{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TREVA B DYE","gend":1,"add":"1076 SALUDAS LANE","city":"CLOVER","state":"VA","zip":245349999,"dob":"1969-04-23","age":"","mstatus":"","insh":11008306,"cliId":"1GT3JQ2RA73","pno":4345792015,"cno":4344713929,"email":"","ename":"","eno":"","pphy":"HAMLOR, GAHEAR","ppno":4345178022,"pcpadd":"15210 L P Bailey Memorial Hwy","pcpcity":"Nathalie","pcpstate":"VA","pcpzip":245773304,"pcpcounty":"","pcpid":"P9058683","pcpname":"HALIFAX PRIMARY CARE","plan":"VPHP - VIRGINIA PREMIER","program":"Medicare","lob":"DSNP","region":"WESTERN\/CHARLOTTESVILLE","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":["I63.9","E10.41","L60.0","M79.674","M79.675","R39.81","R15.9","L22","J45.40","D50.9","K58.0","I10","I25.10","R60.0","E78.2","E11.9","Z71.89","Z71.3","E78.5","Z86.73","Z95.5","Z23","G47.33","H25.012","H25.12","Z96.1","H25.11","G93.89","R42","R90.89","R07.89","R07.9","I95.9","N39.0","R55","R41.82","M62.81","J45.909","D64.9","I69.354","R00.2","I25.2","Z79.82","K58.9","I25.118","R06.00","J43.1","R06.02","I63.89","R19.7","R11.0","Z90.49","K21.9","L20.9","L30.4","R10.9","Z87.891","Z88.6","R21","R10.32","N28.89","K76.0","I70.0","Z80.0"],"date":["2021-06-25","2019-10-18","2019-10-18","2019-10-18","2019-10-18","2021-06-06","2021-06-06","2021-06-06","2021-03-12","2020-11-05","2021-06-17","2021-06-11","2021-06-11","2019-11-25","2020-12-28","2021-06-11","2021-03-02","2021-03-02","2021-06-03","2021-06-11","2021-06-11","2020-09-14","2021-06-03","2020-08-17","2020-08-17","2020-09-01","2020-09-01","2020-09-15","2020-09-14","2020-09-14","2020-09-17","2020-09-14","2020-09-14","2020-09-16","2020-09-24","2020-09-14","2020-09-14","2020-09-16","2020-09-16","2020-09-16","2020-09-16","2021-06-11","2020-09-14","2020-09-24","2020-09-24","2020-10-08","2020-09-24","2020-10-08","2020-12-28","2021-03-02","2021-06-17","2021-06-17","2021-06-17","2021-06-03","2021-06-11","2021-06-11","2021-06-11","2021-06-11","2021-06-11","2021-06-11","2021-06-11","2021-06-11","2021-06-11","2021-06-17"],"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":[["","73070010315","INSULIN ASPA","INJ FLEXPEN","","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","","Select","Select",""],["","43547035411","LISINOPRIL","TAB 20MG","","Select","Select",""],["","59310057922","PROAIR HFA","AER ","","Select","Select",""],["","69097094312","GABAPENTIN","CAP 300MG","","Select","Select",""],["","310737020","BUDES\/FORMOT","AER 160-4.5","","Select","Select",""],["","591565810","CYCLOBENZAPR","TAB 10MG","","Select","Select",""],["","88221905","LANTUS SOLOS","INJ 100\/ML","","Select","Select",""],["","23155010410","METFORMIN","TAB 1000MG","","Select","Select",""],["","49884012305","LABETALOL","TAB 200MG","","Select","Select",""],["","62175089741","ATORVASTATIN","TAB 80MG","","Select","Select",""],["","29300024310","AMLODIPINE","TAB 10MG","","Select","Select",""],["","13668042905","PANTOPRAZOLE","TAB 40MG","","Select","Select",""],["","69117101003","CLOPIDOGREL","TAB 75MG","","Select","Select",""],["","378041510","DIPHEN\/ATROP","TAB 2.5MG","","Select","Select",""],["","597015230","JARDIANCE","TAB 10MG","","Select","Select",""],["","68382009810","PAROXETINE","TAB 