{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BRUCE A BENISHEK","gend":0,"add":"2750 HILLYARD DRIVE  ","city":"Broadway ","state":"VA","zip":"22815-3425","dob":"1941-11-24","age":"","mstatus":"","insh":11018328,"cliId":"1XN6VC8GK56","pno":5402361277,"cno":5404057735,"email":"","ename":"","eno":"","pphy":"LOVELACE, NANCE","ppno":5404591340,"pcpadd":"9166 N Congress St Unit A","pcpcity":"New Market  ","pcpstate":"VA","pcpzip":228449422,"pcpcounty":"","pcpid":"P0060074","pcpname":"NEW MARKET FAMILY HEALTH CENTER","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"","add2":"","add3":"","madd1":"2750 HILLYARD DRIVE  ","madd2":"","madd3":"","mcity":"Broadway ","mstate":"VA","mzip":"22815-3425","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H90.5","M51.36","S59.901S","I49.5","M48.061","M51.26","X58.XXXS","M43.16","S50.01XA","S42.294A","Z95.0","I25.10","I48.0","E78.5","I10","M54.5","M47.818","S49.91XA","M25.511","S59.901A","M25.521","I73.9","Z98.890","E11.52","E11.42","I70.201","E78.00","Z95.828","Z01.818","R94.31","S42.91XA","W19.XXXA","Y93.01","E11.51","I11.0","I50.32","Z95.1","Z86.14","Z87.891","Z88.0","Z88.8","Z88.2","T82.858A","Y83.2","Z89.422","Z89.421","Z91.040","Z91.010","Z79.899","E11.65","M1A.9XX0","K29.70","F32.A","R33.9","E83.42","E55.9","E87.6","R60.9","Z89.412","Z91.048","Z79.82","I77.1","R06.02","I08.1","I70.0","I21.4","R07.89","N17.9","N18.9","I95.9","I51.7","I08.8","I44.7"],"date":["2021-07-30","2021-08-17","2021-08-19","2021-11-28","2021-08-17","2021-08-17","2021-08-19","2021-08-17","2021-08-19","2021-08-19","2021-11-27","2021-11-28","2021-11-28","2021-11-28","2021-10-29","2021-08-11","2021-08-11","2021-08-17","2021-08-17","2021-08-19","2021-08-19","2021-11-27","2021-11-02","2021-10-15","2021-10-15","2021-10-15","2021-10-15","2021-11-02","2021-09-22","2021-09-22","2021-08-17","2021-08-17","2021-08-17","2021-09-27","2021-08-17","2021-08-17","2021-11-27","2021-08-17","2021-08-17","2021-10-15","2021-10-15","2021-10-15","2021-09-27","2021-09-27","2021-10-15","2021-10-15","2021-10-15","2021-10-15","2021-10-15","2021-10-14","2021-10-14","2021-10-14","2021-10-14","2021-10-14","2021-10-29","2021-10-14","2021-10-14","2021-10-14","2021-11-02","2021-10-15","2021-10-15","2021-11-02","2021-11-04","2021-11-03","2021-11-03","2021-11-28","2021-11-27","2021-11-27","2021-11-27","2021-11-28","2021-11-28","2021-11-03","2021-11-28"],"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]}},{"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":[]},{"a":[]}]},{"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":[["","31722070110","LOSARTAN ","50MG","90","Select","Select",""],["","69315011610","FUROSEMIDE ","20MG","90","Select","Select",""],["","67877019805","AMLODIPINE ","5MG","90","Select","Select",""],["","68382009505","CARVEDILOL ","25MG","360","Select","Select",""],["","16714087403","ATORVASTATIN ","10MG","90","Select","Select",""],["","43547028210","ESCITALOPRAM","20MG","90","Select","Select",""],["","31722070110","LOSARTAN","50MG","90","Select","Select",""],["","69315011610","FUROSEMIDE","20MG","90","Select","Select",""],["","67877019805","AMLODIPINE","5MG","90","Select","Select",""],["","68382009505","CARVEDILOL","25MG","360","Select","Select",""],["","00832105415","BACLOFEN","10MG","90","Select","Select",""],["","16714071302","TAMSULOSIN","0.4MG","90","Select","Select",""],["","16714087403","ATORVASTATIN","10MG","90","Select","Select",""],["","62175013643","OMEPRAZOLE","40MG","90","Select","Select",""],["","16714004211","ALLOPURINOL","300MG","90","Select","Select",""],["","70010006310","METFORMIN","500MG","90","Select","Select",""],["","68645059090","CLOPIDOGREL","75MG","30","Select","Select",""],["","49281012165","FLUZONE","2021-22","0.7","Select","Select",""],["","43547028210","ESCITALOPRAM ","TAB 20MG","90","Select","Select",""],["","70010006310","METFORMIN ","TAB 500MG","90","Select","Select",""],["","16714071302","TAMSULOSIN ","CAP 0.4MG","90","Select","Select",""],["","62175013643","OMEPRAZOLE ","CAP 40MG","90","Select","Select",""],["","68645059090","CLOPIDOGREL ","TAB 75MG","30","Select","Select",""],["","00832105415","BACLOFEN ","TAB 10MG","90","Select","Select",""],["","16729013501","ALLOPURINOL ","TAB 300MG","90","Select","Select",""],["","49281012165","FLUZONE ","INJ 2021-22","0.7","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","",""],["No","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":""}]}]}