{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DIANA   L CAMPBELL","gend":1,"add":"444 TOMS LANE","city":"ROSELAND                      ","state":"VA","zip":"22967-3030","dob":"1973-08-14","age":"","mstatus":"","insh":4822139,"cliId":"","pno":4344731606,"cno":"","email":"","ename":"","eno":"","pphy":"BROWN, BENJAMIN T","ppno":4342634000,"pcpadd":"4038 Thomas Nelson Hwy,","pcpcity":"Arrington                     ","pcpstate":"VA","pcpzip":229222302,"pcpcounty":"","pcpid":"","pcpname":"BLUE RIDGE MEDICAL CENTER","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"444 TOMS LANE","add3":"","madd1":"444 TOMS LANE","madd2":"","madd3":"","mcity":"ROSELAND                      ","mstate":"VA","mzip":"22967-3030","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K25.7","R63.4","K22.719","Z46.59","K25.4","K92.0","E43","K31.1","Z68.1","R64","L89.151","E21.3","G89.29","R19.7","K29.70","F41.9","Z87.891","Z98.891","R10.9","R11.2","K74.60","N20.0","K25.9","K22.70","K29.50","K25.3","K76.89","R10.13","K76.9","Z71.89","I45.81","G62.89","R10.84","R52","E86.0","R00.1","Z93.1","Z87.19","Z72.0","Z46.82","E10.9","Z20.822","K94.23","Y83.3","E87.6","K70.9","J45.909","F10.11","R09.02","R00.0","T85.528A","E46","R62.7","K20.90","Z79.891","Z79.899","R06.9","Z93.4","K94.29","K92.1","I95.9","R11.0","Z87.11","Z45.89","D50.8","K70.30","Z66","D64.9","F17.210","R55","R42","K27.9","R11.14","K90.9","Z04.3","M54.5","M25.559","D50.0","F11.90","Z86.59","F06.4","F10.21","E61.1","Z71.3","K58.2","R63.0","G89.4","E87.5","F11.23","R63.39","R11.11","R53.1","T85.598A","Y84.8","R10.10","R58","R53.83","R79.89","G44.89","M54.2","W01.0XXA","Y92.009","M54.50","R10.2","S09.90XA","M54.6","G89.11","R29.6","R74.8","R13.14","Z12.11"],"date":["2022-02-22","2021-07-07","2022-01-14","2022-04-02","2022-03-03","2022-01-14","2022-01-14","2021-10-01","2021-11-16","2022-03-13","2021-07-19","2021-08-27","2022-03-13","2022-03-25","2021-08-27","2022-03-16","2021-10-13","2021-07-12","2022-03-03","2022-04-02","2022-02-22","2021-07-12","2022-01-14","2021-07-13","2021-09-29","2022-03-25","2021-07-14","2022-03-25","2022-03-16","2021-07-19","2021-07-20","2021-08-04","2022-04-02","2022-03-13","2022-02-22","2021-08-02","2021-08-02","2021-08-02","2021-08-02","2021-08-02","2021-08-18","2022-03-13","2021-08-18","2021-08-18","2021-11-23","2021-08-27","2021-09-28","2021-08-18","2021-09-28","2021-08-18","2021-08-18","2021-08-23","2022-03-25","2021-08-27","2021-08-27","2021-08-27","2021-08-27","2021-10-02","2021-09-17","2021-09-17","2021-09-17","2022-03-25","2021-10-01","2021-09-17","2021-09-17","2022-03-25","2021-09-17","2021-12-02","2021-09-28","2021-10-02","2022-04-02","2022-03-25","2021-10-02","2021-10-02","2021-09-28","2021-09-28","2021-09-28","2021-09-29","2021-10-06","2021-10-06","2021-10-06","2021-10-13","2021-12-09","2021-11-16","2022-03-16","2022-03-03","2022-03-16","2021-12-09","2021-12-30","2021-12-30","2022-03-13","2022-02-22","2022-01-25","2022-01-25","2022-02-22","2022-02-22","2022-02-22","2022-03-03","2022-03-13","2022-03-13","2022-03-13","2022-03-13","2022-03-16","2022-03-13","2022-03-13","2022-03-13","2022-03-16","2022-03-16","2022-03-16","2022-03-25","2022-03-25"],"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":[["","00093216568","NALOXONE","SPR 4MG","2","Select","Select",""],["","00406324301","HYDROMORPHON","TAB 2MG","24","Select","Select",""],["","65162074510","PROMETHAZINE","TAB 12.5MG","30","Select","Select",""],["","12496120203","SUBOXONE","MIS 2-0.5MG","18","Select","Select",""],["","00185067401","HYDROXYZ","CAP 25MG","30","Select","Select",""],["","68462043518","ACAMPRO","TAB 333MG","120","Select","Select",""],["","70710122801","AMITRIPTYLIN","TAB 75MG","30","Select","Select",""],["","57664051083","MIRTAZAPINE","TAB 7.5MG","30","Select","Select",""],["","45802095301","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","00228212750","CLONIDINE","TAB 0.1MG","90","Select","Select",""],["","10702001801","OXYCODONE","TAB 5MG","20","Select","Select",""],["","10006073017","VITAMIN","TAB 50MG","28","Select","Select",""],["","68585000801","ZINC","CAP 220MG","21","Select","Select",""],["","00005434462","CENTRUM","LIQ ","472","Select","Select",""],["","68462015713","ONDANSETRON","TAB 4MG ODT","30","Select","Select",""],["","16729020016","BUSPIRONE","TAB 5MG","90","Select","Select",""],["","80777027399","MODERNA","INJ COVID-19","0.50","Select","Select",""],["","49483034010","ACETAMIN","TAB 325MG","120","Select","Select",""],["","50383077504","LIDOCAINE","SOL 2% VISC","100","Select","Select",""],["","70000043401","GAS","CHW 80MG","22","Select","Select",""],["","00093365740","BUPRENORPHIN","DIS 10MCG\/HR","1","Select","Select",""],["","47781064726","ERGOCALCIFER","DRO 8000\/ML","60","Select","Select",""],["","10572010001","PEG-3350","SOL ELECTROL","8,000.00","Select","Select",""],["","45802020126","ACETAMINOPHN","SUS 160\/5ML","354","Select","Select",""],["","54838000180","FERROUS","ELX 220\/5ML","150","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","59779026326","PAIN","SUS 160\/5ML","355","Select","Select",""],["","00093317431","ALBUTEROL","FAT E","8.5","Select","Select",""],["","00603154258","POT  CHLORIDE","SOL 0.1","473","Select","Select",""],["","65162036111","FOLIC","TAB 1MG","90","Select","Select",""],["","40985022702","SENTRY","TAB ","90","Select","Select",""],["","45802005911","NYSTATIN","CRE 100000","30","Select","Select",""],["","00093221005","SUCRALFATE","TAB 1GM","360","Select","Select",""],["","00536129383","ANTACID","SUS REG ST","355","Select","Select",""],["","70000041801","ANTI-DIARRHE","LIQ 1MG\/7.5","720","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":""}]}]}