{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JESSICA M ALLEY","gend":1,"add":"124 MOORE ST","city":"MADISON MILLS  ","state":"VA","zip":"22960-9998","dob":"1991-12-16","age":"","mstatus":"","insh":11013291,"cliId":"3WU9X13KR27","pno":5409208213,"cno":5409208213,"email":"","ename":"","eno":"","pphy":"COOLEY, AMY A  ","ppno":5409486871,"pcpadd":"13198 James Madison Hwy","pcpcity":"Orange","pcpstate":"VA","pcpzip":229602808,"pcpcounty":"","pcpid":"P9307431","pcpname":"ORANGE FAMILY PHYSICIANS","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"","add2":"","add3":"","madd1":"124 MOORE ST","madd2":"","madd3":"","mcity":"MADISON MILLS  ","mstate":"VA","mzip":"22960-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["K80.20","R10.11","R11.2","F17.200","J45.909","Z87.442","Z88.8","Z88.6","R10.9","N30.01","R10.31","F17.210","R10.84","R11.0","M25.512","X50.0XXA","S49.92XA","R07.9","Z79.899","Y93.89","F31.9","E66.9","Z68.41","X50.9XXD","M67.912","Z76.5","M75.52","M40.202","F31.62","N83.291","D72.828","N83.201","R58","R68.89","Z97.5","N83.8","R93.5","N83.292","R19.7","R42","S93.601A","X50.1XXA","W19.XXXA","S99.921A","M79.671","K04.7","K08.89","M75.102","G89.29","Z87.448","S49.90XA","Z88.5","R05","R06.02","K63.89","R10.32","Z79.891","R10.2","N30.00","N83.209","R10.30","M25.552","N89.8","R82.71","R31.9","N93.9","R55","N93.8","R53.1","Z91.19","Z59.7","Z96.652","Z20.822","Z87.42","Z74.3","M79.652","N83.202","R19.04","J06.9","R06.09","M79.10","Z98.890","Z20.828","N39.0","M51.36","N15.9","N73.0","N73.9","Z01.812","N80.3","N80.9","G89.18","Z79.1","R10.13","R10.12","S39.91XA","S39.93XA","F12.10","F12.90","N88.8","S60.221A","S69.91XA","Y04.0XXA","R11.10","R10.33","S83.92XA","S89.92XA","M25.562","S89.92XD","R20.2","X50.1XXD","M89.9","G89.4","D25.9","R35.0","Z01.818","J45.21","J30.1","Z72.0","J20.9","J45.901","R07.89","R07.81","F43.10","F11.11","N73.6","R19.8","Z01.810","I49.8","R10.817","S40.012A","Y93.72","Z90.711","N80.0","F17.21","Z68.39","W50.0XXA","R74.8","R09.81","Z79.51","Z90.710","M54.41","M54.5","M79.604","K86.89","R07.2","R51.9","D26.1","R10.816","R10.813"],"date":["2020-05-04","2021-08-13","2021-10-01","2021-07-03","2021-07-27","2021-05-26","2021-10-20","2021-10-20","2021-10-01","2020-05-05","2021-08-19","2021-10-20","2021-05-24","2021-07-28","2021-07-01","2020-06-23","2020-06-23","2020-06-11","2021-07-20","2021-04-18","2021-10-01","2021-03-15","2021-01-28","2020-06-28","2020-07-01","2021-04-07","2020-10-02","2020-07-28","2021-07-20","2020-12-26","2020-12-26","2020-08-22","2020-08-20","2021-03-30","2020-08-22","2021-01-22","2020-08-24","2020-09-03","2020-09-03","2021-02-07","2020-09-07","2020-09-07","2021-04-17","2020-09-07","2020-09-07","2020-09-11","2020-09-11","2020-09-21","2021-08-19","2020-09-21","2020-09-25","2021-10-20","2021-05-26","2020-11-21","2021-01-02","2021-05-01","2021-05-25","2021-10-20","2021-01-11","2021-01-11","2021-07-03","2021-02-15","2021-02-06","2021-01-27","2021-01-27","2021-05-01","2021-04-13","2021-03-27","2021-03-27","2021-02-09","2021-02-09","2021-08-19","2021-05-28","2021-06-15","2021-02-11","2021-02-15","2021-07-27","2021-02-19","2020-11-21","2020-11-21","2020-11-21","2021-03-20","2020-11-21","2020-12-26","2020-12-29","2020