{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KIM BROWN","gend":1,"add":"77   COLLINS FERRY ROAD                                     ","city":"GLADYS                        ","state":"VA","zip":"24554-2306","dob":"1959-08-28","age":"","mstatus":"","insh":10051813,"cliId":"","pno":4342837596,"cno":4342837596,"email":"","ename":"","eno":"","pphy":"ADDIS, DANIEL M                                             ","ppno":"","pcpadd":"219 Parker Rd","pcpcity":"Danville                      ","pcpstate":"VA","pcpzip":245404034,"pcpcounty":"","pcpid":"P0060036","pcpname":"PIEDMONT FAMILY AND OCCUPATIONAL MEDICINE","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"77   COLLINS FERRY ROAD                                     ","madd2":"                                                            ","madd3":"","mcity":"GLADYS                        ","mstate":"VA","mzip":"24554-2306","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N95.0","K64.8","K92.1","K64.4","J02.9","F17.200","K12.2","J04.0","M79.609","R13.10","R41.82","R53.1","B34.9","F41.1","J44.9","Z79.82","Z79.899","Z86.73","Z87.891","Z88.0","Z88.1","Z88.5","Z88.8","R07.9","M94.0","F41.8","F41.9","F32.9","K21.9","G47.33","R51","S19.9XXA","R91.1","M47.812","S09.90XA","J32.9","R42","H92.21","W11.XXXA","M54.2","E03.9","I69.354","J44.1","E87.6","E78.00","K50.90","K21.0","Z72.0","F17.210","M79.7","F40.00","R06.02","I51.7","R25.2","Z91.040","R52","M54.5","R19.7","K64.9","M25.50","R60.9","S30.861A","R50.9","A77.8","A04.72","K58.9","R19.5","J06.9","R09.81","M19.90","R53.83","Z82.61","R11.10","R10.9","A77.0","G89.29","D64.9","R14.0","R94.31","R14.3","K59.00","K29.70","B96.81","K64.1","Z71.9","R76.8","M79.10","Z86.19","H90.6","H65.90","H90.3","J38.1","R13.19","J45.909","J35.1","N63.0","N63.14","Z80.3","Z80.49","Z80.41","J01.40","J37.0","J30.89","J45.901","J45.998","R35.0","R06.89","R10.32","M79.662","J45.30","J30.9","H66.91","Z11.59","Z20.828","K52.9","R07.89","R09.89","R19.8","K58.0","R10.30","R10.2","K22.2","K29.50","R10.13","J30.2","R06.2","J30.1","R05","R05.9","R51.9"],"date":["2019-01-15","2021-11-22","2019-02-13","2019-02-13","2019-09-23","2019-03-04","2019-03-04","2019-03-04","2019-03-13","2021-02-08","2019-03-13","2020-11-17","2019-03-13","2019-03-13","2020-10-04","2020-11-17","2020-11-17","2020-10-04","2020-11-17","2020-05-22","2021-03-16","2020-05-22","2019-08-25","2019-09-27","2019-05-22","2019-05-22","2019-05-22","2019-05-22","2021-07-14","2021-11-26","2020-05-22","2019-06-17","2019-06-17","2019-06-17","2019-06-17","2019-06-17","2020-11-17","2019-06-17","2019-06-17","2020-01-07","2020-05-22","2019-06-17","2019-08-29","2019-08-20","2020-02-11","2019-09-26","2019-09-27","2020-02-11","2019-08-19","2020-02-11","2019-08-19","2021-03-16","2019-08-19","2019-08-25","2020-05-22","2019-08-29","2020-05-19","2021-03-04","2019-08-29","2019-12-03","2019-08-29","2019-08-29","2019-08-29","2019-08-29","2019-09-23","2019-09-23","2019-09-26","2019-09-23","2019-09-23","2020-02-11","2019-09-23","2019-09-23","2019-09-26","2021-11-22","2019-09-27","2019-09-26","2019-09-26","2019-11-12","2019-09-26","2019-09-26","2021-11-22","2019-11-12","2021-02-08","2019-11-12","2021-11-22","2019-12-03","2019-12-03","2019-12-03","2020-01-07","2020-01-07","2020-01-29","2020-02-27","2020-01-29","2020-07-28","2020-02-27","2020-04-06","2020-04-06","2020-04-06","2020-04-06","2020-04-06","2020-04-20","2020-07-28","2021-03-16","2021-06-16","2020-05-12","2020-05-19","2020-05-22","2020-10-04","2020-05-22","2021-07-14","2020-07-28","2020-08-26","2020-09-01","2021-01-21","2020-10-04","2020-10-04","2020-10-04","2020-11-09","2020-11-17","2021-11-22","2021-03-11","2021-02-08","2021-02-08","2021-02-08","2021-03-16","2021-03-16","2021-03-16","2021-05-25","2021-10-22","2021-10-22"],"priorHcc":["",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":[["","00143312610","DICYCLOMINE","10MG","90","Select","Select",""],["","00378064110","PREDNISONE","10MG","19","Select","Select",""],["","51991096257","POLYETH","3350 NF","510","Select","Select",""],["","62175013643","OMEPRAZOLE","40MG","30","Select","Select",""],["","65862039110","ONDANSETRON","8MG ODT","10","Select","Select",""],["","60432070605","OXYCODONE","5MG\/5ML","168","Select","Select",""],["","00093317431","ALBUTEROL","E","8.5","Select","Select",""],["","49483061850","NAPROXEN","500MG","30","Select","Select",""],["","68180012202","CEPHALEXIN","500MG","30","Select","Select",""],["","29300022010","MONTELUKAST","10MG","30","Select","Select",""],["","65162067684","AZELASTINE","0.10%","30","Select","Select",""],["","59267100002","PFIZER","COVID-19","0.3","Select","Select",""],["","43547040011","CYCLOBENZAPR","10MG","21","Select","Select",""],["","43598051030","ESOMEPRA","40MG DR","30","Select","Select",""],["","00143312610","DICYCLOMINE ","CAP 10MG","90","Select","Select",""],["","00378064110","PREDNISONE ","TAB 10MG","19","Select","Select",""],["","51991096257","POLYETH ","POW 3350 NF","510","Select","Select",""],["","62175013643","OMEPRAZOLE ","CAP 40MG","30","Select","Select",""],["","65862039110","ONDANSETRON ","TAB 8MG ODT","10","Select","Select",""],["","60432070605","OXYCODONE ","SOL 5MG\/5ML","168","Select","Select",""],["","00093317431","ALBUTEROL ","FAT E","8.5","Select","Select",""],["","49483061850","NAPROXEN ","TAB 500MG","30","Select","Select",""],["","27808008601","HYD ","SUS 10-8\/5ML","120","Select","Select",""],["","67877021905","CEPHALEXIN ","CAP 500MG","30","Select","Select",""],["","29300022010","MONTELUKAST ","TAB 10MG","30","Select","Select",""],["","65162067684","AZELASTINE ","SPR 0.001","30","Select","Select",""],["","59267100002","PFIZER ","INJ COVID-19","0.3","Select","Select",""],["","43547040011","CYCLOBENZAPR ","TAB 10MG","21","Select","Select",""],["","43598051030","ESOMEPRA ","CAP 40MG DR","30","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","",""],["N\/A","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","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":""}]}]}