{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MONICA   A SHAVER","gend":1,"add":"KATE CALDWELL                                               ","city":"HARRISONBURG                  ","state":"VA","zip":"22802-4632","dob":"1972-05-04","age":"","mstatus":"","insh":10053728,"cliId":"","pno":5406077735,"cno":5406077735,"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":"1241  N MAIN STREET                                         ","add3":"","madd1":"899 Port Republic Rd Apt C26                                ","madd2":"                                                            ","madd3":"","mcity":"Harrisonburg                  ","mstate":"VA","mzip":"22801-3341","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F25.0","R41.3","Z87.828","G47.10","R41.0","F22","S91.312A","S93.602A","S90.812A","S99.922A","W01.0XXA","Z23","F17.200","Z88.8","S91.115A","W22.8XXA","Y92.008","Z88.1","Z79.899","E55.9","Z11.4","Z13.220","F19.959","Z11.59","Z00.00","F11.20","R68.89","Z12.31","S61.412A","S62.102D","S62.102A","S60.512A","S80.212A","S69.92XA","W18.30XA","F17.210","S62.112A","S62.112D","R23.2","M79.89","Z01.419","Z12.12","Z12.4","M19.032","M18.12","R05","J02.9","F43.20","R45.89","S01.511A","W19.XXXA","U07.1"],"date":["2021-10-27","2019-04-29","2019-04-11","2019-04-11","2019-04-29","2019-04-24","2019-04-30","2019-04-30","2019-04-30","2019-04-30","2019-04-30","2019-04-30","2019-04-30","2021-05-07","2019-07-09","2019-07-09","2019-07-09","2019-07-09","2021-01-27","2019-11-18","2019-11-18","2019-11-18","2021-04-22","2020-09-30","2019-11-18","2019-12-06","2020-12-15","2021-04-06","2020-06-03","2020-06-03","2020-06-03","2020-06-03","2020-06-03","2020-06-03","2020-06-03","2021-05-07","2020-09-04","2020-09-04","2020-06-26","2020-07-15","2020-08-18","2020-08-18","2020-08-18","2020-09-04","2020-09-04","2020-09-30","2020-09-30","2020-12-01","2021-04-22","2021-05-07","2021-05-07","2021-10-01"],"priorHcc":[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":[["","42858010201","OXYCOD\/APAP","5-325MG","30","Select","Select",""],["","69547035302","NARCAN","","2","Select","Select",""],["","69238105601","CHLORPROMAZ","25MG","60","Select","Select",""],["","13107008305","LORAZEPAM","0.5MG","75","Select","Select",""],["","70436001002","BUPROPN","150MG XL","30","Select","Select",""],["","10147095103","PALIPERIDONE","ER 1.5MG","30","Select","Select",""],["","65162019011","NAPROXEN","500MG","20","Select","Select",""],["","69543038810","KETOROLAC","10MG","10","Select","Select",""],["","42858010201","OXYCOD\/APAP ","TAB 5-325MG","30","Select","Select",""],["","69547035302","NARCAN ","SPR ","2","Select","Select",""],["","69238105601","CHLORPROMAZ ","TAB 25MG","60","Select","Select",""],["","13107008305","LORAZEPAM ","TAB 0.5MG","75","Select","Select",""],["","70436001002","BUPROPN ","TAB 150MG XL","30","Select","Select",""],["","10147095103","PALIPERIDONE ","TAB ER 1.5MG","30","Select","Select",""],["","65162019011","NAPROXEN ","TAB 500MG","20","Select","Select",""],["","69543038810","KETOROLAC ","TAB 10MG","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":[[["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["No","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":""}]}]}