-12-29","2021-02-06","2021-02-06","2021-03-12","2021-05-28","2021-08-18","2021-06-29","2021-03-20","2021-03-23","2021-03-23","2021-03-23","2021-03-23","2021-03-30","2021-03-30","2021-04-07","2021-04-10","2021-04-10","2021-04-10","2021-08-19","2021-04-16","2021-04-17","2021-04-19","2021-04-19","2021-04-18","2021-04-18","2021-04-18","2021-04-19","2021-05-25","2021-05-25","2021-05-17","2021-05-28","2021-08-17","2021-04-16","2021-04-16","2021-05-26","2021-05-26","2021-05-26","2021-05-26","2021-08-18","2021-08-18","2021-06-03","2021-05-28","2021-05-28","2021-05-28","2021-06-15","2021-07-01","2021-07-01","2021-08-19","2021-03-15","2021-03-15","2021-03-15","2021-07-01","2021-08-13","2021-05-26","2021-05-26","2021-07-04","2021-08-04","2021-08-04","2021-08-04","2021-08-13","2021-08-17","2021-08-17","2021-06-03","2021-10-01","2021-10-01"],"priorHcc":["","","","","","",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":[["","65162083366","DICLOFENAC","GEL 0.01","","Select","Select",""],["","93816601","QUETIAPINE","TAB 50MG","","Select","Select",""],["","49483060450","IBUPROFEN","TAB 800MG","","Select","Select",""],["","10702001801","OXYCODONE","TAB 5MG","","Select","Select",""],["","42858030101","HYDROMORPHON","TAB 2MG","","Select","Select",""],["","143122701","DICYCLOMINE","TAB 20MG","","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","","Select","Select",""],["","65162019050","NAPROXEN","TAB 500MG","","Select","Select",""],["","378647099","SCOPOLAMINE","DIS 1MG\/3DAY","","Select","Select",""],["","65862051601","NAPROXEN SOD","TAB 550MG","","Select","Select",""],["","65862039010","ONDANSETRON","TAB 4MG ODT","","Select","Select",""],["","93010901","CARBAMAZEPIN","TAB 200MG","","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","","Select","Select",""],["","70710122600","AMITRIPTYLIN","TAB 25MG","","Select","Select",""],["","69097083412","SERTRALINE","TAB 50MG","","Select","Select",""],["","49281042050","FLUZONE QUAD","INJ 2020-21","","Select","Select",""],["","93031401","KETOROLAC","TAB 10MG","","Select","Select",""],["","42806016105","HYDROXYZ HCL","TAB 50MG","","Select","Select",""],["","65162074510","PROMETHAZINE","TAB 12.5MG","","Select","Select",""],["","53489011905","DOXYCYCL HYC","CAP 100MG","","Select","Select",""],["","69097015907","MELOXICAM","TAB 15MG","","Select","Select",""],["","172392670","DIAZEPAM","TAB 5MG","","Select","Select",""],["","93005805","TRAMADOL HCL","TAB 50MG","","Select","Select",""],["","74366303","LUPRON DEPOT","INJ 11.25MG","","Select","Select",""],["","603233832","APAP\/CODEINE","TAB 300-30MG","","Select","Select",""],["","69547035302","NARCAN","SPR ","","Select","Select",""],["","65862050320","AMOX\/K CLAV","TAB 875-125","","Select","Select",""],["","43386048024","ORPHENADRINE","TAB 100MG ER","","Select","Select",""],["","42858010201","OXYCOD\/APAP","TAB 5-325MG","","Select","Select",""],["","65162083366","DICLOFENAC ","GEL 0.01","300","Select","Select",""],["","42858030101","HYDROMORPHON ","TAB 2MG","20","Select","Select",""],["","49483060450","IBUPROFEN ","TAB 800MG","30","Select","Select",""],["","68462030450","NORETHIN ","TAB 5MG","90","Select","Select",""],["","10702001801","OXYCODONE ","TAB 