{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"VANESSA REEVES","gend":1,"add":"148 ANDES DR","city":"DANVILLE","state":"VA","zip":245409999,"dob":"1954-07-02","age":"","mstatus":"","insh":11009648,"cliId":"9G99U44CA20","pno":4348362481,"cno":"","email":"","ename":"","eno":"","pphy":"WINFIELD II, ALBERT C","ppno":4347930700,"pcpadd":"441 Piney Forest Rd","pcpcity":"DANVILLE","pcpstate":"VA","pcpzip":245404154,"pcpcounty":"DANVILLE CITY","pcpid":"P0060246","pcpname":"PROVIDENCE FAMILY AND SPORTS MEDICINE INC","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":["R26.9","R53.1","Z89.612","I10","E11.9","Z79.899","E78.5","Z13.29","E87.5","N18.9","A41.51","E11.10","R65.21","J96.01","G92","N17.0","N39.0","E87.1","E44.0","Z68.41","N18.4","D75.82","J45.909","E83.42","E11.65","R06.9","R09.02","R00.0","R06.2","R06.02","E13.10","R39.81","J18.9","M62.81","R26.2","E66.01","E11.8","L89.616","L24.89","Z99.2","D64.9","N17.9","T82.898A","Z23","D50.9","T82.49XA","N18.6","Z79.01","I48.91","K52.1","E03.9","G62.9","E86.9","R17","R50.9","R31.9","R82.71","A49.9","Z16.12","D63.1","R03.1","Z95.828","N25.81","S70.312A","R23.8","I77.9","J96.90","E11.42","Z89.9","Z20.828","Z89.512","Z01.810","R07.89","E11.621","L97.519","L03.115","J44.9","Z88.6","Z88.1","Z87.891","Z89.619","R52","L89.612","E10.40","E10.22","I12.0","Z88.0","I77.1","L89.610","E11.40","N18.5","I95.9","R69","Z01.812","E11.51","E11.22","E87.79","T85.9XXA","E11.59","I87.2","I87.9","Z79.4","Z20.822","S91.001A","E10.69","M86.8X7","E55.9","M86.38","E10.621","S91.001D","L97.312","R60.0","L89.513","M86.171","I73.9","Z13.6","E78.00","E10.9","T82.868A","E13.621","Z29.8","T82.594A","K21.9","I12.9","T85.698A","M86.9","M86.172","I95.3","I95.89","L97.315","L89.613","L97.812","L89.614","E11.622","M86.671","L97.912","M86.371","L84","Z41.8","J45.20","M21.961","R11.0","T82.858A","U07.1"],"date":["2020-03-31","2020-03-31","2021-06-11","2021-03-11","2020-12-08","2021-06-02","2020-12-08","2020-03-23","2020-12-12","2020-12-17","2020-09-01","2020-06-03","2020-09-01","2020-09-01","2020-06-03","2020-06-22","2020-09-01","2020-06-26","2020-09-01","2021-01-28","2021-01-18","2020-05-18","2021-06-07","2020-05-18","2020-12-12","2020-05-18","2020-05-18","2020-05-18","2020-05-18","2020-05-18","2020-05-18","2021-05-28","2020-09-01","2020-09-11","2020-09-01","2021-05-27","2020-09-01","2020-09-01","2020-09-01","2021-06-14","2020-12-12","2021-06-21","2021-06-02","2021-01-04","2021-05-24","2020-12-30","2021-06-14","2021-03-02","2020-06-10","2020-06-23","2020-06-23","2021-03-09","2020-06-26","2021-06-14","2020-08-13","2020-07-10","2020-07-10","2020-07-14","2020-07-14","2021-05-03","2020-07-30","2020-07-30","2021-06-14","2020-08-11","2020-08-11","2020-08-13","2020-08-13","2020-08-13","2020-08-13","2020-12-12","2020-09-11","2020-11-24","2020-11-12","2020-11-22","2020-11-22","2020-11-22","2020-12-09","2020-12-09","2020-11-22","2021-06-07","2020-11-22","2020-12-01","2021-05-13","2021-06-07","2021-06-07","2021-06-07","2021-06-14","2021-03-18","2021-06-11","2021-06-11","2021-06-06","2020-12-09","2020-12-09","2020-12-09","2020-12-09","2021-04-29","2021-02-01","2020-12-12","2020-12-17","2021-04-15","2020-12-31","2021-03-02","2021-01-11","2021-01-21","2021-06-07","2021-04-01","2021