{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LARRY G SEARS","gend":0,"add":"25 CHURCHVILLE LOOP  ","city":"CHURCHVILLE ","state":"VA","zip":"24421-9998","dob":"1982-01-11","age":"","mstatus":"","insh":11005465,"cliId":"4FN9A94MN48","pno":5403376656,"cno":5404486440,"email":"","ename":"","eno":"","pphy":"YOUNG, SCOTT F ","ppno":5409498241,"pcpadd":"428 S Magnolia Ave Ste 1","pcpcity":"Waynesboro  ","pcpstate":"VA","pcpzip":229803629,"pcpcounty":"","pcpid":"P0125394","pcpname":"CFM ASSOCIATED PHYSICIANS WAYNESBORO","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"","add2":"","add3":"","madd1":"25 CHURCHVILLE LOOP  ","madd2":"","madd3":"","mcity":"CHURCHVILLE ","mstate":"VA","mzip":"24421-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["G81.91","S06.2X0S","J40","G93.1","S06.890A","N20.1","R26.9","M62.81","R13.12","R47.1","R68.89","Z43.1","L89.159","J44.9","G47.33","R39.81","R15.9","J96.01","R00.0","R09.89","A41.9","J69.0","V89.2XXS","J96.22","J96.21","R65.20","Z99.81","S14.101S","Z87.820","Z98.2","E66.9","Z68.38","R13.10","K59.00","G40.909","J18.9","R06.02","J96.00","R56.9","J96.11","R41.89","Z87.891","J20.9","N20.0","J98.11","J98.6","R10.12","R06.2","I10","R10.9","Z87.01","Z87.19","G47.30","Z99.89","Z79.899","G82.50","E78.00","F09","R73.01","R05","R50.9","R09.02","G47.36","Z11.59","N28.1","D41.01","Q63.2","K76.0","Z93.1","R06.89","E66.01","R82.90","R74.0","K86.1","F32.9","N13.30","R74.8","Z23","K85.10","K80.20","Z09","K80.50","E11.9","L89.151","Z79.84","B37.2","J45.909","K21.9","K59.09","K64.8","D50.9","J30.9","N39.46","Z99.3","H57.89","J96.10","Z68.31","J96.12","N39.0","R35.0","R03.0","R47.89","Z20.822","Z87.442","R14.0","K56.41","Z03.818","R31.9","Z87.440","N30.21","D53.9"],"date":["2020-03-17","2021-04-19","2021-06-05","2021-11-12","2021-11-03","2021-08-03","2019-05-08","2019-05-08","2021-04-30","2019-05-08","2019-05-08","2021-11-25","2021-11-25","2021-04-19","2021-04-19","2021-11-06","2021-11-06","2020-03-30","2021-05-06","2020-03-16","2020-03-17","2021-11-12","2021-05-06","2020-03-19","2020-03-19","2020-03-17","2020-07-24","2020-03-17","2021-05-06","2020-03-17","2020-03-17","2020-03-17","2020-03-19","2020-03-17","2020-07-22","2021-05-06","2020-03-17","2020-03-20","2020-03-20","2021-11-12","2020-04-10","2020-04-10","2019-04-26","2020-07-23","2021-05-06","2019-04-26","2019-04-26","2019-04-26","2021-11-12","2019-04-26","2021-05-06","2019-04-26","2019-04-26","2019-04-26","2021-05-06","2021-11-12","2021-11-12","2021-11-12","2021-11-12","2021-05-06","2021-05-06","2020-07-10","2020-07-10","2020-07-07","2020-07-23","2021-08-03","2020-07-23","2020-07-23","2020-07-23","2020-07-24","2021-11-12","2021-06-22","2020-07-27","2021-04-30","2019-08-30","2019-08-30","2021-11-12","2021-11-12","2018-12-19","2018-12-19","2018-12-19","2018-12-19","2021-11-12","2021-01-22","2021-01-22","2020-07-22","2020-07-22","2020-07-22","2020-07-22","2020-07-22","2020-07-22","2020-07-22","2020-07-22","2020-07-22","2020-07-22","2020-07-22","2020-07-22","2021-05-06","2021-05-06","2021-05-06","2021-05-06","2021-05-06","2021-05-06","2021-05-06","2021-05-06","2021-05-06","2021-05-06","2021-06-22","2021-06-22","2021-08-03","2021-11-15"],"priorHcc":["","","",null,null,"","","","","","",null,null,"","",null,null,"","","","",null,"","","","","","","","","","","","","","","","","",null,"","","","","","","","",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":[["","17478071110","LIDOCAINE","GEL 