{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"PANSY M NICHOLSON","gend":1,"add":"3297 MEANDER RUN RD","city":"CULPEPER","state":"VA","zip":227019999,"dob":"1938-10-04","age":"","mstatus":"","insh":11007696,"cliId":"3U43Q83CR06","pno":5405432039,"cno":"","email":"","ename":"","eno":"","pphy":"GONZALEZ, AMAURI","ppno":5408256100,"pcpadd":"1200 Sunset Ln","pcpcity":"Culpeper","pcpstate":"VA","pcpzip":227013376,"pcpcounty":"","pcpid":"P0110934","pcpname":"UVA PRIMARY CARE CULPEPER FAMILY PRACTICE","plan":"VPHP - VIRGINIA PREMIER","program":"Medicare","lob":"DSNP","region":"NORTHERN\/WINCHESTER","aligned":"Y","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["R09.82","J30.1","J34.2","H57.9","J31.0","J01.90","J30.9","R00.2","F41.9","S82.61XS","Z91.81","R26.2","J34.89","J32.9","R07.89","K21.9","Z88.0","Z91.011","Z88.8","Z90.49","Z85.038","R07.9","R68.89","Z01.818","Y83.1","Y79.3","T84.84XA","S72.421D","Y79.8","Z47.89","M62.81","H91.90","C18.9","M79.604","K59.00","M25.551","L60.0","D64.9","T84.84XD","M18.11","M79.641","R21","R35.0","R13.10","Z00.00","N64.4","Z13.6","Z12.11","Z13.820","Z12.31","N83.209","Z86.2","N83.202","Z90.710","N83.292","R05","J38.3","R49.0","Z76.89","R09.81","J30.89","M65.4","J37.0","Z88.6","R09.89","R07.82","M25.531","S69.92XA","H90.3","L30.9","M79.18","D51.0","H35.89","H52.03","H25.13","H52.203","H04.129","H52.4","H35.9","H04.123","E53.8","L28.0","E55.9"],"date":["2020-11-24","2020-01-09","2020-05-20","2021-06-08","2020-08-26","2020-02-27","2020-02-27","2020-02-27","2020-06-03","2020-05-01","2020-05-01","2020-05-01","2020-05-20","2020-05-20","2021-03-03","2021-03-03","2021-01-13","2020-06-03","2021-01-13","2020-06-03","2020-10-15","2020-06-03","2020-06-03","2019-07-11","2019-07-01","2019-07-01","2019-08-01","2019-07-11","2019-07-16","2019-08-01","2019-07-29","2019-08-02","2019-07-31","2019-07-31","2019-07-31","2019-07-25","2019-08-02","2019-07-26","2019-08-02","2021-03-05","2021-01-13","2021-04-20","2020-08-26","2020-09-23","2019-10-01","2019-10-08","2021-03-03","2019-10-01","2019-10-01","2019-10-01","2019-10-08","2019-10-01","2019-10-08","2019-10-08","2019-10-08","2021-03-03","2020-11-09","2021-02-15","2020-11-09","2019-11-14","2020-11-24","2021-03-05","2021-02-15","2021-01-13","2021-03-03","2021-03-09","2021-03-05","2021-03-05","2021-04-15","2021-04-20","2021-04-20","2021-05-11","2021-05-05","2021-05-05","2021-05-18","2021-05-05","2021-05-05","2021-05-05","2021-05-18","2021-05-05","2021-04-20","2021-04-20","2021-04-20"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}},{"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":[["","591024110","LORAZEPAM","TAB 1MG","","Select","Select",""],["","51991081403","AZELASTINE","SPR 0.001","","Select","Select",""],["","61442012101","FAMOTIDINE","TAB 20MG","","Select","Select",""],["","31722057310","ESOMEPRA MAG","CAP 40MG DR","","Select","Select",""],["","68462039610","OMEPRAZOLE","CAP 20MG","","Select","Select",""],["","378064110","PREDNISONE","TAB 10MG","","Select","Select",""],["","68462034690","LEVOCETIRIZI","TAB 5MG","","Select","Select",""],["","65862056099","PANTOPRAZOLE","TAB 40MG","","Select","Select",""],["","68382005001","MELOXICAM","TAB 7.5MG","","Select","Select",""],["","16729011917","MONTELUKAST","TAB 10MG","","Select","Select",""],["","51672128202","TRIAMCINOLON","CRE 0.001","","Select","Select",""],["","54004641","IPRATROPIUM","SPR 0.0006","","Select","Select",""],["","93681673","BUDESONIDE","SUS 0.5MG\/2","","Select","Select",""],["","67877021560","CEFUROXIME","TAB 250MG","","Select","Select",""],["","51672128202","TRIAMCINOLON ","CRE 0.001","30","Select","Select",""],["","591024110","LORAZEPAM ","TAB 1MG","60","Select","Select",""],["","51991081403","AZELASTINE ","SPR 0.001","30","Select","Select",""],["","68462039610","OMEPRAZOLE ","CAP 20MG","180","Select","Select",""],["","31722057310","ESOMEPRA ","CAP 40MG DR","90","Select","Select",""],["","62332000131","FAMOTIDINE ","TAB 20MG","60","Select","Select",""],["","54004641","IPRATROPIUM ","SPR 0.0006","15","Select","Select",""],["","93742610","MONTELUKAST ","TAB 10MG","30","Select","Select",""],["","65862056099","PANTOPRAZOLE ","TAB 40MG","60","Select","Select",""],["","67877021560","CEFUROXIME ","TAB 250MG","20","Select","Select",""],["","378064110","PREDNISONE ","TAB 10MG","15","Select","Select",""],["","68462034690","LEVOCETIRIZI ","TAB 5MG","30","Select","Select",""],["","93681673","BUDESONIDE ","SUS 0.5MG\/2","120","Select","Select",""],["","68382005001","MELOXICAM ","TAB 7.5MG","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":[[["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","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":""}]}]}