{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ELAINE J ARNOLD","gend":1,"add":"102 ELLIS DRIVE","city":"LOUISA","state":"VA","zip":"23093-9998","dob":"1954-11-28","age":"","mstatus":"","insh":11016769,"cliId":"6QY4T92WC79","pno":2706089039,"cno":2705434488,"email":"","ename":"","eno":"","pphy":"HELLAMS, RALPH DONALD","ppno":8043793835,"pcpadd":"294 River Rd W","pcpcity":"Manakin Sabot  ","pcpstate":"VA","pcpzip":231033200,"pcpcounty":"","pcpid":"P0124152","pcpname":"LOUISA HEALTH & REHABILITATION CENTER","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"","add2":"","add3":"","madd1":"112 Cammack St Apt 45","madd2":"","madd3":"","mcity":"Louisa","mstate":"VA","mzip":"23093-6556","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["I21.3","R06.81","R40.20","R09.02","R06.89","I51.7","J96.01","T50.902A","J96.02","R00.1","Z95.0","R40.4","S29.9XXA","S39.92XA","S19.9XXA","S39.91XA","T42.8X2A","Y92.009","F33.2","E87.2","T43.592A","T39.1X2A","T42.4X2A","F11.10","M54.9","G89.21","F41.9","J44.9","R94.31","Z87.891","Z79.899","F13.20","I95.9","T50.902D","A41.9","R65.21","R91.8","J81.1","F32.9","G89.29","F33.9","R45.851","W06.XXXA","Y92.230","N17.9","R73.03","M79.7","M19.90","Z59.9","Z90.710","Z81.8","Z88.1","Z88.5","F33.41","F11.20","I45.81","I49.9","G47.00","K59.00","M25.462","S09.90XA","S00.83XA","G56.01","M51.27","M79.12","Z79.891","E11.9","I10","E78.00","E55.9","F41.1","F32.5","Z01.818","M79.641","M79.18","E04.9","M54.16","M43.06","M54.5","R11.0","K21.9","F51.01","Z23","G56.21","G89.18","M79.631","G43.009","J02.9","J44.1","R06.02","F17.290","Z20.822","Z79.51","Z79.1","Z80.9","R07.9","G89.4","Z51.81","R53.83","R21","R06.00","R07.89","R06.9","H25.813","L25.9","M25.551","Z00.00","M16.11","J20.9","M10.00","I45.5","R53.1","N28.9","Z66","E86.0","F41.8","T50.915A","Z82.49","F33.0","H25.812","Z98.41","Z96.1","H25.811","R41.0","R40.1","H10.45","H52.4"],"date":["2021-01-15","2021-01-15","2021-01-15","2021-01-15","2021-01-15","2021-01-15","2021-06-17","2021-01-19","2021-01-18","2021-10-31","2021-01-15","2021-01-15","2021-01-15","2021-01-15","2021-01-15","2021-01-15","2021-01-15","2021-01-15","2021-01-19","2021-01-15","2021-01-15","2021-01-15","2021-01-15","2021-01-15","2021-01-15","2021-01-15","2021-06-17","2021-11-04","2021-01-15","2021-06-17","2021-06-17","2021-01-20","2021-10-31","2021-01-16","2021-01-16","2021-01-16","2021-10-30","2021-01-16","2021-06-17","2021-10-30","2021-01-20","2021-01-20","2021-01-20","2021-01-20","2021-01-23","2021-01-25","2021-10-30","2021-01-20","2021-01-20","2021-01-20","2021-01-20","2021-06-17","2021-06-17","2021-01-25","2021-01-25","2021-01-21","2021-01-22","2021-02-26","2021-08-13","2021-02-01","2021-02-01","2021-02-01","2021-04-16","2021-02-15","2021-03-17","2021-09-29","2021-10-30","2021-11-04","2021-11-04","2021-09-14","2021-08-10","2021-03-03","2021-04-13","2021-03-08","2021-09-29","2021-03-18","2021-06-21","2021-03-18","2021-07-14","2021-03-22","2021-03-22","2021-03-31","2021-09-14","2021-04-16","2021-04-16","2021-04-16","2021-05-24","2021-05-24","2021-10-31","2021-06-17","2021-10-30","2021-10-30","2021-06-17","2021-06-17","2021-06-17","2021-10-30","2021-09-29","2021-09-29","2021-10-31","2021-08-10","2021-06-17","2021-06-17","2021-06-17","2021-11-03","2021-09-14","2021-09-17","2021-09-14","2021-10-30","2021-10-28","2021-10-08","2021-10-31","2021-10-31","2021-10-31","2021-10-30","2021-10-30","2021-10-30","2021-10-30","2021-10-30","2021-11-04","2021-11-22","2021-11-22","2021-11-22","2021-11-11","2021-10-30","2021-10-30","2021-11-03","2021-11-03"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","",null,"","","","","","","","",null,"","",null,"","","","","","",null,"","","","","","","","","","","","","","","","","","","",null,null,null,"","","","","","","","","","","","","","","","","","","","","",null,null,"","","",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":[["","65162010350","GABAPENTIN","CAP 400MG","","Select","Select",""],["","55111018015","TIZANIDINE","TAB 4MG","","Select","Select",""],["","56151146001","TRUE METRIX","TES GLUCOSE","","Select","Select",""],["","62756014202","METFORMIN","TAB 500MG ER","","Select","Select",""],["","65862056099","PANTOPRAZOLE","TAB 