{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MICHAEL E SKINNER","gend":0,"add":"113 COURTNEY AVENUE NE  ","city":"ROANOKE  ","state":"VA","zip":"24012-9998","dob":"1966-02-10","age":"","mstatus":"","insh":11003454,"cliId":"1AE5Y18KN62","pno":5405628522,"cno":5405628522,"email":"","ename":"","eno":"","pphy":"BALLEW, KENNETH A ","ppno":4349241622,"pcpadd":"415 Ray C Hunt Dr","pcpcity":"Charlottesville","pcpstate":"VA","pcpzip":229032980,"pcpcounty":"","pcpid":"P0060358","pcpname":"UNIVERSITY MEDICAL ASSOCIATES CLINIC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"ROANOKE ALLEGHANY","aligned":"Y","ano":"","add2":"APT 7 ","add3":"","madd1":"113 COURTNEY AVENUE NE  ","madd2":"APT 7 ","madd3":"","mcity":"ROANOKE  ","mstate":"VA","mzip":"24012-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["R00.1","Z01.812","Z01.810","Z23","E11.8","F25.0","F17.210","Z87.898","R73.03","M54.42","G89.29","A42.1","Z01.818","M51.26","J30.9","L60.0","B35.1","M79.675","G47.9","M54.16","M96.0","Y83.1","K21.9","E11.9","E78.5","M19.90","F32.9","Z87.11","Z87.891","Z79.899","Z79.84","Z98.1","L72.0","E78.2","Z76.0","M54.17","M54.5","M43.06","M51.16","M43.10","M25.551","M25.552","F31.81","M43.17","M25.78","Z48.89","D48.5","Z78.9","R20.8","L53.8","M46.96","Z98.890","R60.9","M48.07","R74.8","Z51.81","I10","F10.11","G25.81","F33.1","G47.00","R03.0","M43.16","M47.816","M51.36","L92.3","M43.27","M48.062","R93.7","Z47.89","M54.9","R43.2","R10.84","R11.10","R19.7","Z71.89","E55.9","K92.1","R11.0","K29.50","D12.0","D12.3","Z12.11","R10.13","K64.4","K29.70","Z86.010","K64.8","F32.5","Z72.0","Z81.1","Z83.3","M47.812","M50.30","M54.12","M54.2","M79.605","F43.10","D23.30","M47.22","M43.12","M43.13","M79.603","M48.02","M50.122","M47.893","M48.03","M24.852","M24.851","L20.84","R42","I95.1","R89.2","K92.0","R11.14","Z87.19","F32.89","K91.1","Z65.8","F41.8","R68.81","R11.2","J30.89","Z00.00","R41.3","F54","F33.3","R63.4"],"date":["2019-01-04","2019-01-04","2019-01-04","2021-07-12","2019-01-04","2021-08-26","2021-10-04","2020-02-19","2020-10-12","2020-03-11","2021-04-27","2019-05-03","2019-01-07","2020-04-27","2019-10-23","2020-01-21","2020-01-21","2020-01-21","2020-02-19","2020-09-30","2021-10-20","2019-01-25","2021-10-28","2019-08-28","2020-05-20","2019-01-25","2019-08-28","2019-01-25","2019-01-25","2021-10-20","2019-01-25","2021-07-20","2020-03-18","2020-03-11","2020-02-24","2020-08-12","2021-04-27","2021-10-20","2021-10-20","2020-04-27","2020-04-27","2020-04-27","2020-03-11","2020-03-20","2019-03-18","2019-03-18","2020-03-18","2020-03-18","2020-03-18","2020-03-18","2020-03-20","2020-03-20","2020-03-20","2020-03-20","2021-10-28","2019-12-11","2020-05-20","2020-10-12","2020-10-12","2021-08-26","2021-08-26","2019-08-21","2021-07-20","2019-12-02","2019-07-29","2020-08-06","2019-07-15","2019-07-15","2019-07-29","2018-08-27","2018-07-31","2020-08-06","2018-08-14","2018-08-14","2018-08-14","2018-08-07","2019-08-21","2019-08-21","2021-04-27","2019-08-28","2019-08-28","2019-08-28","2019-08-28","2021-10-28","2019-08-28","2019-08-28","2019-08-28","2019-08-28","2019-09-05","2019-09-05","2019-09-05","2019-09-05","2021-10-20","2020-09-10","2020-12-01","2020-12-01","2018-10-22","2021-10-04","2019-11-13","2020-12-01","2020-12-01","2020-12-01","2020-12-01","2020-12-01","2020-12-01","2020-12-01","2020-12-01","2019-12-02","2019-12-02","2019-12-10","2019-12-11","2019-12-11","2019-12-11","2021-10-28","2021-02-24","2021-07-12","2020-10-12","2021-10-04","2021-01-11","2021-07-12","2021-02-23","2021-03-12","2021-04-27","2021-07-12","2021-07-12","2021-10-04","2021-10-25","2021-10-28"],"priorHcc":["","","","","","","","","","","","","","","","","","","","",null,"",null,"","","","","","","","","","","","","","",null,null,"","","","","","","","","","","","","","","",null,"","","","","","","","","","","","","","","","","","","","","","","","","","","","",null,"","","","","","","","",null,"","","","","","","","","","","","","","","","","","","","",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":[["","52817033200","CYCLOBENZAPR","TAB 