{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JOYCE G FARMER","gend":1,"add":"329 STANLEY DR ","city":"DANVILLE ","state":"VA","zip":"24541-9998","dob":"1962-03-26","age":"","mstatus":"","insh":11012124,"cliId":"3RR9ET1XY21","pno":4344296743,"cno":4344296743,"email":"","ename":"","eno":"","pphy":"ULEP, REBECCA R","ppno":4347994495,"pcpadd":"142 S Main St","pcpcity":"Danville ","pcpstate":"VA","pcpzip":245412922,"pcpcounty":"","pcpid":"P0124059","pcpname":"DANVILLE PHYSICIAN PRACTICES LLC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"","add2":"","add3":"","madd1":"329 STANLEY DR ","madd2":"","madd3":"","mcity":"DANVILLE ","mstate":"VA","mzip":"24541-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["G47.10","G89.29","Z68.43","M48.061","E10.41","M54.16","E11.9","G62.9","I11.0","F43.22","K21.9","R05","I10","G47.00","E66.9","G44.209","E11.8","I11.9","G89.4","M54.5","G47.30","G47.33","G47.61","M47.26","M19.90","M17.0","E11.40","Z79.4","E66.01","M47.816","I27.0","L29.9","G56.03","G60.9","F17.200","Z20.828","E78.5","I87.2","I82.403","R07.2","Z79.84","Z79.01","Z68.42","F17.210","Z82.49","E10.9","H25.13","M79.2","M47.812","G56.22","R13.10","K57.90","Z86.010","K44.9","M51.36","M25.522","R22.32","Z79.82","Z79.899","Z03.818","T18.2XXA","K22.2","Z51.81","E11.42","Z99.89","Z97.3","K59.09","K64.9","F33.0","R26.89","E78.2","B37.3","D17.20","R52","Z74.3","R25.2","Z53.20","M51.17","M47.27","M48.07","M43.17","F41.1","G56.02","M50.91","M54.50","Z28.21"],"date":["2020-03-10","2021-10-13","2020-10-28","2021-11-04","2020-10-13","2021-11-04","2021-10-13","2021-06-16","2021-11-22","2021-11-15","2021-05-13","2020-04-21","2021-10-13","2021-10-13","2020-08-27","2021-01-25","2021-11-22","2020-11-04","2020-08-06","2021-09-08","2020-08-27","2020-08-27","2020-08-27","2021-04-08","2020-09-02","2021-08-10","2021-11-15","2021-11-28","2021-05-24","2021-08-10","2020-09-16","2020-09-20","2021-10-13","2020-10-05","2021-01-25","2021-04-15","2021-02-02","2020-10-08","2020-10-08","2020-10-08","2021-04-08","2021-07-22","2021-04-29","2021-04-29","2020-10-15","2020-10-19","2020-10-19","2021-10-13","2020-10-28","2021-10-20","2021-05-13","2021-02-04","2021-02-04","2021-02-04","2021-11-04","2021-02-17","2021-11-18","2021-04-08","2021-04-29","2021-04-15","2021-05-13","2021-05-13","2021-05-24","2020-10-28","2020-10-28","2020-10-28","2020-10-28","2020-10-28","2020-10-28","2020-10-28","2021-11-15","2021-11-15","2021-07-27","2021-09-08","2021-09-08","2021-09-08","2021-09-08","2021-09-29","2021-09-29","2021-09-29","2021-09-29","2021-10-13","2021-11-18","2021-11-18","2021-11-04","2021-11-15"],"priorHcc":["","","",null,"",null,null,"",null,null,"","",null,"","","",null,"","","","","","","","","",null,null,"","","","","","","","","","","","","","","","","","","","","","","","","","",null,"",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":[["","60505264807","TIZANIDINE","CAP 2MG","","Select","Select",""],["","169406013","VICTOZA","INJ 18MG\/3ML","","Select","Select",""],["","93015010","APAP\/CODEINE","TAB 300-30MG","","Select","Select",""],["","67877032105","IBUPROFEN","TAB 800MG","","Select","Select",""],["","62175061743","PANTOPRAZOLE","TAB 40MG","","Select","Select",""],["","10702001150","HYDROXYZ HCL","TAB 25MG","","Select","Select",""],["","13668013601","ESCITALOPRAM","TAB 10MG","","Select","Select",""],["","43598029690","PREGABALIN","CAP 200MG","","Select","Select",""],["","14539067401","HYDROXYZ PAM","CAP 25MG","","Select","Select",""],["","93816201","QUETIAPINE","TAB 100MG","","Select","Select",""],["","76385011250","CARVEDILOL","TAB 12.5MG","","Select","Select",""],["","68382097001","CHLORTHALID","TAB 25MG","","Select","Select",""],["","68462033290","PRAMIPEXOLE","TAB 0.5MG","","Select","Select",""],["","17478071130","LIDOCAINE","GEL 