2% JELLY","","Select","Select",""],["","54838055080","RANITIDINE","SYP 75MG\/5ML","","Select","Select",""],["","68382053701","POT CITRATE","TAB 1080MG","","Select","Select",""],["","574200802","NYSTOP","POW 100000","","Select","Select",""],["","60432083116","LEVETIRACETA","SOL 100MG\/ML","","Select","Select",""],["","69097086107","ZONISAMIDE","CAP 100MG","","Select","Select",""],["","76204020025","ALBUTEROL","NEB 0.00083","","Select","Select",""],["","62037099901","POT CL MICRO","TAB 20MEQ ER","","Select","Select",""],["","76204010060","IPRATROPIUM","SOL 0.02%INH","","Select","Select",""],["","172572860","FAMOTIDINE","TAB 20MG","","Select","Select",""],["","65862053750","LEVOFLOXACIN","TAB 500MG","","Select","Select",""],["","54327099","FLUTICASONE","SPR 50MCG","","Select","Select",""],["","52817018000","CLONIDINE","TAB 0.1MG","","Select","Select",""],["","45963043965","CONSTULOSE","SOL 10GM\/15","","Select","Select",""],["","60432053760","NYSTATIN","SUS 100000","","Select","Select",""],["","66685100100","AMOX\/K CLAV","TAB 875-125","","Select","Select",""],["","65862042005","SMZ\/TMP DS","TAB 800-160","","Select","Select",""],["","42543040701","POT  CITRATE ","TAB 1080MG","120","Select","Select",""],["","17478071110","LIDOCAINE ","GEL 2% JELLY","30","Select","Select",""],["","69097086107","ZONISAMIDE ","CAP 100MG","90","Select","Select",""],["","54838055080","RANITIDINE ","SYP 75MG\/5ML","1,200.00","Select","Select",""],["","50383024116","LEVETIRACETA ","SOL 100MG\/ML","600","Select","Select",""],["","65862053750","LEVOFLOXACIN ","TAB 500MG","10","Select","Select",""],["","76204020060","ALBUTEROL ","NEB 0.00083","360","Select","Select",""],["","54327099","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","574200802","NYSTOP ","POW 100000","60","Select","Select",""],["","172572860","FAMOTIDINE ","TAB 20MG","180","Select","Select",""],["","52817018000","CLONIDINE ","TAB 0.1MG","180","Select","Select",""],["","76204010060","IPRATROPIUM ","SOL 0.02%INH","300","Select","Select",""],["","62037099901","POT  CL MICRO","TAB 20MEQ ER","90","Select","Select",""],["","57237005920","CEFUROXIME ","TAB 500MG","20","Select","Select",""],["","781808926","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","45963043965","CONSTULOSE ","SOL 10GM\/15","1,892.00","Select","Select",""],["","60432053760","NYSTATIN ","SUS 100000","60","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","14","Select","Select",""],["","93314705","CEPHALEXIN ","500MG","21","Select","Select",""],["","66685100100","AMOX\/K ","875-125","20","Select","Select",""],["","68382013201","TAMSULOSIN","0.4MG","90","Select","Select",""],["","00093314705","CEPHALEXIN","500MG","21","Select","Select",""],["","68382053701","POT CITRA ER","1080MG","120","Select","Select",""],["","57237005920","CEFUROXIME","500MG","20","Select","Select",""],["","65862042005","SMZ\/TMP","800-160","14","Select","Select",""],["","66685100100","AMOX\/K","875-125","20","Select","Select",""],["","00781808926","AZITHROMYCIN","250MG","6","Select","Select",""],["","68382013201","TAMSULOSIN ","CAP 0.4MG","90","Select","Select",""],["","68382053701","POT  CITRA ER","TAB 1080MG","120","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":""}]}]}