{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"GEORGIA JONES","gend":1,"add":"413 W MONITOR ROAD","city":"AMHERST","state":"VA","zip":245219999,"dob":"1943-12-02","age":"","mstatus":"","insh":11008522,"cliId":"1GQ4PQ3EE93","pno":4342136412,"cno":4349460906,"email":"","ename":"","eno":"","pphy":"ZAMAN, SAMIRA","ppno":4349245348,"pcpadd":"1221 Lee Street","pcpcity":"Charlottesville","pcpstate":"VA","pcpzip":229080001,"pcpcounty":"","pcpid":"P9409321","pcpname":"CENTRA MEDICAL GROUP","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":"Previously Documented Conditions","q":[{"a":{"diag":["R39.81","N39.46","I12.9","N18.4","D64.9","E55.9","E11.42","E11.9","I67.9","I13.0","E11.22","D63.1","H40.9","E78.5","M06.9","R53.1","R53.81","R26.89","Z91.81","Z79.84","Z79.02","Z79.82","H40.1133","H18.20","Z96.1","H54.0X33","I51.9","I67.1","I50.20","E11.40","I50.32","G93.41","N39.0","E87.0","Z86.73","Z83.3","Z82.49","Z82.3","Z79.899","R40.4","R09.02","T14.8XXA","L08.9","R42","Z02.2","M62.81","R26.2","D63.8","I10","E11.319","E11.21","F01.50","E16.2","B96.89","F03.90","Z78.9","K92.9","Z23","D50.9","R19.5","Z79.01","H54.7","B37.81","K92.2","E87.6","M79.642","M79.641","I11.0","Z68.23","I50.9","I87.2","E11.39","H54.3","N18.9","M24.542","M72.0","I63.89","E78.9","I63.9","Z86.79","M25.642","R90.89","G93.89","I67.89","R26.9","B20","N28.9","R27.0","R63.0","R79.89","N17.9","E11.65","E86.1","R13.10","I69.393","R41.82","I51.7","R26.81","M05.9","J30.9","G62.9","G93.40","I21.4","E86.0","K92.1","I21.A1","D62","Z11.59","R29.810","R40.20","R41.0","G31.9","R10.9","I50.21","K29.50","K44.9","K29.70","E11.649","R77.9","G93.9","E16.1","I49.9","Z71.89","E11.00","Z53.20","Z09","B96.1","D50.0","H54.8","I34.0"],"date":["2021-04-07","2021-04-07","2021-02-03","2021-02-03","2020-10-19","2021-02-03","2020-08-21","2020-10-16","2020-10-01","2020-10-16","2020-10-16","2021-02-03","2020-10-16","2020-10-16","2020-10-16","2020-08-31","2020-08-21","2020-08-21","2020-08-21","2020-08-31","2020-08-21","2020-10-16","2020-07-16","2020-07-16","2020-07-16","2020-08-28","2021-04-07","2021-04-07","2021-04-07","2021-04-07","2021-03-19","2020-10-01","2020-10-16","2020-08-31","2020-08-31","2020-08-31","2020-08-31","2020-08-31","2020-08-31","2020-08-31","2020-08-31","2020-08-31","2020-08-31","2020-08-31","2020-09-02","2020-10-01","2020-10-01","2020-10-01","2020-10-01","2020-10-01","2020-10-01","2020-10-01","2020-09-07","2020-09-07","2020-09-15","2020-09-17","2020-09-23","2019-10-15","2020-10-17","2020-10-16","2020-10-16","2020-10-16","2020-10-17","2020-10-17","2020-10-19","2019-11-13","2019-12-04","2019-12-20","2019-12-20","2019-12-20","2019-12-20","2019-12-20","2019-12-20","2020-06-12","2020-03-10","2020-01-22","2020-02-26","2020-03-05","2020-03-13","2020-03-05","2020-03-10","2020-03-13","2020-03-13","2020-04-29","2020-04-29","2020-04-02","2020-04-25","2020-04-25","2020-04-25","2020-04-25","2020-05-10","2020-04-24","2020-04-24","2020-04-24","2020-04-24","2020-05-16","2020-04-24","2020-05-16","2020-05-16","2020-05-16","2020-04-29","2020-05-19","2020-05-18","2020-05-10","2020-10-16","2020-05-10","2020-05-10","2020-05-10","2020-05-10","2020-05-19","2020-05-10","2020-05-10","2020-05-10","2020-05-11","2020-05-12","2020-05-12","2020-05-12","2020-06-12","2020-05-19","2020-05-19","2020-05-19","2020-05-19","2020-05-20","2020-05-21","2020-05-21","2020-06-12","2020-10-16","2020-10-16","2020-10-16","2020-10-16"],"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":[["","65862035790","CLOPIDOGREL","TAB 75MG","","Select","Select",""],["","10370074501","GLIPIZIDE ER","TAB 5MG","","Select","Select",""],["","70377002811","ATORVASTATIN","TAB 20MG","","Select","Select",""],["","23155000301","HYDRALAZINE","TAB 50MG","","Select","Select",""],["","93742698","MONTELUKAST","TAB 10MG","","Select","Select",""],["","69097094312","GABAPENTIN","CAP 300MG","","Select","Select",""],["","23155012001","ACETAZOLAMID","CAP 500MG ER","","Select","Select",""],["","245531911","KLOR-CON M20","TAB 20MEQ ER","","Select","Select",""],["","23921105","COMBIGAN","SOL 0.2\/0.5%","","Select","Select",""],["","6022131","JANUVIA","TAB 25MG","","Select","Select",""],["","76385011350","CARVEDILOL","TAB 25MG","","Select","Select",""],["","59310057922","PROAIR HFA","AER ","","Select","Select",""],["","68180072003","AMLODIPINE","TAB 5MG","","Select","Select",""],["","60505059304","TRAVOPROST","DRO 0.00004","","Select","Select",""],["","378021610","FUROSEMIDE","TAB 40MG","","Select","Select",""],["","53885039310","ONETOUCH US","MIS LANCETS","","Select","Select",""],["","65862007701","CIPROFLOXACN","TAB 500MG","","Select","Select",""],["","54418425","DEXAMETHASON","TAB 4MG","","Select","Select",""],["","23155060601","GLYCOPYRROL","TAB 1MG","","Select","Select",""],["","66993068130","OLANZAPINE","TAB 5MG","","Select","Select",""],["","65026025","TRAVATAN Z","DRO 0.00004","","Select","Select",""],["","13107008305","LORAZEPAM","TAB 0.5MG","","Select","Select",""],["","54038663","HYDROMORPHON","LIQ 1MG\/ML","","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","",false,""],["Yes","Select","",false,""],["Yes","Select","",false,""],["No","Select","",false,""],["N\/A","Select","",false,""],["Yes","Select","",false,""],["No","Select","",false,""]]]},{"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":""}]}]}