{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BEVERLY A ZIMMERMAN","gend":1,"add":"609 N AUGUSTA AVENUE ","city":"WAYNESBORO  ","state":"VA","zip":"22980-2803","dob":"1944-05-27","age":"","mstatus":"","insh":11001677,"cliId":"5R68TV4VT48","pno":5404714286,"cno":5409430613,"email":"","ename":"","eno":"","pphy":"ENGEL, GINA D  ","ppno":5409421200,"pcpadd":"15 Pratts Run,Ste 103","pcpcity":"Waynesboro  ","pcpstate":"VA","pcpzip":229806606,"pcpcounty":"","pcpid":"P0060086","pcpname":"UVA WAYNESBORO PRIMARY CARE","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"","add2":"","add3":"","madd1":"609 N AUGUSTA AVENUE ","madd2":"","madd3":"","mcity":"WAYNESBORO  ","mstate":"VA","mzip":"22980-2803","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["E03.9","R53.81","F03.90","F22","R41.3","E78.5","R44.3","G31.89","R41.9","Z04.6","F23","R44.2","R51","Z88.8","I10","K21.9","J45.909","F32.9","M31.6","J30.2","Z51.5","N39.0","J44.9","R41.82","F03.91","F41.1","F51.05","Z82.49","E55.9","Z68.35","E66.3","J30.9","Z79.899","Z91.14","Z91.19","E87.6","R11.0","R19.7","R42","Z90.710","Z90.49","Z88.5","G30.9","F02.81","R05","R30.0","R31.9","R31.0","Z80.51","N28.1"],"date":["2021-07-27","2020-01-17","2021-09-08","2018-06-26","2018-04-11","2021-07-27","2018-05-24","2018-04-22","2018-06-26","2018-06-26","2018-04-22","2018-04-22","2018-07-31","2018-07-31","2021-07-27","2021-03-04","2020-06-25","2021-07-27","2021-07-27","2021-07-27","2021-07-27","2018-07-31","2018-06-26","2018-06-26","2018-06-27","2018-06-27","2018-06-27","2018-06-27","2018-06-27","2018-06-27","2018-06-27","2018-06-27","2018-07-31","2018-06-27","2018-06-27","2018-07-31","2018-07-31","2018-07-31","2018-07-31","2018-07-31","2018-07-31","2018-07-31","2019-08-28","2019-08-28","2020-12-01","2021-10-27","2021-10-13","2021-11-22","2021-10-27","2021-11-19"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",null,"",null]}},{"a":[]}]},{"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":{"indx":["","",""],"comment":["","",""],"sub":[]}},{"a":{"indx":["","",""],"comment":["","",""],"sub":[]}}]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","68180051802","LISINOP\/HCTZ","TAB 10-12.5","","Select","Select",""],["","43547027611","DONEPEZIL","TAB 10MG","","Select","Select",""],["","378180510","LEVOTHYROXIN","TAB 75MCG","","Select","Select",""],["","16714045301","QUETIAPINE","TAB 50MG","","Select","Select",""],["","61442012101","FAMOTIDINE","TAB 20MG","","Select","Select",""],["","65862057490","MONTELUKAST","TAB 10MG","","Select","Select",""],["","43547028111","ESCITALOPRAM","TAB 10MG","","Select","Select",""],["","54327099","FLUTICASONE","SPR 50MCG","","Select","Select",""],["","59310057922","PROAIR HFA","AER ","","Select","Select",""],["","65162025311","RANITIDINE","TAB 150MG","","Select","Select",""],["","378180510","LEVOTHYROXIN ","TAB 75MCG","30","Select","Select",""],["","68180051802","LISINOP\/HCTZ ","TAB 10-12.5","60","Select","Select",""],["","43547027611","DONEPEZIL ","TAB 10MG","30","Select","Select",""],["","61442012101","FAMOTIDINE ","TAB 20MG","30","Select","Select",""],["","67877024901","QUETIAPINE ","TAB 50MG","30","Select","Select",""],["","65862057490","MONTELUKAST ","TAB 10MG","30","Select","Select",""],["","60505082901","FLUTICASONE ","SPR 50MCG","48","Select","Select",""],["","59310057922","PROAIR ","AER ","8.5","Select","Select",""],["","43547028111","ESCITALOPRAM ","TAB 10MG","90","Select","Select",""],["","65162025311","RANITIDINE ","TAB 150MG","180","Select","Select",""],["","68382009205","CARVEDILOL ","3.125MG","60","Select","Select",""],["","68382009205","CARVEDILOL","3.125MG","60","Select","Select",""],["","59310057922","PROAIR","","8.5","Select","Select",""]]}},{"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":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[[["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""]]]},{"t":"Mini-Cog","q":[{"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":""}]}]}