{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DAVID   W SPICER","gend":0,"add":"ROBIN JAMERSON SPICER","city":"GORDONSVILLE","state":"VA","zip":"22942-0848","dob":"1962-02-07","age":"","mstatus":"","insh":10053572,"cliId":"","pno":4344095370,"cno":4348824722,"email":"","ename":"","eno":"","pphy":"TAYLOR, MARSHA L","ppno":4349852891,"pcpadd":"140 Stoneridge Dr S, Ste 100","pcpcity":"Ruckersville","pcpstate":"VA","pcpzip":229683096,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":4348820687,"add2":"P O BOX 848","add3":"","madd1":"ROBIN JAMERSON SPICER","madd2":"P O BOX 848","madd3":"","mcity":"GORDONSVILLE","mstate":"VA","mzip":"22942-0848","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R07.9","R06.00","R06.89","H25.11","J98.8","J38.4","R19.7","D64.9","N17.9","R79.0","F10.20","J39.0","R53.1","R55","W19.XXXA","E83.42","S00.81XA","I10","F17.210","F17.220","K70.9","K72.10","I73.9","I77.9","Z45.2","L03.115","R60.0","Z51.89","Z72.0","F10.10","Z48.02","N20.0","N39.41","Z87.442","M54.2","R03.0","F10.920","R07.2","S19.9XXA","R13.10","R63.3","R06.02","L97.519","N13.2","T81.32XA","K76.89","K76.0","R51.9","Z20.822","R68.89","H26.8","J38.7","J39.1","Z87.09","Z86.39","I51.7","K76.9","D52.9","K74.60","K80.20","R31.9","Z46.6","N20.1","N13.30","Z98.890","Z98.41","T79.7XXA","K70.0","L97.518","I70.201","R42","R11.0","I74.3","T82.858A","I70.8","K55.1","I70.0","R93.6","Z48.812","R00.0","R13.12","R60.9","Z13.220","Z20.9","R40.4","R06.9","T82.898A","I77.1","E78.5","R05","Z88.0","Z95.828","R22.1","J98.2","J18.1","R91.8","Z09","Z87.828","T81.31XA","M43.6","R53.81","F17.290","Y90.0","X58.XXXA","Y92.230","J04.31","E87.2","F10.230","E66.9","T39.016A","Z91.14","S09.90XA","I25.2","I70.235","J45.909","F41.9","I25.10","Z79.82","Z79.899","R07.89","M25.519","F10.929","I25.83","I42.9","Z98.62","I70.211","Z79.01","Z79.891"],"date":["2020-10-30","2020-03-02","2019-06-28","2020-01-16","2020-03-01","2020-03-01","2020-04-28","2020-04-17","2020-04-17","2020-04-28","2020-04-20","2020-03-19","2020-04-20","2020-04-20","2020-04-20","2020-04-23","2020-04-20","2021-01-20","2021-01-20","2021-01-20","2020-06-15","2020-05-28","2021-01-27","2020-06-10","2020-06-15","2020-06-25","2020-07-24","2020-07-28","2020-07-28","2021-01-20","2020-07-22","2021-01-28","2021-01-28","2021-01-28","2021-01-29","2019-03-26","2020-05-18","2020-03-03","2020-04-20","2020-05-04","2020-05-04","2020-05-18","2020-06-15","2020-08-06","2020-07-04","2020-08-06","2020-08-06","2021-01-20","2021-01-20","2021-01-20","2020-01-16","2020-03-01","2020-04-17","2020-04-29","2020-05-05","2020-06-16","2020-08-06","2020-07-16","2020-08-06","2020-08-06","2020-10-30","2020-12-10","2020-12-10","2020-12-10","2020-02-24","2020-01-23","2020-03-05","2020-06-04","2020-06-22","2020-06-30","2020-10-30","2020-10-30","2019-04-03","2019-06-26","2020-06-08","2019-04-03","2020-06-08","2019-06-26","2020-06-22","2020-05-18","2020-03-06","2020-04-16","2020-04-17","2020-05-18","2020-05-18","2020-05-18","2020-06-08","2020-06-08","2020-10-13","2021-01-20","2021-01-20","2021-01-27","2020-03-01","2020-03-02","2020-03-02","2020-10-30","2020-03-12","2020-03-12","2020-07-01","2021-01-20","2021-01-20","2021-01-27","2020-03-01","2020-03-01","2020-03-01","2020-03-01","2020-03-01","2020-03-01","2020-03-01","2020-03-01","2020-03-01","2020-04-20","2020-06-22","2020-06-15","2020-06-22","2020-06-15","2020-06-22","2020-06-22","2020-06-15","2019-06-27","2019-06-27","2019-06-27","2020-06-16","2020-06-22","2020-06-22","2020-06-22","2020-06-22","2020-06-22"],"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":[["","11534016503","FOLIC ","TAB 1MG","30","Select","Select",""],["","00904679480","ASPIRIN ","CHW 81MG","30","Select","Select",""],["","65862021860","CEFDINIR ","SUS 125\/5ML","120","Select","Select",""],["","00085113204","PROVENTIL ","AER HFA","6.7","Select","Select",""],["","57664005799","AMLODIPINE ","TAB 10MG","30","Select","Select",""],["","00904555159","BANOPHEN ","TAB 25MG","6","Select","Select",""],["","60258017101","MAG ","TAB 400MG","30","Select","Select",""],["","11917017621","PROB ","CHW BEARS","20","Select","Select",""],["","60505058204","MOXIFLOXACIN ","SOL HCL 0.5%","3","Select","Select",""],["","00003089421","ELIQUIS ","TAB 5MG","60","Select","Select",""],["","87701040729","VITAMIN ","TAB 100MG","90","Select","Select",""],["","68001028108","DICLOFENAC ","TAB 75MG DR","180","Select","Select",""],["","87701042634","MELATONIN ","SUB 10MG","60","Select","Select",""],["","60505015801","BUPROPION ","TAB 75MG","60","Select","Select",""],["","43547039950","CYCLOBENZAPR ","TAB 5MG","30","Select","Select",""],["","47781030301","NITROFURANTN ","CAP 100MG","20","Select","Select",""],["","00067815202","VOLTAREN ","GEL 0.01","50","Select","Select",""],["","51293081001","PHENAZOPYRID ","TAB 100MG","10","Select","Select",""],["","45802086802","POLYETH ","POW 3350 NF","238","Select","Select",""],["","50428883947","PROBIOTIC ","CHW ","30","Select","Select",""],["","57237001405","TAMSULOSIN ","CAP 0.4MG","42","Select","Select",""],["","10702001801","OXYCODONE ","TAB 5MG","12","Select","Select",""],["","40985021151","B-1 ","TAB 100MG","60","Select","Select",""],["","00904671980","ACETAMINOPHEN ","TA B 325","40","Select","Select",""],["","00254200801","COLCHICINE ","TAB 0.6MG","30","Select","Select",""],["","00054429931","FUROSEMIDE ","TAB 40MG","7","Select","Select",""],["","00093317431","ALBUTEROL ","FAT E","8.5","Select","Select",""],["","42571016201","AMOX\/K ","TAB 875-125","12","Select","Select",""],["","00536589588","NICOTINE ","DIS 14MG\/24H","14","Select","Select",""],["","61314063710","PREDNISOLONE ","SUS 1% OP","10","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","14","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":[[["No","Select","","","","","Select","",""],["No","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":""}]}]}