{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LARRY RUDDLE","gend":0,"add":"7066HAT CREEK LANE","city":"BROADWAY ","state":"VA","zip":"22815-2680","dob":"1950-07-09","age":"","mstatus":"","insh":11012099,"cliId":"4YX7DR9NP40","pno":5405781899,"cno":5405781899,"email":"","ename":"","eno":"","pphy":"RICE, GILBERT C","ppno":5409010800,"pcpadd":"165 New Market Rd","pcpcity":"Timberville ","pcpstate":"VA","pcpzip":228539715,"pcpcounty":"","pcpid":"P0143279","pcpname":"SRMH EVERLYN BRYD HEALTH CENTER","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"","add2":"APARTMENT B ","add3":"","madd1":"7066HAT CREEK LANE","madd2":"APARTMENT B ","madd3":"","mcity":"BROADWAY ","mstate":"VA","mzip":"22815-2680","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["G47.33","R55","G47.10","I10","R07.9","R91.8","J98.4","R94.39","E78.5","R06.02","Z01.812","I25.10","I27.20","E66.9","M10.9","R62.50","F81.9","F32.9","F41.9","Z79.82","Z68.42","R06.09","E78.2","E55.9","M1A.9XX0","E66.09","Z99.89","Z23","R06.83","H90.3","Z20.828","Z20.9","H90.5","F89","Z12.5","R21","Z00.00","H61.23","E03.9","T16.1XXA","T16.2XXA","N39.498","N32.81","I49.3"],"date":["2021-10-22","2020-10-06","2021-10-22","2021-07-02","2020-06-05","2020-05-05","2020-05-05","2020-06-05","2021-11-10","2021-11-10","2020-06-01","2021-11-10","2020-06-05","2020-06-05","2020-06-05","2021-07-02","2020-06-11","2021-07-02","2020-06-05","2020-06-05","2020-06-05","2020-06-05","2021-07-02","2021-07-02","2021-07-02","2021-07-02","2021-07-02","2021-10-01","2020-10-06","2021-01-05","2021-01-23","2021-01-23","2021-01-27","2021-03-11","2021-03-11","2021-04-23","2021-03-11","2021-06-30","2021-07-02","2020-09-30","2020-09-30","2021-11-23","2021-11-23","2021-11-10"],"priorHcc":["","","","","","","","",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":[["","68645055354","LISINOPRIL","TAB 20MG","","Select","Select",""],["","16714004107","ALLOPURINOL","TAB 100MG","","Select","Select",""],["","68645056854","ATORVASTATIN","TAB 40MG","","Select","Select",""],["","45802006435","TRIAMCINOLON","CRE 0.001","","Select","Select",""],["","65862069730","VENLAFAXINE","CAP 150MG ER","","Select","Select",""],["","68645055354","LISINOPRIL ","TAB 20MG","90","Select","Select",""],["","16714004107","ALLOPURINOL ","TAB 100MG","90","Select","Select",""],["","31722000490","VENLAFAXINE ","CAP 150MG ER","90","Select","Select",""],["","68645056854","ATORVASTATIN ","TAB 40MG","90","Select","Select",""],["","45802006435","TRIAMCINOLON ","CRE 0.001","45","Select","Select",""],["","68462029817","CLOTRIM\/BETA ","DIPROP","30","Select","Select",""],["","72305005030","EUTHYROX ","50MCG","60","Select","Select",""],["","72305005030","EUTHYROX","50MCG","60","Select","Select",""],["","68462029817","CLOTRIM\/BETA","DIPROP","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":[[["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","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":""}]}]}