{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"GEORGE MORTON JR","gend":0,"add":"92 HIGH MOUNTAIN ACRES LANE","city":"PALMYRA                       ","state":"VA","zip":"22963-5380","dob":"1975-09-21","age":"","mstatus":"","insh":3244242,"cliId":"","pno":4342705045,"cno":"","email":"","ename":"","eno":"","pphy":"LANFORD, RANDOLPH E","ppno":4348423244,"pcpadd":"4064 JAMES MADISON HWY,","pcpcity":"FORK UNION                    ","pcpstate":"VA","pcpzip":230550001,"pcpcounty":"","pcpid":"","pcpname":"FORK UNION MEDICAL ASSOCIATES INC","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"92 HIGH MOUNTAIN ACRES LANE","add3":"","madd1":"92 HIGH MOUNTAIN ACRES LANE","madd2":"","madd3":"","mcity":"PALMYRA                       ","mstate":"VA","mzip":"22963-5380","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I50.22","E78.5","N18.2","I42.8","N18.3","Z87.39","Z95.810","M62.82","S62.640A","S62.640B","S61.212A","S61.210A","R20.0","W23.0XXA","N18.5","Z99.2","N52.2","R39.12","N52.1","G47.30","J30.9","M10.9","E55.9","I11.0","I50.9","E78.00","K59.00","E66.1","Z68.36","J01.90","B96.89","Z23","K04.7","Z00.00","E11.9","I10","N18.31","Z12.5"],"date":["2021-12-17","2021-10-15","2020-07-02","2021-08-26","2020-01-22","2020-01-22","2021-12-15","2020-02-12","2020-03-13","2020-03-12","2020-03-12","2020-03-12","2020-03-12","2020-03-12","2020-03-12","2020-03-12","2021-10-15","2020-10-17","2020-10-17","2020-10-17","2020-10-17","2020-10-17","2020-10-17","2020-10-17","2020-10-17","2020-10-17","2020-10-17","2020-10-17","2020-10-17","2020-10-19","2020-10-19","2021-10-15","2021-10-06","2021-10-15","2021-10-15","2021-10-15","2021-10-15","2021-10-15"],"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":[["","40985027292","VITAMIN","TAB 1000UNIT","30","Select","Select",""],["","59762171002","EPLERENONE","TAB 25MG","30","Select","Select",""],["","68180051201","LISINOPRIL","TAB 2.5MG","30","Select","Select",""],["","27808015701","ROSUVASTATIN","TAB 20MG","30","Select","Select",""],["","00143124001","DIGOXIN","TAB 0.125MG","90","Select","Select",""],["","68382009505","CARVEDILOL","TAB 25MG","60","Select","Select",""],["","00054429931","FUROSEMIDE","TAB 40MG","60","Select","Select",""],["","55111072910","ALLOPURINOL","TAB 100MG","45","Select","Select",""],["","00378668910","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","00078065920","ENTRESTO","TAB 24-26MG","60","Select","Select",""],["","00093015001","APAP\/CODEINE","TAB 300-30MG","30","Select","Select",""],["","66685100100","AMOX\/K","TAB 875-125","14","Select","Select",""],["","65862001401","AMOXICILLIN","TAB 500MG","21","Select","Select",""],["","49483060450","IBUPROFEN","TAB 800MG","20","Select","Select",""],["","00904672040","ACETAMIN","TAB 500MG","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":""}]}]}