{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"PEDRO LOPEZ-CABRERA","gend":0,"add":"215 VINE STREET","city":"HARRISONBURG","state":"VA","zip":"22802-6017","dob":"1963-09-23","age":"","mstatus":"","insh":10052701,"cliId":"","pno":5402827203,"cno":5402827203,"email":"","ename":"","eno":"","pphy":"MORGAN, ALAN J","ppno":5404332554,"pcpadd":"1661 S Main St, ","pcpcity":"Harrisonburg","pcpstate":"VA","pcpzip":228012728,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"APT 1B","add3":"","madd1":"215 Vine St Apt B1","madd2":"                                                            ","madd3":"","mcity":"Harrisonburg","mstate":"VA","mzip":"22802-6017","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R68.89","E11.3591","E11.3592","Z79.4","E11.319","Z89.511","I10","E11.69","E78.5","H33.41","S40.011A","S49.91XA","R50.9","W22.01XA","E11.21","Z88.0","E11.8","E11.65","Z71.3","Z79.899","E11.9","E78.9","M79.89","L03.115","T87.43","A41.9","R79.89","E78.00","D72.829","R31.29","T87.40","M86.061","M86.161","L02.415","N49.2","R10.31","L53.8","B37.89","E11.36","K21.9","Z11.4","Z11.59","E11.621","K29.60","T39.395A","T39.395D","F79","F32.9","Z91.81","N18.3","D63.1","G44.89","M25.519","R52","H25.11","H35.82","H47.011","Z96.1","Z98.41","L03.818","E11.29","E11.628","R80.9","L08.9","L03.116","L97.524","R60.9","L03.032","K29.01","K92.2","D62","F70","R42","Z97.13","Z86.31","K92.0","R26.2","M62.81","I96","Z56.0","Z79.82","Z79.84","Z87.19","Z83.3","Z82.49","G60.9","R60.0","B35.1","M86.672","R10.32","N28.89","R07.9","Z12.5","H25.041","E11.3593","H25.13","H21.561","M19.90","Z98.890","M79.604","Y83.5","R65.20","J45.909","Z20.828","H25.12","R58","W19.XXXA","H26.491","S81.801A","H33.42","H33.021","Z01.818","Z45.2","L97.522","N18.31","E11.3531"],"date":["2021-02-18","2019-07-02","2019-07-09","2020-11-03","2020-11-03","2021-05-13","2021-05-07","2020-01-06","2020-06-13","2019-08-30","2019-10-06","2019-10-06","2020-06-13","2019-10-06","2021-05-07","2021-05-07","2020-06-30","2020-12-14","2020-01-15","2021-05-07","2020-02-05","2021-03-15","2021-05-07","2020-06-18","2020-07-21","2020-06-18","2020-06-18","2020-06-18","2020-06-18","2020-07-01","2020-06-18","2020-06-23","2020-08-14","2020-08-14","2020-08-23","2020-08-23","2020-08-23","2020-08-23","2021-05-07","2020-11-03","2020-11-03","2020-11-03","2021-05-13","2019-01-29","2019-01-25","2019-01-29","2019-03-21","2019-01-29","2019-01-29","2019-08-02","2021-03-15","2019-10-06","2019-10-06","2020-06-13","2020-02-25","2020-08-06","2020-08-06","2021-04-21","2021-05-07","2020-08-23","2019-03-21","2020-07-21","2019-06-21","2020-07-21","2021-05-07","2021-05-13","2021-05-13","2021-05-13","2019-01-22","2019-01-22","2019-01-22","2020-06-13","2019-01-22","2019-01-22","2019-01-22","2019-01-22","2021-05-13","2019-02-15","2019-09-03","2021-05-07","2021-05-07","2021-05-07","2021-05-07","2021-05-07","2021-05-07","2021-05-13","2021-05-13","2021-05-11","2021-05-13","2019-01-22","2019-01-22","2019-10-06","2020-01-06","2020-02-25","2021-04-21","2020-02-25","2020-02-25","2020-02-25","2020-02-25","2020-06-13","2020-06-13","2020-06-13","2020-06-13","2020-06-13","2021-04-21","2020-06-13","2020-06-13","2020-10-07","2019-06-04","2019-06-07","2019-07-23","2020-01-08","2020-06-16","2021-03-15","2021-03-15","2019-07-23"],"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":[["","62175013643","OMEPRAZOLE ","CAP 40MG","30","Select","Select",""],["","43598071901","CHLORTHALID ","TAB 25MG","30","Select","Select",""],["","69097012805","AMLODIPINE ","TAB 10MG","30","Select","Select",""],["","00536106210","STOOL ","CAP 100MG","30","Select","Select",""],["","43547035611","LISINOPRIL ","TAB 40MG","30","Select","Select",""],["","23155010210","METFORMIN ","TAB 500MG","60","Select","Select",""],["","00172572970","FAMOTIDINE ","TAB 40MG","30","Select","Select",""],["","60505258008","ATORVASTATIN ","TAB 40MG","30","Select","Select",""],["","42858010250","OXYCOD\/APAP ","TAB 5-325MG","12","Select","Select",""],["","00536117201","ACETAMIN ","TAB 500MG","60","Select","Select",""],["","42806031205","DOXYCYCL ","TAB 100MG","20","Select","Select",""],["","00193730850","BAYER ","NE XT 50CT","50","Select","Select",""],["","00904198860","MAPAP ","TAB 500MG","60","Select","Select",""],["","00904645780","DOK ","CAP 100MG","30","Select","Select",""],["","00088222033","LANTUS ","INJ 100\/ML","10","Select","Select",""],["","56151014401","TRUPLUS ","MIS 30G","100","Select","Select",""],["","29300013005","HYDROCHLOROT ","CAP 12.5MG","30","Select","Select",""],["","56151173301","INSULIN ","MIS 1ML\/31G","30","Select","Select",""],["","60505058204","MOXIFLOXACIN ","SOL HCL 0.5%","3","Select","Select",""],["","00472034356","HYDROCORT ","CRE 0.01","28","Select","Select",""],["","31722072250","LEVOFLOXACIN ","TAB 500MG","10","Select","Select",""],["","67877032005","IBUPROFEN ","TAB 600MG","90","Select","Select",""],["","57599000200","FREESTYLE    MIS READER","MIS READER","1","Select","Select",""],["","57599000101","FREESTYLE    KIT SENSOR","KIT SENSOR","2","Select","Select",""],["","00193731150","CONTOUR ","TES NEXT","50","Select","Select",""],["","04142000024","FLORASTOR ","CAP 250MG","40","Select","Select",""],["","64380080438","RANITIDINE ","TAB 300MG","30","Select","Select",""],["","49348079072","ATHLETE ","CRE 0.01","30","Select","Select",""],["","16729000617","SIMVASTATIN ","TAB 40MG","30","Select","Select",""],["","00406048401","APAP\/CODEINE ","TAB 300-30MG","12","Select","Select",""],["","53885000810","ONETOUCH ","MIS PLUS 33G","100","Select","Select",""],["","65862007701","CIPROFLOXACN ","TAB 500MG","14","Select","Select",""],["","69618004410","DOCUSATE ","CAP 100MG","30","Select","Select",""],["","16714076901","NYSTATIN ","POW 100000","30","Select","Select",""],["","76385011150","CARVEDILOL ","6.25MG","60","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":""}]}]}