10MG","","Select","Select",""],["","65162010350","GABAPENTIN","CAP 400MG","","Select","Select",""],["","62175011843","OMEPRAZOLE","CAP 20MG","","Select","Select",""],["","406052201","OXYCOD\/APAP","TAB 7.5-325","","Select","Select",""],["","378230201","PRAZOSIN HCL","CAP 2MG","","Select","Select",""],["","13107000334","MIRTAZAPINE","TAB 30MG","","Select","Select",""],["","378668999","PANTOPRAZOLE","TAB 40MG","","Select","Select",""],["","93220305","METOCLOPRAM","TAB 10MG","","Select","Select",""],["","43598029490","PREGABALIN","CAP 100MG","","Select","Select",""],["","55111012305","ATORVASTATIN","TAB 40MG","","Select","Select",""],["","65862019401","FLUOXETINE","CAP 40MG","","Select","Select",""],["","527133001","BACLOFEN","TAB 10MG","","Select","Select",""],["","67877056105","METFORMIN","TAB 500MG","","Select","Select",""],["","68382004001","PROMETHAZINE","TAB 12.5MG","","Select","Select",""],["","71101368","LYRICA","CAP 50MG","","Select","Select",""],["","591079401","DICYCLOMINE","CAP 10MG","","Select","Select",""],["","68462025401","ROPINIROLE","TAB 0.5MG","","Select","Select",""],["","65862001205","SERTRALINE","TAB 50MG","","Select","Select",""],["","68462029052","AUG BETAMET","CRE 0.0005","","Select","Select",""],["","168008031","HYDROCORT","CRE 0.025","","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","","Select","Select",""],["","60505025203","TIZANIDINE","TAB 4MG","","Select","Select",""],["","172572960","FAMOTIDINE","TAB 40MG","","Select","Select",""],["","10572030201","PEG-3350\/KCL","SOL \/SODIUM","","Select","Select",""],["","69097082707","BENZTROPINE","TAB 1MG","","Select","Select",""],["","143980305","DOXYCYCL HYC","CAP 100MG","","Select","Select",""],["","52817033200","CYCLOBENZAPR ","TAB 10MG","90","Select","Select",""],["","93762598","PREGABALIN ","CAP 100MG","60","Select","Select",""],["","59651000205","OMEPRAZOLE ","CAP 20MG","30","Select","Select",""],["","406052301","OXYCOD\/APAP ","TAB 10-325MG","90","Select","Select",""],["","378230201","PRAZOSIN ","CAP 2MG","30","Select","Select",""],["","13107000334","MIRTAZAPINE ","TAB 30MG","30","Select","Select",""],["","65162010350","GABAPENTIN ","CAP 400MG","180","Select","Select",""],["","527133001","BACLOFEN ","TAB 10MG","90","Select","Select",""],["","378668999","PANTOPRAZOLE ","TAB 40MG","60","Select","Select",""],["","93220305","METOCLOPRAM ","TAB 10MG","20","Select","Select",""],["","172572960","FAMOTIDINE ","TAB 40MG","30","Select","Select",""],["","60505025203","TIZANIDINE ","TAB 4MG","65","Select","Select",""],["","55111012305","ATORVASTATIN ","TAB 40MG","30","Select","Select",""],["","68462025401","ROPINIROLE ","TAB 0.5MG","60","Select","Select",""],["","71101568","LYRICA ","CAP 100MG","60","Select","Select",""],["","65862019401","FLUOXETINE ","CAP 40MG","60","Select","Select",""],["","67877056105","METFORMIN ","TAB 500MG","30","Select","Select",""],["","68382004001","PROMETHAZINE ","TAB 12.5MG","56","Select","Select",""],["","168008031","HYDROCORT ","CRE 0.025","60","Select","Select",""],["","10572030201","PEG-3350\/KCL ","SOL \/SODIUM","4,000.00","Select","Select",""],["","591079401","DICYCLOMINE ","CAP 10MG","144","Select","Select",""],["","60505082901","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","55111025660","ZIPRASIDONE ","CAP 20MG","30","Select","Select",""],["","65862001205","SERTRALINE ","TAB 50MG","30","Select","Select",""],["","69097082707","BENZTROPINE ","TAB 1MG","30","Select","Select",""],["","143980305","DOXYCYCL ","CAP 100MG","28","Select","Select",""],["","68462029052","AUG ","CRE 0.0005","50","Select","Select",""],["","00378230201","PRAZOSIN","2MG","30","Select","Select",""],["","00143980305","DOXYCYCL","100MG","28","Select","Select",""],["","55111025660","ZIPRASIDONE","20MG","30","Select","Select",""],["","68462029052","AUG","0.0005","50","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":[[["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["Yes","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":""}]}]}