{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ANGELA   F HARPINE","gend":1,"add":"2527 MOSBY COURT                                            ","city":"HARRISONBURG                  ","state":"VA","zip":"22801-2638","dob":"1964-07-10","age":"","mstatus":"","insh":10053044,"cliId":"","pno":5402146149,"cno":5402146149,"email":"","ename":"","eno":"","pphy":"KOCH, ADRIENNE J                                            ","ppno":"","pcpadd":"1871 Evelyn Byrd Ave","pcpcity":"Harrisonburg                  ","pcpstate":"VA","pcpzip":228013487,"pcpcounty":"","pcpid":"P9723548","pcpname":"SENTARA INTERNAL MEDICINE PHYS","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"APARTMENT C                                                 ","add3":"","madd1":"2527 MOSBY COURT                                            ","madd2":"APARTMENT C                                                 ","madd3":"","mcity":"HARRISONBURG                  ","mstate":"VA","mzip":"22801-2638","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F33.2","F43.12","F33.3","Z00.00","E11.9","E78.5","I10","K59.09","A04.9","F43.10","N81.6","M79.645","M79.644","S63.8X2D","G43.909","M18.12","B00.1","B37.2","K13.0","H02.9","M19.049","H00.14","M25.519","S80.11XA","R73.01","Z96.692","G43.709","Z47.89","M25.632","M79.642","L03.211","R22.0","R68.83","L53.9","Z79.84","Z88.5","Z88.8","L03.90","R22.1","L02.01","L72.9","Z53.8","E78.00","F10.21","Z79.899","Z01.810","R11.0","J30.9","S46.912A","Z96.1","Z12.31","Z23","M70.60","M79.676","M25.642","H35.371","H35.412","H33.322","E55.9","K58.9","K30","K59.00","R51","Z88.6","N95.1","Z48.89","M25.532","R22.32","Z01.419","M70.61","M70.62","R35.0","R39.15","N81.89","R19.7","K59.02","K31.84","K59.04","Z90.710","Z91.410","Z01.818","N81.2","N99.3","H66.91","Z09","H35.3131","M62.838","S39.012A","F32.9","F31.81","G43.819","R51.9","M79.2","G89.29","F50.9","R45.851","F41.9","E11.65","Z71.3","F50.00","M25.559","K62.5","R07.9","R06.02","Z90.49","E66.01"],"date":["2021-11-11","2021-11-08","2019-10-30","2021-05-07","2021-10-11","2021-05-07","2021-10-11","2020-08-25","2019-01-16","2020-06-15","2020-07-02","2020-02-13","2019-02-14","2019-02-18","2021-08-02","2019-07-16","2019-02-22","2019-02-22","2019-02-25","2019-03-07","2019-05-28","2019-03-07","2019-03-18","2019-03-18","2021-05-07","2019-04-30","2021-07-22","2019-05-10","2020-01-02","2020-03-11","2019-07-11","2019-06-19","2019-06-19","2019-06-19","2019-07-22","2021-10-11","2021-10-11","2019-06-19","2019-06-19","2019-07-11","2019-07-22","2019-07-22","2021-08-02","2019-07-22","2021-08-02","2019-07-22","2020-10-02","2020-02-12","2019-09-16","2021-10-08","2021-10-21","2020-10-23","2019-10-21","2019-11-18","2020-03-11","2021-01-05","2021-01-05","2021-01-05","2021-09-17","2021-10-11","2020-06-15","2021-07-23","2020-02-05","2020-02-05","2020-02-12","2020-02-13","2020-02-19","2020-02-19","2020-03-03","2020-04-20","2020-04-20","2020-04-27","2020-04-27","2020-05-19","2020-05-22","2020-06-15","2020-06-15","2020-06-15","2020-06-15","2020-06-15","2020-06-29","2020-07-02","2020-07-02","2020-07-09","2020-08-10","2021-01-05","2021-01-07","2021-01-07","2021-05-07","2021-05-07","2021-05-24","2021-06-17","2021-06-17","2021-06-17","2021-11-22","2021-08-02","2021-08-02","2021-08-02","2021-11-22","2021-09-10","2021-11-03","2021-10-05","2021-10-11","2021-10-11","2021-10-11","2021-11-05"],"priorHcc":[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":[["","43547035311","LISINOPRIL","10MG","30","Select","Select",""],["","67877056105","METFORMIN","500MG","30","Select","Select",""],["","00115166001","PROPRANOLOL","20MG","60","Select","Select",""],["","00093720298","PRAVASTATIN","40MG","30","Select","Select",""],["","69452015120","VITAMIN","50000UNT","4","Select","Select",""],["","00456114030","VIIBRYD","40MG","30","Select","Select",""],["","63402030830","LATUDA","80MG","30","Select","Select",""],["","59746011506","PROCHLORPER","10MG","30","Select","Select",""],["","37000014343","ALIGN","4MG","84","Select","Select",""],["","00574200802","NYSTOP","100000","60","Select","Select",""],["","70954002110","PRAZOSIN","5MG","60","Select","Select",""],["","42043013109","NARATRIPTAN","2.5MG","9","Select","Select",""],["","00054327099","FLUTICASONE","50MCG","16","Select","Select",""],["","55513084301","AIMOVIG","140MG\/ML","1","Select","Select",""],["","00904645760","DOK","100MG","90","Select","Select",""],["","16571020150","DICLOFENAC","75MG