5MG","3","Select","Select",""],["","68180012202","CEPHALEXIN ","CAP 500MG","28","Select","Select",""],["","65862039010","ONDANSETRON ","TAB 4MG ODT","20","Select","Select",""],["","143122701","DICYCLOMINE ","TAB 20MG","21","Select","Select",""],["","69097083412","SERTRALINE ","TAB 50MG","45","Select","Select",""],["","93816601","QUETIAPINE ","TAB 50MG","30","Select","Select",""],["","378647099","SCOPOLAMINE ","DIS 1MG\/3DAY","1","Select","Select",""],["","555077902","MEDROXYPR ","TAB 10MG","10","Select","Select",""],["","65162019050","NAPROXEN ","TAB 500MG","14","Select","Select",""],["","43386048024","ORPHENADRINE ","TAB 100MG ER","20","Select","Select",""],["","93010901","CARBAMAZEPIN ","TAB 200MG","90","Select","Select",""],["","59746000103","METHYLPRED ","TAB 4MG","21","Select","Select",""],["","70710122600","AMITRIPTYLIN ","TAB 25MG","30","Select","Select",""],["","42806016105","HYDROXYZ ","TAB 50MG","60","Select","Select",""],["","65862050320","AMOX\/K ","TAB 875-125","20","Select","Select",""],["","74366303","LUPRON ","INJ 11.25MG","1","Select","Select",""],["","53489011905","DOXYCYCL ","CAP 100MG","28","Select","Select",""],["","65162074510","PROMETHAZINE ","TAB 12.5MG","12","Select","Select",""],["","49281042050","FLUZONE ","INJ 2020-21","0.5","Select","Select",""],["","93031401","KETOROLAC ","TAB 10MG","15","Select","Select",""],["","378064205","PREDNISONE ","TAB 20MG","10","Select","Select",""],["","93317431","ALBUTEROL ","FAT E","8.5","Select","Select",""],["","68180016013","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","603233832","APAP\/CODEINE ","TAB 300-30MG","40","Select","Select",""],["","93005805","TRAMADOL ","TAB 50MG","40","Select","Select",""],["","42858010201","OXYCOD\/APAP ","TAB 5-325MG","10","Select","Select",""],["","69547035302","NARCAN ","SPR ","2","Select","Select",""],["","172392670","DIAZEPAM ","TAB 5MG","2","Select","Select",""],["","3089321","ELIQUIS ","2.5MG","28","Select","Select",""],["","69097015907","MELOXICAM ","15MG","90","Select","Select",""],["","597002402","COMBIVENT ","20-100","4","Select","Select",""],["","68462030450","NORETHIN","5MG","90","Select","Select",""],["","69097084615","CYCLOBENZAPR","10MG","15","Select","Select",""],["","00378064205","PREDNISONE","20MG","10","Select","Select",""],["","00555077902","MEDROXYPR","10MG","10","Select","Select",""],["","00003089321","ELIQUIS","2.5MG","28","Select","Select",""],["","42806016105","HYDROXYZ","50MG","60","Select","Select",""],["","65862085901","FAMOTIDINE","20MG","28","Select","Select",""],["","65862050320","AMOX\/K","875-125","20","Select","Select",""],["","53489011905","DOXYCYCL","100MG","28","Select","Select",""],["","00074366303","LUPRON","11.25MG","1","Select","Select",""],["","49281042050","FLUZONE","2020-21","0.5","Select","Select",""],["","00093005805","TRAMADOL","50MG","10","Select","Select",""],["","00597002402","COMBIVENT","20-100","4","Select","Select",""],["","00093317431","ALBUTEROL","E","8.5","Select","Select",""],["","68180016013","AZITHROMYCIN","250MG","6","Select","Select",""],["","69097084615","CYCLOBENZAPR ","TAB 10MG","15","Select","Select",""],["","65862085901","FAMOTIDINE ","TAB 20MG","28","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":""}]}]}