{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CYNTHIA ORANGE","gend":1,"add":"2237   RIVERMONT AVENUE                                     ","city":"LYNCHBURG                     ","state":"VA","zip":"24503-4115","dob":"1965-10-13","age":"","mstatus":"","insh":10052929,"cliId":"","pno":4345096196,"cno":4345096196,"email":"","ename":"","eno":"","pphy":"WHITE, KELLEY ELIZABETH                                     ","ppno":"","pcpadd":"7001 Forest Ave Ste 2500","pcpcity":"Richmond                      ","pcpstate":"VA","pcpzip":232301726,"pcpcounty":"","pcpid":"P0060030","pcpname":"WEST END INTERNAL MEDICINE","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"APT 1                                                       ","add3":"","madd1":"2237   RIVERMONT AVENUE                                     ","madd2":"APT 1                                                       ","madd3":"","mcity":"LYNCHBURG                     ","mstate":"VA","mzip":"24503-4115","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K21.9","R13.10","R10.816","K92.1","R19.7","Z80.0","Z71.9","R10.11","R40.4","R42","G44.89","R51","R11.10","E11.9","I10","Z79.84","K80.20","J44.9","F17.210","Z88.0","K29.70","R11.2","S82.441B","K62.5","S82.241B","S82.831A","S82.201A","T14.8XXA","S82.201B","S82.401A","S82.401B","S82.831B","S82.251B","S82.301B","F31.9","K59.00","M79.7","F41.9","W01.0XXA","Y92.009","S82.91XA","Y93.01","Z79.82","Z79.899","Z88.5","S82.90XA","M25.571","Z02.89","R27.9","Z74.3","S82.201E","S82.401E","Z47.89","W01.0XXD","M62.81","M79.604","M79.661","M79.89","Z87.81","R03.0","R60.0","R68.89","F43.20","F41.8","R06.02","J44.1","Z72.0","R07.9","G43.909","Z88.8","Z91.041","I16.0","R05","R06.9","S90.229A","L60.0","E11.49","L84","R11.11","N39.0","B96.89","M96.672","M54.2","E10.49","B35.1","R10.13","L03.113","Z23","L53.9","Z00.01","Z76.0","R73.03","R89.9","R77.8","R00.0","E78.5","D72.829","I20.8","R10.9","R94.31","E66.9","R51.9","B34.9","J45.909","M54.50","S82.201D","M47.816","M51.36","G93.40","F19.10","T17.920A","R09.02","J69.0","J96.01","N17.9","R91.8","R09.89","A41.9","R52","R11.0","J96.02","G92.8","T17.928A","J44.0","T40.3X5A","T40.725A","T42.4X5A","Z66","R40.20","R61"],"date":["2021-10-20","2019-01-09","2019-01-09","2019-01-09","2020-01-21","2019-01-09","2019-01-09","2019-01-22","2021-10-20","2021-09-23","2019-12-19","2019-12-19","2019-01-22","2021-06-10","2021-10-20","2019-01-22","2019-01-22","2021-10-20","2021-10-20","2021-10-20","2019-02-13","2021-09-22","2019-02-13","2019-02-13","2019-02-13","2019-02-14","2019-02-25","2019-02-20","2019-02-20","2019-02-25","2019-02-14","2019-02-14","2019-02-14","2019-02-14","2019-02-22","2019-02-14","2019-12-19","2021-09-23","2019-02-14","2019-02-14","2019-02-14","2019-02-14","2021-10-20","2021-05-07","2021-05-07","2019-02-14","2019-02-14","2019-02-19","2019-02-22","2019-02-22","2021-05-26","2021-05-26","2020-03-17","2019-02-22","2019-02-22","2019-04-08","2021-10-15","2019-03-08","2019-04-08","2019-04-08","2019-04-08","2020-10-28","2019-07-22","2021-06-10","2019-09-04","2021-09-23","2021-09-23","2021-09-23","2019-07-28","2021-10-20","2019-07-28","2021-09-23","2019-12-20","2019-09-04","2019-11-06","2020-03-20","2019-11-06","2020-03-20","2021-09-22","2019-12-19","2019-12-19","2020-02-18","2020-03-17","2020-03-20","2020-03-20","2020-09-23","2021-05-07","2021-09-23","2021-05-07","2021-06-10","2021-07-12","2021-07-12","2021-07-12","2021-09-23","2021-09-22","2021-09-22","2021-09-22","2021-09-22","2021-09-22","2021-09-22","2021-09-22","2021-09-23","2021-09-23","2021-10-20","2021-10-15","2021-10-15","2021-10-15","2021-10-15","2021-10-20","2021-10-20","2021-10-20","2021-10-20","2021-10-20","2021-10-20","2021-10-20","2021-10-20","2021-10-20","2021-10-20","2021-09-22","2021-09-22","2021-10-20","2021-10-20","2021-10-20","2021-10-20","2021-10-20","2021-10-20","2021-10-20","2021-10-20","2021-10-20","2021-10-20"],"priorHcc":[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":[["","68645047954","METOPROL","100MG ER","30","Select","Select",""],["","68180072103","AMLODIPINE","10MG","30","Select","Select",""],["","69097084615","CYCLOBENZAPR","10MG","30","Select","Select",""],["","67877024601","QUETIAPINE","200MG","90","Select","Select",""],["","65862052401","GABAPENTIN","800MG","90","Select","Select",""],["","68180051303","LISINOPRIL","5MG","90","Select","Select",""],["","68382004201","PROMETHAZINE","50MG","30","Select","Select",""],["","00185067405","HYDROXYZ","25MG","90","Select","Select",""],["","55111064534","OMEPRAZOLE","40MG","90","Select","Select",""],["","00781185220","AMOX\/K","875-125","28","Select","Select",""],["","13668013601","ESCITALOPRAM","10MG","30","Select","Select",""],["","62175061743","PANTOPRAZOLE","40MG","30","Select","Select",""],["","70377002911","ATORVASTATIN","40MG","30","Select","Select",""],["","59746067134","TIZANIDINE","4MG","90","Select","Select",""],["","31722061490","PREGABALIN","150MG","60","Select","Select",""],["","00143992701","CIPROFLOXACN","250MG","10","Select","Select",""],["","68645047954","METOPROL ","TAB 100MG ER","30","Select","Select",""],["","68180072103","AMLODIPINE ","TAB 10MG","30","Select","Select",""],["","69097084615","CYCLOBENZAPR ","TAB 10MG","30","Select","Select",""],["","67877024601","QUETIAPINE ","TAB 200MG","90","Select","Select",""],["","65862052401","GABAPENTIN ","TAB 800MG","90","Select","Select",""],["","68180051303","LISINOPRIL ","TAB 5MG","90","Select","Select",""],["","68382004201","PROMETHAZINE ","TAB 50MG","30","Select","Select",""],["","00185067405","HYDROXYZ ","CAP 25MG","90","Select","Select",""],["","55111064534","OMEPRAZOLE ","CAP 40MG","90","Select","Select",""],["","00781185220","AMOX\/K ","TAB 875-125","28","Select","Select",""],["","31722061490","PREGABALIN ","CAP 150MG","60","Select","Select",""],["","13668013601","ESCITALOPRAM ","TAB 10MG","30","Select","Select",""],["","62175061743","PANTOPRAZOLE ","TAB 40MG","30","Select","Select",""],["","70377002911","ATORVASTATIN ","TAB 40MG","30","Select","Select",""],["","59746067134","TIZANIDINE ","CAP 4MG","90","Select","Select",""],["","00143992701","CIPROFLOXACN ","TAB 250MG","10","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":""}]}]}