{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"NANCY J SHIELDS","gend":1,"add":"1428 MULBERRY ST  ","city":"WAYNESBORO  ","state":"VA","zip":"22980-9998","dob":"1942-04-02","age":"","mstatus":"","insh":11003901,"cliId":"6WM8QQ3AC69","pno":5402414903,"cno":5402414903,"email":"","ename":"","eno":"","pphy":"SNODGRASS, SHELLEY L","ppno":5403325687,"pcpadd":"53 S Medical Park Dr","pcpcity":"Fishersville","pcpstate":"VA","pcpzip":229392333,"pcpcounty":"","pcpid":"P0110997","pcpname":"AUGUSTA HEALTH INTERNAL MEDICINE WAYNESBORO","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"","add2":"","add3":"","madd1":"1428 MULBERRY ST  ","madd2":"","madd3":"","mcity":"WAYNESBORO  ","mstate":"VA","mzip":"22980-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["J44.9","M54.5","M46.1","M41.20","F11.20","R91.1","M79.7","I10","Z87.891","E78.00","M81.0","I50.30","R73.01","E55.9","Z79.891","R22.9","Z85.828","M53.3","D17.30","M65.30","M54.31","R94.2","R30.0","G89.29","M47.818","Z79.899","Z88.0","Z88.1","Z88.3","Z88.8","M47.817","M54.16","M54.2","E08.9","Z23","R53.83","R73.9","Z12.31","Z00.00","R30.9","I50.32","J96.11","R54","L81.4","D18.01","D17.1","Z08","L57.0","I51.89","G57.01","L72.0","L82.1","R22.2","R91.8","J43.9","I25.10","I71.2","M25.561","R73.03","I51.9","Z99.81","Z11.59","E11.9"],"date":["2021-10-02","2021-09-20","2021-09-20","2020-09-15","2021-09-20","2020-12-21","2021-07-12","2021-10-22","2020-09-15","2021-10-22","2021-07-12","2020-09-15","2020-09-11","2021-09-27","2021-09-20","2020-06-29","2020-06-29","2020-05-21","2019-06-03","2019-06-03","2021-09-20","2020-06-29","2020-06-29","2020-09-15","2020-09-15","2019-07-09","2020-09-15","2020-09-15","2019-07-09","2020-09-15","2020-09-15","2018-08-07","2021-01-11","2018-08-02","2021-10-22","2018-10-19","2018-10-19","2021-04-29","2020-09-11","2020-09-11","2020-09-11","2020-09-11","2020-09-11","2020-11-12","2020-11-12","2019-09-19","2019-09-19","2020-11-12","2019-10-07","2019-10-09","2020-11-12","2020-11-12","2020-12-10","2019-12-13","2019-12-13","2019-12-13","2019-12-13","2018-12-18","2021-09-27","2021-01-11","2021-01-11","2021-01-11","2021-10-22"],"priorHcc":[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":[["","16729018317","HYDROCHLOROT","TAB 25MG","","Select","Select",""],["","43598029590","PREGABALIN","CAP 150MG","","Select","Select",""],["","42858010201","OXYCOD\/APAP","TAB 5-325MG","","Select","Select",""],["","27241009903","DULOXETINE","CAP 60MG","","Select","Select",""],["","60505025103","TIZANIDINE","TAB 2MG","","Select","Select",""],["","173088710","TRELEGY","AER ELLIPTA","","Select","Select",""],["","71101668","LYRICA","CAP 150MG","","Select","Select",""],["","65862032904","ALENDRONATE","TAB 70MG","","Select","Select",""],["","93720198","PRAVASTATIN","TAB 20MG","","Select","Select",""],["","93317431","ALBUTEROL SUL","FAT E","","Select","Select",""],["","49281012065","FLUZONE HD","INJ PF 20-21","","Select","Select",""],["","574222545","TRETINOIN","CRE 0.00025","","Select","Select",""],["","59310057922","PROAIR HFA","AER ","","Select","Select",""],["","68180029606","DULOXETINE ","CAP 60MG","180","Select","Select",""],["","71101668","LYRICA ","CAP 150MG","180","Select","Select",""],["","42858010201","OXYCOD\/APAP ","TAB 5-325MG","90","Select","Select",""],["","16729018317","HYDROCHLOROT ","TAB 25MG","45","Select","Select",""],["","43598029590","PREGABALIN ","CAP 150MG","180","Select","Select",""],["","59310057922","PROAIR ","AER ","8.5","Select","Select",""],["","60505025103","TIZANIDINE ","TAB 2MG","90","Select","Select",""],["","173088710","TRELEGY ","AER ELLIPTA","180","Select","Select",""],["","93317431","ALBUTEROL ","FAT E","8.5","Select","Select",""],["","65862032904","ALENDRONATE ","TAB 70MG","12","Select","Select",""],["","93720198","PRAVASTATIN ","TAB 20MG","90","Select","Select",""],["","574222545","TRETINOIN ","CRE 0.00025","45","Select","Select",""],["","49281012065","FLUZONE ","PF 20-21","0.7","Select","Select",""],["","59310057922","PROAIR","","8.5","Select","Select",""],["","00093317431","ALBUTEROL","E","8.5","Select","Select",""],["","49281012065","FLUZONE","PF 20-21","0.7","Select","Select",""],["","70377002911","ATORVASTATIN ","TAB 40MG","90","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","",""],["No","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":""}]}]}