{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ARLENE BARKSDALE","gend":1,"add":"2130 UNION GROOVE RD ","city":"SOUTH BOSTON","state":"VA","zip":"24592-9998","dob":"1959-06-19","age":"","mstatus":"","insh":11010417,"cliId":"4W99RN3WK26","pno":4345799587,"cno":4345799587,"email":"","ename":"","eno":"","pphy":"KING, BRODERICK D ","ppno":4345751336,"pcpadd":"101 Aubreys Loop,Ste C","pcpcity":"South Boston","pcpstate":"VA","pcpzip":245925054,"pcpcounty":"","pcpid":"P9058683","pcpname":"HALIFAX PRIMARY CARE","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"","add2":"","add3":"","madd1":"PO BOX 211  ","madd2":"","madd3":"","mcity":"HALIFAX  ","mstate":"VA","mzip":"24558-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["Z11.3","I10","I11.9","E78.49","E11.9","E66.01","M54.16","M47.816","M51.36","M54.5","M51.37","M48.07","E13.69","N10","R10.9","N30.01","E78.2","T50.905S","E55.9","R10.84","R74.8","K76.0","N13.30","N76.0","A59.9","B96.89","K76.9","N20.1","N13.2","K82.8","K86.89","Z12.31","Z01.810","N20.0","Z01.818","Z01.812","Z20.828","E78.00","Z79.899","Z79.82","Z79.84","Z88.1","Z87.891","M19.90","N89.8","Z23","H35.3122","E11.65","H18.51","H25.13","Z12.4","R82.994","R63.8","Z01.419","Z80.3","M54.30","Z12.11","Z80.0","Z86.010","K63.5","K62.1","K57.30","E78.5","E21.3","H35.30","Z98.51","Z87.19","K75.81","D12.8","D12.3","H18.513","H52.4"],"date":["2021-11-16","2021-08-03","2020-02-03","2021-02-03","2021-10-11","2020-02-03","2020-02-07","2020-04-10","2020-04-10","2021-04-26","2020-02-28","2020-02-28","2020-03-12","2020-05-14","2020-05-14","2020-05-14","2021-08-03","2020-06-04","2021-07-01","2020-06-23","2020-06-23","2021-06-24","2020-07-23","2020-12-01","2020-07-16","2020-12-01","2020-07-23","2020-09-01","2020-07-23","2020-07-23","2020-07-23","2021-08-26","2020-08-18","2020-12-01","2020-08-24","2020-08-27","2020-12-01","2021-06-24","2020-09-01","2020-09-01","2020-09-01","2021-06-24","2021-06-24","2020-09-01","2020-09-10","2021-10-11","2021-11-23","2021-11-23","2020-09-29","2021-11-23","2021-01-22","2020-12-01","2020-12-01","2021-11-16","2021-01-22","2021-04-26","2021-06-24","2021-06-24","2021-06-24","2021-06-24","2021-06-24","2021-06-24","2021-06-24","2021-06-24","2021-06-24","2021-06-24","2021-06-24","2021-10-11","2021-06-24","2021-06-24","2021-11-23","2021-11-23"],"priorHcc":[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":[["","68645055254","LISINOPRIL","TAB 10MG","","Select","Select",""],["","68645057454","GLIPIZIDE","TAB 5MG","","Select","Select",""],["","6008061","JANUMET XR","TAB 50-1000","","Select","Select",""],["","68645056854","ATORVASTATIN","TAB 40MG","","Select","Select",""],["","65162047810","NITROFURANTN","CAP 100MG","","Select","Select",""],["","16571020210","DICLOFENAC","TAB 50MG DR","","Select","Select",""],["","50111033402","METRONIDAZOL","TAB 500MG","","Select","Select",""],["","10702000709","CYCLOBENZAPR","TAB 10MG","","Select","Select",""],["","65862007701","CIPROFLOXACN","TAB 500MG","","Select","Select",""],["","832105415","BACLOFEN","TAB 10MG","","Select","Select",""],["","50228046601","NABUMETONE","TAB 750MG","","Select","Select",""],["","406012301","HYDROCO\/APAP","TAB 5-325MG","","Select","Select",""],["","68645055254","LISINOPRIL ","TAB 10MG","90","Select","Select",""],["","68645057454","GLIPIZIDE ","TAB 5MG","60","Select","Select",""],["","6008061","JANUMET ","TAB 50-1000","30","Select","Select",""],["","16571020210","DICLOFENAC ","TAB 50MG DR","60","Select","Select",""],["","68645056854","ATORVASTATIN ","TAB 40MG","90","Select","Select",""],["","65862007701","CIPROFLOXACN ","TAB 500MG","20","Select","Select",""],["","65162047810","NITROFURANTN ","CAP 100MG","14","Select","Select",""],["","50111033402","METRONIDAZOL ","TAB 500MG","14","Select","Select",""],["","832105415","BACLOFEN ","TAB 10MG","21","Select","Select",""],["","50228046601","NABUMETONE ","TAB 750MG","7","Select","Select",""],["","10702000709","CYCLOBENZAPR ","10MG","30","Select","Select",""],["","406012301","HYDROCO\/APAP ","5-325MG","5","Select","Select",""],["","00006008061","JANUMET","50-1000","30","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","",""],["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":""}]}]}