{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"RAHIMA NAZARY","gend":1,"add":"13637 NEWTONMORE PLACE  ","city":"BRISTOW  ","state":"VA","zip":"20136-9998","dob":"1944-07-01","age":"","mstatus":"","insh":11012422,"cliId":"4QX2AV1FK05","pno":7033502452,"cno":7033502452,"email":"","ename":"","eno":"","pphy":"CHAMBERS, JOSEPH F","ppno":7033683161,"pcpadd":"8640 SUDLEY RD,STE 203","pcpcity":"MANASSAS ","pcpstate":"VA","pcpzip":201104404,"pcpcounty":"","pcpid":"P9444487","pcpname":"NOVANT HEALTH UVA HEALTH SYSTEM BRISTOW RUN","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"NORTHERN & WINCHESTER","aligned":"Y","ano":"","add2":"","add3":"","madd1":"13637 NEWTONMORE PLACE  ","madd2":"","madd3":"","mcity":"BRISTOW  ","mstate":"VA","mzip":"20136-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["ASIAN\/PACIFIC"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["J45.51","G20","I67.89","G25.0","K21.9","M25.511","M25.512","M43.12","M40.204","M41.9","M50.321","M47.814","M47.816","M54.9","M48.061","J45.998","I67.9","M47.812","M48.02","M54.2","G89.29","Z79.891","M54.12","M48.062","M54.6","Z51.81","S32.010A","S32.030A","H54.40","M48.00","I10","J45.20","M19.90","Z93.1","Z68.24","M47.899","G89.4","M50.20","M43.02","M43.03","M19.012","M47.22","J44.9","M54.5","T14.8XXA","R05","J92.9","Z00.00","E78.00","D64.9","R63.4","M17.9","J45.909","R91.8"],"date":["2020-04-13","2021-10-01","2020-06-19","2020-06-19","2021-08-23","2021-01-12","2021-01-12","2021-02-15","2020-07-17","2020-07-17","2020-07-17","2020-07-17","2020-07-17","2020-07-17","2020-07-17","2021-05-26","2021-04-12","2021-02-15","2021-02-15","2021-02-15","2021-02-15","2021-02-15","2021-03-08","2021-02-15","2021-02-15","2021-02-15","2020-06-29","2020-06-29","2020-07-10","2020-07-10","2020-07-10","2020-07-10","2020-07-10","2020-07-10","2020-07-10","2020-08-03","2020-08-03","2020-08-03","2020-08-20","2020-08-20","2020-12-04","2020-12-04","2021-06-14","2020-07-17","2020-07-17","2021-05-26","2021-06-14","2021-10-13","2021-11-05","2021-11-05","2021-11-05","2021-10-13","2021-10-13","2021-06-14"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",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":[["","70461012003","FLUAD QUADRI","INJ 0.5ML","","Select","Select",""],["","57664037708","TRAMADOL HCL","TAB 50MG","","Select","Select",""],["","591555410","PROPRANOLOL","TAB 10MG","","Select","Select",""],["","16714097601","DICLOFENAC","GEL 0.01","","Select","Select",""],["","487950125","ALBUTEROL","NEB 0.00083","","Select","Select",""],["","65862057490","MONTELUKAST","TAB 10MG","","Select","Select",""],["","16714073601","ESOMEPRA MAG","CAP 40MG DR","","Select","Select",""],["","59762444002","METHYLPRED","TAB 4MG","","Select","Select",""],["","62175061746","PANTOPRAZOLE","TAB 40MG","","Select","Select",""],["","310737020","BUDES\/FORMOT","AER 160-4.5","","Select","Select",""],["","16714066101","GABAPENTIN","CAP 100MG","","Select","Select",""],["","406048401","APAP\/CODEINE","TAB 300-30MG","","Select","Select",""],["","58160082311","SHINGRIX","INJ 50\/0.5ML","","Select","Select",""],["","58160082311","SHINGRIX ","INJ 50\/0.5ML","1","Select","Select",""],["","70461012003","FLUAD ","INJ 0.5ML","0.5","Select","Select",""],["","57664037708","TRAMADOL ","TAB 50MG","60","Select","Select",""],["","591555410","PROPRANOLOL ","TAB 10MG","90","Select","Select",""],["","65862057490","MONTELUKAST ","TAB 10MG","90","Select","Select",""],["","16714097601","DICLOFENAC ","GEL 0.01","400","Select","Select",""],["","16714098001","ESOMEPRA ","CAP 40MG DR","30","Select","Select",""],["","487950125","ALBUTEROL ","NEB 0.00083","300","Select","Select",""],["","59762444002","METHYLPRED ","TAB 4MG","21","Select","Select",""],["","62175061746","PANTOPRAZOLE ","TAB 40MG","30","Select","Select",""],["","310737020","BUDES\/FORMOT ","AER 160-4.5","10.2","Select","Select",""],["","16714066101","GABAPENTIN ","CAP 100MG","90","Select","Select",""],["","406048401","APAP\/CODEINE ","TAB 300-30MG","28","Select","Select",""],["","16714098801","ROSUVASTATIN ","TAB 5MG","30","Select","Select",""],["","00173088210","BREO ","200-25","60","Select","Select",""],["","70461012003","FLUAD","0.5ML","0.5","Select","Select",""],["","16714098801","ROSUVASTATIN","5MG","30","Select","Select",""],["","57664037708","TRAMADOL","50MG","60","Select","Select",""],["","00173088210","BREO","200-25","60","Select","Select",""],["","16714098001","ESOMEPRA","40MG DR","30","Select","Select",""],["","00172572860","FAMOTIDINE","20MG","60","Select","Select",""],["","00172572860","FAMOTIDINE ","TAB 20MG","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":[[["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","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":""}]}]}