20MG","","Select","Select",""],["","143122701","DICYCLOMINE","TAB 20MG","","Select","Select",""],["","2771559","BASAGLAR","INJ 100UNIT","","Select","Select",""],["","173068220","VENTOLIN HFA","AER ","","Select","Select",""],["","169633910","NOVOLOG","INJ FLEXPEN","","Select","Select",""],["","60505100301","KETOROLAC","SOL 0.005","","Select","Select",""],["","193731221","CONTOUR","TES NEXT","","Select","Select",""],["","68180030360","CEFUROXIME","TAB 500MG","","Select","Select",""],["","64764017530","DEXILANT","CAP 60MG DR","","Select","Select",""],["","50111033401","METRONIDAZOL","TAB 500MG","","Select","Select",""],["","61314063710","PREDNISOLONE","SUS 1% OP","","Select","Select",""],["","24208060203","PROLENSA","SOL 0.0007","","Select","Select",""],["","93317431","ALBUTEROL SUL","FAT E","","Select","Select",""],["","65862084003","MOXIFLOXACIN","SOL HCL 0.5%","","Select","Select",""],["","93220401","METOCLOPRAM","TAB 5MG","","Select","Select",""],["","24208060203","PROLENSA ","SOL 0.0007","3","Select","Select",""],["","591565810","CYCLOBENZAPR ","TAB 10MG","45","Select","Select",""],["","43547035411","LISINOPRIL ","TAB 20MG","90","Select","Select",""],["","88221905","LANTUS ","INJ 100\/ML","45","Select","Select",""],["","73070010315","INSULIN ","INJ FLEXPEN","45","Select","Select",""],["","66993001968","ALBUTEROL ","AER HFA","18","Select","Select",""],["","59310057922","PROAIR ","AER ","25.5","Select","Select",""],["","310737020","BUDES\/FORMOT ","AER 160-4.5","10.2","Select","Select",""],["","69097094312","GABAPENTIN ","CAP 300MG","270","Select","Select",""],["","64764017530","DEXILANT ","CAP 60MG DR","30","Select","Select",""],["","68382009810","PAROXETINE ","TAB 20MG","90","Select","Select",""],["","13668042905","PANTOPRAZOLE ","TAB 40MG","90","Select","Select",""],["","49884012305","LABETALOL ","TAB 200MG","180","Select","Select",""],["","29300024310","AMLODIPINE ","TAB 10MG","90","Select","Select",""],["","16729004716","ATORVASTATIN ","TAB 80MG","90","Select","Select",""],["","23155010410","METFORMIN ","TAB 1000MG","180","Select","Select",""],["","50228012410","CLOPIDOGREL ","TAB 75MG","90","Select","Select",""],["","597015230","JARDIANCE ","TAB 10MG","30","Select","Select",""],["","378041510","DIPHEN\/ATROP ","TAB 2.5MG","20","Select","Select",""],["","2771559","BASAGLAR ","INJ 100UNIT","30","Select","Select",""],["","143122701","DICYCLOMINE ","TAB 20MG","120","Select","Select",""],["","173068220","VENTOLIN ","AER ","36","Select","Select",""],["","65862084003","MOXIFLOXACIN ","SOL HCL 0.5%","3","Select","Select",""],["","60505100301","KETOROLAC ","SOL 0.005","5","Select","Select",""],["","68180030360","CEFUROXIME ","TAB 500MG","10","Select","Select",""],["","169633910","NOVOLOG ","INJ FLEXPEN","45","Select","Select",""],["","193731221","CONTOUR ","TES NEXT","300","Select","Select",""],["","93220401","METOCLOPRAM ","TAB 5MG","2","Select","Select",""],["","67877025130","TRIAMCINOLON ","0.10%","30","Select","Select",""],["","50111033401","METRONIDAZOL ","500MG","21","Select","Select",""],["","61314063710","PREDNISOLONE ","1% OP","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":[[["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","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":""}]}]}