07","2023-04-21","2023-04-21","2023-04-01","2023-04-21","2023-03-14","2023-03-14","2023-04-01","2023-04-01","2023-02-05","2022-12-05","2023-04-04","2023-04-21","2021-01-21","2023-04-01","2022-09-15","2023-04-21","2023-01-27","2023-04-19","2022-09-21","2022-02-02","2021-02-11","2022-06-16","2021-02-12","2021-02-24","2021-02-24","2021-05-04","2021-05-03","2022-12-04","2021-05-03","2021-05-03","2023-04-01","2022-02-02","2021-07-04","2021-05-24","2021-05-24","2021-05-24","2023-01-02","2021-06-30","2021-06-30","2021-06-30","2021-07-04","2021-07-04","2022-09-20","2021-07-04","2021-07-04","2023-04-17","2021-07-04","2021-07-07","2021-07-07","2021-07-07","2021-07-04","2021-07-04","2022-02-11","2021-07-07","2021-07-05","2022-09-14","2021-12-29","2023-03-14","2023-04-17","2021-08-23","2023-04-21","2023-04-01","2023-01-12","2021-11-01","2022-08-29","2021-11-11","2023-04-02","2021-11-11","2021-11-28","2022-02-02","2023-03-14","2021-12-02","2021-12-02","2021-12-02","2023-04-17","2021-12-27","2021-12-29","2022-02-02","2022-02-02","2023-04-03","2023-04-17","2022-02-11","2022-12-05","2022-12-05","2022-02-15","2022-02-15","2022-03-02","2022-12-05","2022-03-21","2022-04-07","2022-04-07","2022-12-05","2022-07-14","2022-07-14","2023-02-05","2022-07-14","2022-07-14","2022-07-14","2022-07-14","2022-12-05","2022-09-20","2023-04-04","2022-09-20","2022-09-15","2022-09-15","2022-09-15","2022-09-14","2023-04-21","2022-09-19","2023-04-21","2022-09-21","2023-02-05","2022-09-21","2023-03-14","2022-09-21","2022-09-23","2022-09-21","2022-09-21","2022-09-21","2022-09-23","2023-02-23","2022-11-01","2023-01-02","2022-11-03","2022-12-05","2022-12-05","2023-01-07","2023-01-27","2023-02-05","2023-02-05","2023-02-05","2023-03-29","2023-03-14","2023-03-14","2023-04-01","2023-04-04","2023-04-01","2023-04-04","2023-04-02","2023-04-04","2023-04-04","2023-04-03","2023-04-07","2023-04-04","2023-04-17","2023-04-17","2023-04-17","2023-04-21","2023-04-21","2023-04-21","2023-04-21"],"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":[]},{"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":[["","23155051905","ISOSORB MONO","TAB 30MG ER","30","Select","Select",""],["","70000021802","ASPIRIN LOW","TAB 81MG EC","30","Select","Select",""],["","67877019710","AMLODIPINE","TAB 2.5MG","30","Select","Select",""],["","52817036000","METOPROL TAR","TAB 25MG","60","Select","Select",""],["","59762330403","NITROGLYCERN","SUB 0.4MG","25","Select","Select",""],["","45963067796","METOPROL SUC","TAB 100MG ER","90","Select","Select",""],["","52937000120","VASCEPA","CAP 1GM","120","Select","Select",""],["","00536252525","CAPSAICIN","CRE 0.00025","60","Select","Select",""],["","00172572880","FAMOTIDINE","TAB 20MG","60","Select","Select",""],["","68382013510","LOSARTAN POT","TAB 25MG","30","Select","Select",""],["","68382009505","CARVEDILOL","TAB 25MG","60","Select","Select",""],["","72511076002","REPATHA SURE","INJ 140MG\/ML","2","Select","Select",""],["","45963067611","METOPROLOL","TAB 50MG ER","30","Select","Select",""],["","00603533831","PREDNISONE","PAK 10MG","48","Select","Select",""],["","63304061650","DOXYCYC MONO","CAP 100MG","20","Select","Select",""],["","42806071405","BENZONATATE","CAP 100MG","30","Select","Select",""],["","60432060416","PROMETHAZINE","SYP DM","60","Select","Select",""],["","00143177101","ISOSORB DIN","TAB 10MG","60","Select","Select",""],["","65862056099","PANTOPRAZOLE","TAB 40MG","60","Select","Select",""],["","16729021816","CLOPIDOGREL","TAB 75MG","90","Select","Select",""],["","68462030201","INDOMETHACIN","CAP 50MG","45","Select","Select",""],["","62037059790","CARTIA XT","CAP 120\/24HR","30","Select","Select",""],["","00781808926","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","68180097201","LEVOTHYROXIN","TAB 137MCG","30","Select","Select",""],["","69315011710","FUROSEMIDE","TAB 40MG","90","Select","Select",""],["","27808006502","PROMETH\/COD","SOL 6.25-10","473","Select","Select",""],["","68462029301","VERAPAMIL","TAB 180MG ER","30","Select","Select",""],["","68462029855","CLOTRIM\/BETA","CRE DIPROP","45","Select","Select",""],["","60505464303","PRASUGREL","TAB 10MG","30","Select","Select",""],["","72205001390","PREGABALIN","CAP 75MG","60","Select","Select",""],["","57237001899","DULOXETINE","CAP 30MG","30","Select","Select",""],["","27808003501","HYDROCO\/APAP","TAB 5-325MG","28","Select","Select",""],["","67877031901","IBUPROFEN","TAB 400MG","16","Select","Select",""],["","00116200116","CHLORHEX GLU","SOL 0.0012","473","Select","Select",""],["","68462015713","ONDANSETRON","TAB 4MG ODT","12","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","00597015290","JARDIANCE","TAB 10MG","30","Select","Select",""],["","00078065920","ENTRESTO","TAB 24-26MG","60","Select","Select",""],["","43598071910","CHLORTHALID","TAB 25MG","30","Select","Select",""],["","00143992801","CIPROFLOXACN","TAB 500MG","10","Select","Select",""],["","23155065205","METRONIDAZOL","TAB 500MG","10","Select","Select",""],["","57664050289","TIZANIDINE","TAB 2MG","90","Select","Select",""],["","69097012215","TOPIRAMATE","TAB 25MG","60","Select","Select",""],["","00310620530","FARXIGA","TAB 5MG","30","Select","Select",""],["","50228014610","HYDROCHLOROT","CAP 12.5MG","30","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":""}]}]}