40MG","","Select","Select",""],["","70010049105","METFORMIN HCL","ER ORAL TAB","","Select","Select",""],["","67877025010","QUETIAPINE","TAB 100MG","","Select","Select",""],["","51991074710","DULOXETINE","CAP 30MG","","Select","Select",""],["","93100301","BUSPIRONE","TAB 15MG","","Select","Select",""],["","781107905","ALPRAZOLAM","TAB 1MG","","Select","Select",""],["","173086910","ANORO ELLIPT","AER 62.5-25","","Select","Select",""],["","23155050105","HYDROXYZ HCL","TAB 25MG","","Select","Select",""],["","68382050010","OMEPRAZOLE","CAP 40MG","","Select","Select",""],["","42858058640","BUPRENORPHIN","DIS 15MCG\/HR","","Select","Select",""],["","51672128202","TRIAMCINOLON","CRE 0.001","","Select","Select",""],["","10702000350","PROMETHAZINE","TAB 25MG","","Select","Select",""],["","67877043003","ARIPIPRAZOLE","TAB 2MG","","Select","Select",""],["","62756052269","SUMATRIPTAN","TAB 100MG","","Select","Select",""],["","16729013600","CLONAZEPAM","TAB 0.5MG","","Select","Select",""],["","68308015215","NYSTATIN","POW 100000","","Select","Select",""],["","65162010350","GABAPENTIN ","CAP 400MG","270","Select","Select",""],["","55111018015","TIZANIDINE ","TAB 4MG","90","Select","Select",""],["","56151146001","TRUE ","TES GLUCOSE","100","Select","Select",""],["","67877043003","ARIPIPRAZOLE ","TAB 2MG","30","Select","Select",""],["","781107905","ALPRAZOLAM ","TAB 1MG","90","Select","Select",""],["","70010049105","METFORMIN ","ER ORAL TAB","30","Select","Select",""],["","62756052269","SUMATRIPTAN ","TAB 100MG","9","Select","Select",""],["","51991074710","DULOXETINE ","CAP 30MG","90","Select","Select",""],["","68308015215","NYSTATIN ","POW 100000","60","Select","Select",""],["","65862056099","PANTOPRAZOLE ","TAB 40MG","90","Select","Select",""],["","16729013600","CLONAZEPAM ","TAB 0.5MG","90","Select","Select",""],["","67877025010","QUETIAPINE ","TAB 100MG","30","Select","Select",""],["","713022680","TRIAMCINOLON ","CRE 0.00025","80","Select","Select",""],["","42858058640","BUPRENORPHIN ","DIS 15MCG\/HR","1","Select","Select",""],["","93100301","BUSPIRONE ","TAB 15MG","90","Select","Select",""],["","173086910","ANORO ","AER 62.5-25","60","Select","Select",""],["","68382050010","OMEPRAZOLE ","CAP 40MG","60","Select","Select",""],["","23155050105","HYDROXYZ ","TAB 25MG","90","Select","Select",""],["","406012305","HYDROCO\/APAP ","TAB 5-325MG","15","Select","Select",""],["","65862001705","AMOXICILLIN ","500MG","30","Select","Select",""],["","10702000350","PROMETHAZINE ","25MG","30","Select","Select",""],["","69547035302","NARCAN ","","2","Select","Select",""],["","00591544305","PREDNISONE ","20MG","7","Select","Select",""],["","00093317431","ALBUTEROL ","E","8.5","Select","Select",""],["","00781808926","AZITHROMYCIN ","250MG","6","Select","Select",""],["","00173086910","ANORO","62.5-25","180","Select","Select",""],["","11917017389","TRUE","AIR","1","Select","Select",""],["","00173089310","TRELEGY","ELLIPTA","60","Select","Select",""],["","23155050105","HYDROXYZ","25MG","90","Select","Select",""],["","00406012305","HYDROCO\/APAP","5-325MG","15","Select","Select",""],["","69547035302","NARCAN","","2","Select","Select",""],["","00781808926","AZITHROMYCIN","250MG","6","Select","Select",""],["","65862001705","AMOXICILLIN","500MG","30","Select","Select",""],["","00591544305","PREDNISONE","20MG","7","Select","Select",""],["","00093317431","ALBUTEROL","E","8.5","Select","Select",""],["","53489012002","DOXYCYCL","100MG","20","Select","Select",""],["","65162062711","TRAMADOL","50MG","90","Select","Select",""],["","55111012205","ATORVASTATIN","20MG","90","Select","Select",""],["","61314063705","PREDNISOLONE ","SUS 1% OP","5","Select","Select",""],["","69315030805","CIPROFLOXACN ","SOL 0.3% OP","5","Select","Select",""],["","00173089310","TRELEGY ","AER ELLIPTA","60","Select","Select",""],["","53489012002","DOXYCYCL ","TAB 100MG","20","Select","Select",""],["","65162062711","TRAMADOL ","TAB 50MG","90","Select","Select",""],["","55111012205","ATORVASTATIN ","TAB 20MG","90","Select","Select",""],["","59310057922","PROAIR ","AER ","8.5","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":""}]}]}