-01-28","2021-01-28","2021-05-27","2021-01-28","2021-04-15","2021-06-07","2021-05-07","2021-06-06","2021-03-18","2021-02-11","2021-03-02","2021-02-11","2020-12-11","2020-11-24","2020-12-02","2020-12-12","2020-12-12","2020-12-12","2020-12-12","2021-05-06","2021-04-02","2021-02-01","2021-02-01","2021-04-01","2021-06-06","2021-04-01","2021-06-07","2021-04-15","2021-06-28","2021-05-07","2021-06-11","2021-06-07","2021-06-02","2021-06-06","2021-06-07","2021-06-14","2021-06-24","2020-11-27"],"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":[["","66993001968","ALBUTEROL","AER HFA","","Select","Select",""],["","88221905","LANTUS SOLOS","INJ 100\/ML","","Select","Select",""],["","68462039790","OMEPRAZOLE","CAP 40MG","","Select","Select",""],["","121057716","LACTULOSE","SOL 10GM\/15","","Select","Select",""],["","69097094312","GABAPENTIN","CAP 300MG","","Select","Select",""],["","62175061743","PANTOPRAZOLE","TAB 40MG","","Select","Select",""],["","70377002711","ATORVASTATIN","TAB 10MG","","Select","Select",""],["","50742061510","METOPROL SUC","TAB 25MG ER","","Select","Select",""],["","93317431","ALBUTEROL SUL","FAT E","","Select","Select",""],["","57664050658","METOPROL TAR","TAB 25MG","","Select","Select",""],["","50484001030","SANTYL","OIN 250\/GM","","Select","Select",""],["","169633910","NOVOLOG","INJ FLEXPEN","","Select","Select",""],["","23155053102","CALC ACETATE","CAP 667MG","","Select","Select",""],["","50458057760","XARELTO","TAB 2.5MG","","Select","Select",""],["","66733082259","INSULIN LISP","INJ 100\/ML","","Select","Select",""],["","63304069205","CLINDAMYCIN","CAP 150MG","","Select","Select",""],["","49230064331","PHOSLYRA","SOL ","","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","","Select","Select",""],["","53436008404","VELTASSA","POW 8.4GM","","Select","Select",""],["","88221905","LANTUS ","INJ 100\/ML","3","Select","Select",""],["","66993001968","ALBUTEROL ","AER HFA","18","Select","Select",""],["","68462039790","OMEPRAZOLE ","CAP 40MG","30","Select","Select",""],["","121057716","LACTULOSE ","SOL 10GM\/15","473","Select","Select",""],["","66733082259","INSULIN ","INJ 100\/ML","3","Select","Select",""],["","49230064331","PHOSLYRA ","SOL ","473","Select","Select",""],["","50742061510","METOPROL ","TAB 25MG ER","17","Select","Select",""],["","69097094312","GABAPENTIN ","CAP 300MG","60","Select","Select",""],["","169633910","NOVOLOG ","INJ FLEXPEN","15","Select","Select",""],["","781208102","CALC ","CAP 667MG","90","Select","Select",""],["","62175061743","PANTOPRAZOLE ","TAB 40MG","30","Select","Select",""],["","60505257809","ATORVASTATIN ","TAB 10MG","30","Select","Select",""],["","59922063101","AURYXIA ","TAB 210MG","90","Select","Select",""],["","50484001030","SANTYL ","OIN 250\/GM","60","Select","Select",""],["","50458057760","XARELTO ","TAB 2.5MG","60","Select","Select",""],["","53436008404","VELTASSA ","POW 8.4GM","32","Select","Select",""],["","53746010901","HYDROCO\/APAP ","TAB 5-325MG","20","Select","Select",""],["","143992801","CIPROFLOXACN ","500MG","14","Select","Select",""],["","59651024701","MIDODRINE ","5MG","36","Select","Select",""],["","63304069205","CLINDAMYCIN ","150MG","42","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":""}]}]}