DR","10","Select","Select",""],["","62332004060","LAMOTRIGINE","200MG","60","Select","Select",""],["","69238111701","BUSPIRONE","10MG","105","Select","Select",""],["","55111062660","ZAFIRLUKAST","20MG","60","Select","Select",""],["","45802042578","FEXOFENADINE","60MG","60","Select","Select",""],["","69238161503","OFLOXACIN","0.3%OTIC","5","Select","Select",""],["","33342008845","RIZATRIPTAN","10MG","12","Select","Select",""],["","68382080601","TRAZODONE","100MG","14","Select","Select",""],["","00456228030","FETZIMA","80MG","30","Select","Select",""],["","68180037603","LOSARTAN","25MG","30","Select","Select",""],["","00168034720","TERCONAZOLE","0.80%","20","Select","Select",""],["","57237000511","FLUCONAZOLE","150MG","2","Select","Select",""],["","00904699860","DOCUSATE","100MG","90","Select","Select",""],["","64764073030","TRINTELLIX","10MG","30","Select","Select",""],["","65862057490","MONTELUKAST","10MG","30","Select","Select",""],["","00093314705","CEPHALEXIN","500MG","30","Select","Select",""],["","00254302802","LUBIPROSTONE","8MCG","120","Select","Select",""],["","39423066048","FLORAJEN3","","60","Select","Select",""],["","55111018015","TIZANIDINE","4MG","60","Select","Select",""],["","55111012701","CIPROFLOXACN","500MG","14","Select","Select",""],["","45802086802","POLYETH","3350 NF","476","Select","Select",""],["","58160082311","SHINGRIX","50\/0.5ML","1","Select","Select",""],["","69230030001","ALLERGY","180MG","34","Select","Select",""],["","64380080807","IBUPROFEN","600MG","30","Select","Select",""],["","00406055201","OXYCODONE","5MG","10","Select","Select",""],["","54092054701","MOTEGRITY","2MG","30","Select","Select",""],["","43547035311","LISINOPRIL ","TAB 10MG","30","Select","Select",""],["","67877056105","METFORMIN ","TAB 500MG","30","Select","Select",""],["","00115166001","PROPRANOLOL ","TAB 20MG","60","Select","Select",""],["","00093720298","PRAVASTATIN ","TAB 40MG","30","Select","Select",""],["","69452015120","VITAMIN ","CAP 50000UNT","4","Select","Select",""],["","00456114030","VIIBRYD ","TAB 40MG","30","Select","Select",""],["","63402030830","LATUDA ","TAB 80MG","30","Select","Select",""],["","59746011506","PROCHLORPER ","TAB 10MG","30","Select","Select",""],["","68180037603","LOSARTAN ","TAB 25MG","30","Select","Select",""],["","37000014343","ALIGN ","CAP 4MG","84","Select","Select",""],["","00574200802","NYSTOP ","POW 100000","60","Select","Select",""],["","70954002110","PRAZOSIN ","CAP 5MG","60","Select","Select",""],["","42043013109","NARATRIPTAN ","TAB 2.5MG","9","Select","Select",""],["","00054327099","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","55513084301","AIMOVIG ","INJ 140MG\/ML","1","Select","Select",""],["","00904645760","DOK ","CAP 100MG","90","Select","Select",""],["","16571020150","DICLOFENAC ","TAB 75MG DR","10","Select","Select",""],["","62332004060","LAMOTRIGINE ","TAB 200MG","60","Select","Select",""],["","69238111701","BUSPIRONE ","TAB 10MG","105","Select","Select",""],["","55111062660","ZAFIRLUKAST ","TAB 20MG","60","Select","Select",""],["","45802042578","FEXOFENADINE ","TAB 60MG","60","Select","Select",""],["","69238161503","OFLOXACIN ","DRO 0.3%OTIC","5","Select","Select",""],["","69097084805","ESCITALOPRAM ","TAB 10MG","30","Select","Select",""],["","33342008845","RIZATRIPTAN ","TAB 10MG","12","Select","Select",""],["","68382080601","TRAZODONE ","TAB 100MG","14","Select","Select",""],["","00456224030","FETZIMA ","CAP 40MG","21","Select","Select",""],["","00168034720","TERCONAZOLE ","CRE 0.008","20","Select","Select",""],["","57237000511","FLUCONAZOLE ","TAB 150MG","2","Select","Select",""],["","00904699860","DOCUSATE ","CAP 100MG","90","Select","Select",""],["","64764073030","TRINTELLIX ","TAB 10MG","30","Select","Select",""],["","65862057490","MONTELUKAST ","TAB 10MG","30","Select","Select",""],["","00093314705","CEPHALEXIN ","CAP 500MG","30","Select","Select",""],["","00254302802","LUBIPROSTONE ","CAP 8MCG","120","Select","Select",""],["","39423066048","FLORAJEN3 ","CAP ","60","Select","Select",""],["","55111018015","TIZANIDINE ","TAB 4MG","60","Select","Select",""],["","55111012701","CIPROFLOXACN ","TAB 500MG","14","Select","Select",""],["","69230030001","ALLERGY ","TAB 180MG","34","Select","Select",""],["","45802086802","POLYETH ","POW 3350 NF","476","Select","Select",""],["","58160082311","SHINGRIX ","INJ 50\/0.5ML","1","Select","Select",""],["","64380080807","IBUPROFEN ","TAB 600MG","30","Select","Select",""],["","00406055201","OXYCODONE ","TAB 5MG","10","Select","Select",""],["","54092054701","MOTEGRITY ","TAB 2MG","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":[[["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":""}]}]}