{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"WILLIAM L MAYNE","gend":0,"add":"142 LAWHILL RD.","city":"VERONA","state":"VA","zip":"24482-9998","dob":"1952-09-05","age":"","mstatus":"","insh":11003049,"cliId":"4UU9KP8NQ36","pno":5404487288,"cno":5404487288,"email":"","ename":"","eno":"","pphy":"LE, NGOC H","ppno":5402485110,"pcpadd":"3881 Churchville Ave","pcpcity":"Churchville ","pcpstate":"VA","pcpzip":244212525,"pcpcounty":"","pcpid":"P0113830","pcpname":"AUGUSTA HEALTH FAMILY PRACTICE","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"","add2":"12 Lawhill Road","add3":"","madd1":"PO BOX 632  ","madd2":"12 Lawhill Road","madd3":"","mcity":"VERONA","mstate":"VA","mzip":"24482-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["K56.609","M51.24","F51.04","N39.46","L22","R33.9","N40.1","N13.8","R39.89","F32.9","Z79.899","Z87.891","Z88.8","Z91.040","C7A.8","C7B.8","R19.00","D64.9","G89.18","R10.9","R33.8","I10","Z90.49","Z28.21","Z96.0","Z98.0","N39.0","R31.29","Y84.6","N32.89","N30.80","T83.511A","K21.9","Z98.1","C7B.01","G89.4","M47.12","F41.8","D3A.012","Z48.816","D3A.8","N31.9","F41.1","F43.10","F51.5","G47.9","G62.9","K08.409","K59.03","L90.5","M25.9","M47.812","M47.816","M95.2","Q68.1","Q72.811","R51","S91.104D","Y07.499","Z68.24","Z79.2","Z79.891","Z87.81","Z91.410","Z97.3","Z00.00","Z12.11","M54.6","G89.29","R26.81","R29.6","Z98.890","Z86.73","C7A.012","R18.8","D62","K56.7","E46","C7B.09","I95.9","C7A.021","R60.0","E87.6","K52.89","D72.829","F41.9","K56.600","R11.2","R19.7","T18.3XXA","J98.4","R07.9","K63.89","Z46.6","R00.0"],"date":["2020-01-02","2021-09-13","2021-09-13","2021-11-20","2021-11-20","2020-03-27","2020-03-27","2020-03-27","2020-01-13","2020-02-21","2020-02-21","2020-06-15","2020-02-21","2020-01-20","2020-01-20","2020-01-20","2020-01-20","2020-01-20","2020-01-20","2020-01-20","2020-02-24","2020-02-21","2020-04-02","2020-02-21","2020-01-20","2020-01-20","2020-02-19","2020-02-19","2020-02-21","2020-02-21","2020-02-21","2020-02-21","2020-02-21","2020-02-21","2020-02-21","2021-09-13","2021-09-13","2020-03-17","2020-03-17","2020-03-27","2020-04-02","2021-11-20","2018-07-20","2018-07-20","2018-07-20","2018-07-20","2018-07-20","2018-07-20","2019-12-17","2018-07-20","2018-07-20","2018-07-20","2018-07-20","2018-07-20","2018-07-20","2018-07-20","2018-07-20","2018-07-20","2018-07-20","2018-07-20","2018-07-20","2018-07-20","2018-07-20","2018-07-20","2018-07-20","2019-09-18","2019-09-18","2019-12-12","2019-12-12","2019-12-12","2019-12-12","2019-12-12","2019-12-12","2019-12-27","2019-12-26","2019-12-26","2019-12-26","2019-12-26","2019-12-26","2019-12-26","2019-12-26","2019-12-26","2019-12-26","2019-12-26","2019-12-26","2019-12-26","2019-12-27","2019-12-26","2019-12-26","2019-12-26","2019-12-26","2019-12-26","2019-12-27","2019-12-27","2019-12-28"],"priorHcc":["","","",null,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":[["","13668000701","ZOLPIDEM","TAB 5MG","","Select","Select",""],["","406012501","HYDROCO\/APAP","TAB 10-325MG","","Select","Select",""],["","65862056090","PANTOPRAZOLE","TAB 40MG","","Select","Select",""],["","16729021616","SERTRALINE","TAB 50MG","","Select","Select",""],["","62037099901","POT CL MICRO","TAB 20MEQ ER","","Select","Select",""],["","65162062711","TRAMADOL HCL","TAB 50MG","","Select","Select",""],["","16714071302","TAMSULOSIN","CAP 0.4MG","","Select","Select",""],["","62175044215","POLYETH GLYC","POW 3350 NF","","Select","Select",""],["","57237000430","FLUCONAZOLE","TAB 100MG","","Select","Select",""],["","378668977","PANTOPRAZOLE ","TAB 40MG","90","Select","Select",""],["","13668000701","ZOLPIDEM ","TAB 5MG","30","Select","Select",""],["","16729021616","SERTRALINE ","TAB 50MG","30","Select","Select",""],["","406012501","HYDROCO\/APAP ","TAB 10-325MG","60","Select","Select",""],["","62175044215","POLYETH ","POW 3350 NF","510","Select","Select",""],["","57237000430","FLUCONAZOLE ","TAB 100MG","3","Select","Select",""],["","16714071302","TAMSULOSIN ","CAP 0.4MG","30","Select","Select",""],["","65162062711","TRAMADOL ","TAB 50MG","20","Select","Select",""],["","62037099901","POT  CL MICRO","TAB 20MEQ ER","5","Select","Select",""],["","62175044215","POLYETH","3350 NF","510","Select","Select",""],["","65162062711","TRAMADOL","50MG","10","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","",""],["Yes","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":""}]}]}