{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BARBARA PANNELL","gend":1,"add":"75   FEDERAL STREET                                         ","city":"LYNCHBURG                     ","state":"VA","zip":"24504-2201","dob":"1949-10-13","age":"","mstatus":"","insh":10053298,"cliId":"","pno":4349078289,"cno":4343335200,"email":"","ename":"","eno":"","pphy":"ALGEIER, RHONDA M","ppno":"","pcpadd":"165 LEGRANDE AVE","pcpcity":"CHARLOTTE COURT HOUSE         ","pcpstate":"VA","pcpzip":239233747,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"75   FEDERAL STREET                                         ","madd2":"                                                            ","madd3":"","mcity":"LYNCHBURG                     ","mstate":"VA","mzip":"24504-2201","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11.65","E03.9","E55.9","E78.5","F32.89","K21.9","M25.511","Z68.29","R30.0","R68.89","Z12.31","R07.81","R93.7","S22.42XA","I10","E11.9","S01.81XA","N39.0","F10.10","W10.9XXA","M79.602","M79.601","Z96.659","Z88.0","F17.210","S09.90XA","G44.89","G31.9","S19.9XXA","M10.00","M10.9","M54.5","Z91.81","Z79.4","S09.8XXA","R51","W10.8XXA","Y93.89","Y92.89","Y90.7","S01.01XA","F10.129","Z23","S29.9XXA","Z00.01","R94.4","N17.9","Z01.89","Z48.02","M79.10","M54.2","M25.562","J30.1","R53.81","R51.9","Z20.828","M25.551","M25.561","E83.52","D50.9","M79.604","G56.03","G56.01","M54.16","M51.36","M47.816","M48.061","M51.27","M51.25","M70.32","M13.0","M25.522","R52","R60.9","M19.071","M25.50","Z79.899","M25.571","R53.1","Z68.28","B37.49","R10.84","I49.9","N20.0","K42.9","K57.90","N28.1","N83.201","R10.9","M51.9"],"date":["2021-08-26","2021-09-25","2021-01-13","2021-09-25","2019-04-22","2021-09-25","2020-03-26","2019-04-22","2020-02-04","2020-12-18","2019-02-15","2019-05-01","2019-05-01","2019-05-01","2021-09-25","2021-09-25","2019-06-20","2019-12-17","2019-06-20","2019-06-20","2019-06-20","2019-06-20","2019-06-20","2021-09-25","2021-09-25","2019-10-01","2020-11-19","2019-10-01","2019-10-01","2019-07-30","2021-08-03","2021-08-26","2019-09-04","2019-09-04","2019-10-01","2019-10-01","2019-10-01","2019-10-01","2019-10-01","2019-10-01","2019-11-27","2019-10-01","2019-11-26","2019-10-01","2019-11-27","2019-11-27","2019-11-27","2019-11-27","2019-11-27","2020-02-04","2020-02-04","2021-08-03","2021-08-03","2020-11-19","2021-01-13","2020-12-18","2020-12-18","2021-02-22","2021-01-13","2021-01-13","2021-03-05","2021-01-21","2021-02-22","2021-02-22","2021-03-05","2021-02-23","2021-02-23","2021-02-23","2021-02-23","2021-07-02","2021-07-02","2021-07-02","2021-08-26","2021-07-02","2021-07-20","2021-07-20","2021-08-26","2021-07-20","2021-07-20","2021-08-03","2021-08-26","2021-08-26","2021-08-26","2021-09-25","2021-09-25","2021-09-25","2021-09-25","2021-09-25","2021-09-25","2021-09-25"],"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":[["","55111064534","OMEPRAZOLE","40MG","30","Select","Select",""],["","68180072103","AMLODIPINE","10MG","30","Select","Select",""],["","69238183207","LEVOTHYROXIN","75MCG","30","Select","Select",""],["","55111073001","ALLOPURINOL","300MG","30","Select","Select",""],["","68645058954","SERTRALINE","100MG","30","Select","Select",""],["","31722053405","METHOCARBAM","750MG","30","Select","Select",""],["","68645047954","METOPROL","100MG ER","30","Select","Select",""],["","27241011703","FENOFIBRATE","160MG","24","Select","Select",""],["","10370074501","GLIPIZIDE","5MG","24","Select","Select",""],["","45802065078","LORATADINE","10MG","4","Select","Select",""],["","65162019010","NAPROXEN","500MG","20","Select","Select",""],["","00254200801","COLCHICINE","0.6MG","60","Select","Select",""],["","65162037110","OXYBUTYNIN","5MG ER","30","Select","Select",""],["","00245531911","KLOR-CON","20MEQ ER","30","Select","Select",""],["","69097052444","DICLOFENAC","1%","100","Select","Select",""],["","68382005001","MELOXICAM","7.5MG","40","Select","Select",""],["","59267100002","PFIZER","COVID-19","0.3","Select","Select",""],["","53746061701","TRAMADL\/APAP","37.5-325","6","Select","Select",""],["","51672130406","TERCONAZOLE","0.40%","45","Select","Select",""],["","55111064534","OMEPRAZOLE ","CAP 40MG","30","Select","Select",""],["","68180072103","AMLODIPINE ","TAB 10MG","30","Select","Select",""],["","69238183207","LEVOTHYROXIN ","TAB 75MCG","30","Select","Select",""],["","55111073001","ALLOPURINOL ","TAB 300MG","30","Select","Select",""],["","68645058954","SERTRALINE ","TAB 100MG","30","Select","Select",""],["","31722053405","METHOCARBAM ","TAB 750MG","30","Select","Select",""],["","68645047954","METOPROL ","TAB 100MG ER","30","Select","Select",""],["","27241011703","FENOFIBRATE ","TAB 160MG","24","Select","Select",""],["","10370074501","GLIPIZIDE ","TAB 5MG","24","Select","Select",""],["","45802065078","LORATADINE ","TAB 10MG","4","Select","Select",""],["","65162019010","NAPROXEN ","TAB 500MG","20","Select","Select",""],["","00254200801","COLCHICINE ","TAB 0.6MG","60","Select","Select",""],["","65162037110","OXYBUTYNIN ","TAB 5MG ER","30","Select","Select",""],["","00245531911","KLOR-CON ","TAB 20MEQ ER","30","Select","Select",""],["","69097052444","DICLOFENAC ","GEL 0.01","100","Select","Select",""],["","59267100002","PFIZER ","INJ COVID-19","0.3","Select","Select",""],["","68382005001","MELOXICAM ","TAB 7.5MG","40","Select","Select",""],["","53746061701","TRAMADL\/APAP ","TAB 37.5-325","6","Select","Select",""],["","51672130406","TERCONAZOLE ","CRE 0.004","45","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":""}]}]}