{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SECNARFPPETS ","gend":1,"add":"GNINROM 877NRUT YROLG ","city":"RUCKERSVILLE","state":"VA","zip":"22968-9998","dob":"1956-11-29","age":"","mstatus":"","insh":"6320210*03","cliId":"","pno":"42\/4345457-9","cno":"","email":"","ename":"","eno":"","pphy":"CORBETT, MICHAEL PA","ppno":"757\/222-0300","pcpadd":"SUITE 450 2901 SOUTH LYNNHAVEN ROAD","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":"23452","pcpcounty":"","pcpid":"","pcpname":"LEGACY CARE LLC","plan":"OHP","program":"ACA","lob":"Individual","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["A49.1","N30.01","N17.9","T14.8XXA","I89.0","E86.0","R26.89","R73.9","Z16.21","R62.7","E13.622","J18.9","I10.","F32.0","M62.81","I11.0","I50.9","R09.02","S81.801A","S81.802A","Z87.891","Z20.822","L03.119","E11.621","A41.9","F41.9","L89.319","R60.1","I33.0","R78.81","B95.62","L03.90","E11.59","J96.11","E44.1","E44.0","E11.40","L89.102","R65.20","L89.152","Z60.2","N17.0","F32.9","E04.2","L03.116","D72.829","E87.2","R00.0","R91.8","R07.9","L03.115","N39.0","R53.1","J43.9","Z74.3","L97.513","Z91.19","N18.30","E87.5","N18.32","N06.8","D63.1","A41.59","J96.21","Z66.","L89.323","S30.810A","L22.","L30.4","L89.322","R53.81","Z74.01","I83.012","I83.018","Z74.09","E66.01","D65.","I50.23","E43.","I21.A1","R65.21","I13.0","N18.4","A04.72","I70.263","G93.40","E66.9","Z68.34","N13.30","I50.33","L97.519","L97.819","I50.30","E11.22","E11.42","E03.9","E11.65","D64.9","L89.90","A49.8","L89.159","I50.22","D69.6","R62.51","M14.671","B95.2","J96.01","J69.0","L30.9","E87.1","E11.628","E78.5","N20.1","Z87.440","A28.0","H26.9","S81.809A","R79.89","L97.415","Z68.38","S91.301D","R06.02","R45.89","Z71.89","Z51.5","R26.2","J98.6","R50.9","L08.89","I96.","Z97.8","I50.32","Z79.4","R60.9","D63.8","J18.8","I35.0","E55.9","Z68.36","Z88.8","Z88.2","I50.21","R17.","Z16.23","B96.5","L97.419","E11.622"],"date":["2021-01-05","2021-01-23","2021-09-27","2021-01-05","2021-09-26","2021-01-05","2021-01-05","2021-01-05","2021-01-23","2021-10-04","2021-01-13","2021-01-13","2021-08-05","2021-01-13","2021-01-13","2021-06-15","2021-10-05","2021-09-30","2021-08-05","2021-08-05","2021-09-27","2021-09-27","2021-09-01","2021-09-26","2021-09-01","2021-09-26","2021-08-05","2021-09-27","2021-08-08","2021-09-30","2021-09-01","2021-08-26","2021-09-01","2021-09-01","2021-09-01","2021-09-01","2021-09-01","2021-09-01","2021-09-01","2021-09-01","2021-09-01","2021-09-28","2021-09-01","2021-09-01","2021-09-26","2021-01-27","2021-08-06","2021-01-23","2021-01-23","2021-01-23","2021-08-06","2021-08-05","2021-06-21","2021-01-23","2021-01-23","2021-02-08","2021-02-08","2021-04-28","2021-06-16","2021-06-16","2021-06-16","2021-06-16","2021-09-27","2021-09-27","2021-09-27","2021-09-27","2021-07-19","2021-07-19","2021-07-19","2021-07-19","2021-08-20","2021-08-20","2021-09-27","2021-09-27","2021-09-27","2021-09-27","2021-10-05","2021-09-27","2021-09-27","2021-09-27","2021-09-27","2021-09-27","2021-09-27","2021-09-27","2021-09-27","2021-09-27","2021-09-27","2021-09-27","2021-01-06","2021-09-05","2021-07-01","2021-04-28","2021-04-28","2021-09-27","2021-07-19","2021-04-28","2021-07-01","2021-08-05","2021-08-13","2021-08-13","2021-08-13","2021-09-27","2021-09-30","2021-01-06","2021-01-19","2021-01-19","2021-01-19","2021-01-19","2021-01-19","2021-06-15","2021-01-23","2021-06-15","2021-03-15","2021-03-15","2021-06-15","2021-06-15","2021-06-15","2021-06-15","2021-07-19","2021-07-19","2021-07-19","2021-09-29","2021-10-04","2021-10-04","2021-10-04","2021-01-09","2021-06-15","2021-06-15","2021-07-01","2021-07-01","2021-07-01","2021-07-01","2021-07-01","2021-08-05","2021-01-09","2021-01-09","2021-08-06","2021-01-09","2021-01-09","2021-01-09","2021-01-09","2021-08-06","2021-08-05","2021-08-05","2021-08-05","2021-07-19","2021-07-19"],"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":[["","31722070210","LOSARTAN","TAB 100MG","90","Select","Select",""],["","50742061710","METOPROL","TAB 100MG ER","90","Select","Select",""],["","65862052899","VENLAFAXINE","CAP 75MG ER","90","Select","Select",""],["","69238183607","LEVOTHYROXIN","TAB 125MCG","90","Select","Select",""],["","00169185550","NOVOFINE","MIS 32GX4MM","-100","Select","Select",""],["","00169633910","NOVOLOG","INJ FLEXPEN","-15","Select","Select",""],["","66733082259","INSULIN","INJ 100\/ML","15","Select","Select",""],["","57599000101","FREESTYLE    KIT SENSOR","KIT SENSOR","6","Select","Select",""],["","00088221905","LANTUS","INJ 100\/ML","60","Select","Select",""],["","00002879959","HUMALOG","INJ 100\/ML","15","Select","Select",""],["","68462019690","PRAVASTATIN","TAB 20MG","-30","Select","Select",""],["","69097012815","AMLODIPINE","TAB 10MG","90","Select","Select",""],["","00054429931","FUROSEMIDE","TAB 40MG","180","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","-40","Select","Select",""],["","59746017310","PREDNISONE","TAB 10MG","63","Select","Select",""],["","67877041920","LINEZOLID","TAB 600MG","4","Select","Select",""],["","00168000480","TRIAMCINOLON","CRE 0.001","80","Select","Select",""],["","65862085901","FAMOTIDINE","TAB 20MG","30","Select","Select",""],["","16714045201","QUETIAPINE","TAB 25MG","10","Select","Select",""],["","00904679489","ASPIRIN","CHW 81MG","90","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":""}]}]}