{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BARBARA   G PARKER","gend":1,"add":"1097 HUNTERS LANE","city":"BLAIRS","state":"VA","zip":"24527-2733","dob":"1954-07-01","age":"","mstatus":"","insh":10052417,"cliId":"","pno":4348361123,"cno":4348361123,"email":"","ename":"","eno":"","pphy":"SHAH, MINESH R","ppno":4347994488,"pcpadd":"19144 HIGHTWAY 29 NORTH, ","pcpcity":"CHATHAM","pcpstate":"VA","pcpzip":245310001,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"1097 HUNTERS LANE","madd2":"                                                            ","madd3":"","mcity":"BLAIRS","mstate":"VA","mzip":"24527-2733","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H40.1111","H40.1123","J96.20","F17.200","J44.0","T40.3X1A","N39.41","M62.81","J44.9","J44.1","E11.9","I10","J96.90","F41.1","J96.10","I27.81","R10.9","J96.22","J96.21","E87.1","G93.49","T42.4X1A","E11.65","K52.9","F41.9","Z99.81","M06.9","I50.9","F17.210","Z79.899","M96.1","M54.5","M54.81","J43.2","R68.89","H25.13","R05","E11.40","K21.9","R19.7","E78.2","R30.0","B37.3","R41.82","Z79.82","Z88.1","Z88.0","Z72.0"],"date":["2019-12-03","2019-12-03","2019-10-13","2020-06-04","2019-10-13","2019-10-12","2021-04-29","2021-04-29","2021-04-20","2019-10-12","2019-11-11","2019-06-17","2019-10-22","2019-10-22","2020-09-23","2020-09-23","2019-10-12","2019-10-12","2019-10-12","2019-10-12","2019-10-12","2019-10-12","2020-06-04","2019-10-12","2019-10-12","2019-10-12","2019-10-12","2019-10-12","2019-10-12","2019-10-12","2019-04-08","2019-04-08","2019-04-08","2019-07-03","2019-04-08","2019-11-11","2019-04-02","2019-06-17","2019-06-17","2019-10-12","2020-06-04","2020-06-04","2020-06-04","2019-10-10","2019-10-10","2019-10-10","2019-10-10","2019-10-10"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}},{"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":[["","65162089129","MOMETASONE ","SPR 50MCG","17","Select","Select",""],["","00093317431","ALBUTEROL ","FAT E","8.5","Select","Select",""],["","69315090510","LORAZEPAM ","TAB 1MG","60","Select","Select",""],["","24208046325","LATANOPROST ","SOL 0.00005","2.5","Select","Select",""],["","64980028105","GLIPIZIDE ","TAB 10MG","30","Select","Select",""],["","68180016006","AZITHROMYCIN ","TAB 250MG","12","Select","Select",""],["","00054327099","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","13668009690","PANTOPRAZOLE ","TAB 20MG","30","Select","Select",""],["","58657015010","FOLIC ","TAB 1MG","30","Select","Select",""],["","29300016910","TIZANIDINE ","TAB 4MG","90","Select","Select",""],["","00186037020","SYMBICORT ","AER 160-4.5","10.2","Select","Select",""],["","24208091055","ERYTHROMYCIN ","OIN 5MG\/GM","3.5","Select","Select",""],["","00071101768","LYRICA ","CAP 200MG","90","Select","Select",""],["","69452015120","VITAMIN ","CAP 50000UNT","4","Select","Select",""],["","69097028970","LEVOFLOXACIN ","TAB 500MG","7","Select","Select",""],["","16729000517","SIMVASTATIN ","TAB 20MG","30","Select","Select",""],["","67877011601","METHADONE ","TAB 10MG","90","Select","Select",""],["","69238131509","PREGABALIN ","CAP 200MG","60","Select","Select",""],["","60432053716","NYSTATIN ","SUS 100000","200","Select","Select",""],["","00904772512","ANTI-DIARRHE ","TAB 2MG","24","Select","Select",""],["","00310460012","BEVESPI ","AER 9-4.8MCG","10.7","Select","Select",""],["","00168013346","CLOTRIMAZOLE ","CRE 0.01","30","Select","Select",""],["","00006027731","JANUVIA ","TAB 100MG","30","Select","Select",""],["","59310057922","PROAIR ","AER ","8.5","Select","Select",""],["","00603533715","PREDNISONE ","PAK 5MG","21","Select","Select",""],["","68462010530","ONDANSETRON ","TAB 4MG","20","Select","Select",""],["","00574200802","NYSTOP ","POW 100000","60","Select","Select",""],["","67405060301","FLUCONAZOLE ","TAB 150MG","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","",""],["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":""}]}]}