{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"GLORIA A SMITH","gend":1,"add":"8873 SPOTSWOOD TRAIL #206  ","city":"STANARDSVILLE  ","state":"VA","zip":"22973-9998","dob":"1955-03-20","age":"","mstatus":"","insh":11014234,"cliId":"7UD8E19FK29","pno":6614411699,"cno":6614411699,"email":"","ename":"","eno":"","pphy":"BOSTIC, BROOKE A  ","ppno":4349852891,"pcpadd":"140 Stoneridge Dr S,Ste 100","pcpcity":"Ruckersville","pcpstate":"VA","pcpzip":229683096,"pcpcounty":"","pcpid":"P9307359","pcpname":"GREENE FAMILY MEDICINE","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"","add2":"","add3":"","madd1":"8873 SPOTSWOOD TRAIL #206  ","madd2":"","madd3":"","mcity":"STANARDSVILLE  ","mstate":"VA","mzip":"22973-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["I10","I25.10","F32.9","K21.9","I25.2","Z86.73","Z71.89","M54.42","K52.9","M54.16","A41.9","F11.20","E87.6","F17.210","Z20.828","G89.4","E83.42","Z79.899","N30.10","Z79.82","Z79.02","E78.5","R10.9","R19.7","R00.0","R79.1","Z72.0","F11.29","R65.20","R06.02","Z09","Z79.891","M54.5","M47.816","F33.1","G47.00","Z12.31","Z71.6","R79.89","R40.4","F29","T88.7XXA","W19.XXXA","T51.2X2A","G93.40","W18.30XA","G92","F19.10","F33.2","N17.9","R07.81","E87.2","G89.29","D72.829","Z59.9","Z20.822","T51.2X4A","R41.82","R51.9","R74.8","E78.00","F43.25","F17.200","F12.90","F10.20","S19.9XXA","R10.11","Z91.5","R07.9","Z23","Z12.2","R05.3","R06.00","J30.1","N76.1","K08.89","E78.2"],"date":["2021-10-12","2021-09-13","2021-08-06","2021-10-12","2021-07-21","2020-07-06","2020-06-02","2020-07-06","2021-07-19","2021-06-21","2020-10-14","2021-07-13","2020-10-23","2021-09-29","2020-10-08","2020-10-14","2021-07-22","2020-10-08","2020-10-08","2020-10-08","2020-10-08","2020-10-08","2020-10-08","2020-10-08","2020-10-08","2020-10-08","2020-10-09","2020-10-09","2020-10-14","2021-10-07","2021-08-06","2020-10-19","2020-10-19","2021-06-21","2021-11-02","2021-05-17","2021-09-13","2021-07-13","2021-08-06","2021-07-19","2021-07-19","2021-07-19","2021-07-19","2021-07-20","2021-07-20","2021-07-21","2021-07-19","2021-07-19","2021-07-22","2021-07-19","2021-07-21","2021-07-19","2021-07-21","2021-07-19","2021-07-19","2021-07-19","2021-07-19","2021-07-19","2021-07-20","2021-07-20","2021-07-20","2021-07-21","2021-10-12","2021-07-21","2021-07-21","2021-07-20","2021-07-20","2021-09-13","2021-09-09","2021-09-13","2021-09-29","2021-10-12","2021-10-12","2021-10-12","2021-11-16","2021-11-16","2021-11-16"],"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":[["","68180098103","LISINOPRIL","TAB 20MG","","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","","Select","Select",""],["","62559049001","DIPHEN\/ATROP","TAB 2.5MG","","Select","Select",""],["","527128201","DICYCLOMINE","TAB 20MG","","Select","Select",""],["","68382080610","TRAZODONE","TAB 100MG","","Select","Select",""],["","65862035705","CLOPIDOGREL","TAB 75MG","","Select","Select",""],["","68382041205","OMEPRAZOLE","CAP 20MG","","Select","Select",""],["","43547028210","ESCITALOPRAM","TAB 20MG","","Select","Select",""],["","59310057922","PROAIR HFA","AER ","","Select","Select",""],["","93317431","ALBUTEROL SUL","FAT E","","Select","Select",""],["","60505267108","ATORVASTATIN","TAB 80MG","","Select","Select",""],["","406012505","HYDROCO\/APAP","TAB 10-325MG","","Select","Select",""],["","66993058497","FLUTIC\/SALME","AER 100\/50","","Select","Select",""],["","65862035705","CLOPIDOGREL ","TAB 75MG","90","Select","Select",""],["","68382041205","OMEPRAZOLE ","CAP 20MG","90","Select","Select",""],["","60505267108","ATORVASTATIN ","TAB 80MG","90","Select","Select",""],["","66993001968","ALBUTEROL ","AER HFA","18","Select","Select",""],["","62559049001","DIPHEN\/ATROP ","TAB 2.5MG","120","Select","Select",""],["","527128201","DICYCLOMINE ","TAB 20MG","120","Select","Select",""],["","68382080610","TRAZODONE ","TAB 100MG","90","Select","Select",""],["","68180098103","LISINOPRIL ","TAB 20MG","90","Select","Select",""],["","43547028210","ESCITALOPRAM ","TAB 20MG","90","Select","Select",""],["","66993058497","FLUTIC\/SALME ","AER 100\/50","60","Select","Select",""],["","59310057922","PROAIR ","AER ","8.5","Select","Select",""],["","406012505","HYDROCO\/APAP ","TAB 10-325MG","120","Select","Select",""],["","68180031902","BUPROPN ","150MG XL","90","Select","Select",""],["","00069047103","CHANTIX ","0.5& 1MG","53","Select","Select",""],["","00069047103","CHANTIX","0.5& 1MG","53","Select","Select",""],["","59310057922","PROAIR","","8.5","Select","Select",""],["","68180031902","BUPROPN","150MG XL","90","Select","Select",""],["","58160082311","SHINGRIX","50\/0.5ML","1","Select","Select",""],["","58160084252","BOOSTRIX ","INJ ","0.5","Select","Select",""],["","58160082311","SHINGRIX ","INJ 50\/0.5ML","1","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":""}]}]}