2% JELLY","","Select","Select",""],["","53885027210","ONETOUCH","TES VERIO","","Select","Select",""],["","169255013","TRESIBA FLEX","INJ 200UNIT","","Select","Select",""],["","3089421","ELIQUIS","TAB 5MG","","Select","Select",""],["","6008061","JANUMET XR","TAB 50-1000","","Select","Select",""],["","65162083909","VALSARTAN","TAB 160MG","","Select","Select",""],["","51991074890","DULOXETINE","CAP 60MG","","Select","Select",""],["","904639061","LOSARTAN POT","TAB 50MG","","Select","Select",""],["","72511076002","REPATHA SURE","INJ 140MG\/ML","","Select","Select",""],["","378064110","PREDNISONE","TAB 10MG","","Select","Select",""],["","69097094312","GABAPENTIN","CAP 300MG","","Select","Select",""],["","13107015590","PAROXETINE","TAB 20MG","","Select","Select",""],["","45802005435","TRIAMCINOLON","OIN 0.00025","","Select","Select",""],["","10702001150","HYDROXYZ ","TAB 25MG","60","Select","Select",""],["","93015010","APAP\/CODEINE ","TAB 300-30MG","60","Select","Select",""],["","93816201","QUETIAPINE ","TAB 100MG","30","Select","Select",""],["","13668013601","ESCITALOPRAM ","TAB 10MG","30","Select","Select",""],["","43598029690","PREGABALIN ","CAP 200MG","60","Select","Select",""],["","67877032105","IBUPROFEN ","TAB 800MG","30","Select","Select",""],["","60505264807","TIZANIDINE ","CAP 2MG","30","Select","Select",""],["","17478071130","LIDOCAINE ","GEL 2% JELLY","30","Select","Select",""],["","169406013","VICTOZA ","INJ 18MG\/3ML","27","Select","Select",""],["","62175061743","PANTOPRAZOLE ","TAB 40MG","90","Select","Select",""],["","76385011250","CARVEDILOL ","TAB 12.5MG","180","Select","Select",""],["","169255013","TRESIBA ","INJ 200UNIT","18","Select","Select",""],["","68382097001","CHLORTHALID ","TAB 25MG","90","Select","Select",""],["","68462033290","PRAMIPEXOLE ","TAB 0.5MG","90","Select","Select",""],["","6008061","JANUMET ","TAB 50-1000","90","Select","Select",""],["","53885027210","ONETOUCH ","TES VERIO","100","Select","Select",""],["","3089421","ELIQUIS ","TAB 5MG","60","Select","Select",""],["","65162083909","VALSARTAN ","TAB 160MG","90","Select","Select",""],["","64764017530","DEXILANT ","CAP 60MG DR","90","Select","Select",""],["","65862085901","FAMOTIDINE ","TAB 20MG","180","Select","Select",""],["","45802005435","TRIAMCINOLON ","OIN 0.00025","60","Select","Select",""],["","904639061","LOSARTAN ","TAB 50MG","90","Select","Select",""],["","51991074890","DULOXETINE ","CAP 60MG","30","Select","Select",""],["","13107015590","PAROXETINE ","TAB 20MG","90","Select","Select",""],["","378064110","PREDNISONE ","TAB 10MG","48","Select","Select",""],["","72511076002","REPATHA ","INJ 140MG\/ML","2","Select","Select",""],["","69547035302","NARCAN ","","2","Select","Select",""],["","69097094312","GABAPENTIN ","300MG","81","Select","Select",""],["","10702001150","HYDROXYZ","25MG","60","Select","Select",""],["","53746010901","HYDROCO\/APAP","5-325MG","14","Select","Select",""],["","00169255013","TRESIBA","200UNIT","18","Select","Select",""],["","00006008061","JANUMET","50-1000","90","Select","Select",""],["","70710113908","FLUCONAZOLE","150MG","2","Select","Select",""],["","64764017530","DEXILANT","60MG DR","90","Select","Select",""],["","00904639061","LOSARTAN","50MG","90","Select","Select",""],["","65862085901","FAMOTIDINE","20MG","180","Select","Select",""],["","69547035302","NARCAN","","2","Select","Select",""],["","72511076002","REPATHA","140MG\/ML","2","Select","Select",""],["","69097084507","CYCLOBENZAPR","5MG","30","Select","Select",""],["","53746010901","HYDROCO\/APAP ","TAB 5-325MG","14","Select","Select",""],["","69097084507","CYCLOBENZAPR ","TAB 5MG","30","Select","Select",""],["","70710113908","FLUCONAZOLE ","TAB 150MG","2","Select","Select",""],["","60505384801","CELECOXIB ","CAP 100MG","60","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":""}]}]}