{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BRIAN K FITZGERALD","gend":0,"add":"217 ALLENS PARADISE LN  ","city":"TYRO  ","state":"VA","zip":"22976-9998","dob":"1978-08-18","age":"","mstatus":"","insh":11016044,"cliId":"3WX4GE1NQ09","pno":4342778347,"cno":4242778347,"email":"","ename":"","eno":"","pphy":"RUCKER, TINSLEY W ","ppno":4343612555,"pcpadd":"2871 ROCKFISH VALLEY HIGHWAY","pcpcity":"NELLYSFORD  ","pcpstate":"VA","pcpzip":229582310,"pcpcounty":"","pcpid":"P0060094","pcpname":"UVA STONEY CREEK FAMILY PRACTICE","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"","add2":"","add3":"","madd1":"217 ALLENS PARADISE LN  ","madd2":"","madd3":"","mcity":"TYRO  ","mstate":"VA","mzip":"22976-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["Q05.9","Z43.6","G82.20","Z87.440","N39.498","Z93.6","R31.9","R62.7","Z99.3","R32","L22","N39.41","H71.01","H69.83","H92.11","Z20.828","Q05.8","Z23","L89.522","H90.6","N31.9","N20.0","Q05.6","R60.0","H00.014","L89.119","R82.90","Z98.890","N13.2","N13.4","N21.0","N42.9","N13.30"],"date":["2021-11-23","2021-11-22","2021-11-21","2021-11-21","2021-11-21","2021-11-22","2021-11-23","2021-11-23","2021-11-23","2020-12-08","2021-11-23","2021-11-23","2021-05-26","2021-05-26","2020-11-23","2020-12-23","2021-11-23","2021-03-31","2021-03-31","2021-05-26","2021-08-25","2021-11-19","2021-10-11","2021-06-30","2021-06-30","2021-06-10","2021-08-25","2021-08-25","2021-09-29","2021-09-29","2021-09-29","2021-09-29","2021-11-19"],"priorHcc":[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":[["","60432026415","FLUTICASONE","SPR 50MCG","","Select","Select",""],["","43547040111","FUROSEMIDE","TAB 20MG","","Select","Select",""],["","50383024116","LEVETIRACETA","SOL 100MG\/ML","","Select","Select",""],["","49281042050","FLUZONE QUAD","INJ 2020-21","","Select","Select",""],["","68382053601","POT CITRATE","TAB 540MG ER","","Select","Select",""],["","60432026415","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","50383024116","LEVETIRACETA ","SOL 100MG\/ML","542","Select","Select",""],["","43547040111","FUROSEMIDE ","TAB 20MG","150","Select","Select",""],["","49281042050","FLUZONE ","INJ 2020-21","0.5","Select","Select",""],["","68382053601","POT  CITRATE ","TAB 540MG ER","360","Select","Select",""],["","68382053601","POT  CITRA ER","540MG","360","Select","Select",""],["","61314070101","SULFACET ","10% OP","15","Select","Select",""],["","61314070101","SULFACET","10% OP","15","Select","Select",""],["","49281042050","FLUZONE","2020-21","0.5","Select","Select",""],["","68382053601","POT CITRA ER","540MG","360","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":""}]}]}