{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ERNESTINE BOOKER","gend":1,"add":"2619   SCOTTS BOTTOM  ROAD                                  ","city":"DILLWYN                       ","state":"VA","zip":"23936-2706","dob":"1989-01-18","age":"","mstatus":"","insh":10122646,"cliId":"","pno":4348380119,"cno":4348380119,"email":"","ename":"","eno":"","pphy":"CHEEK, KIMBERLY M                                           ","ppno":"","pcpadd":"201 Lew Dewitt Blvd","pcpcity":"Waynesboro                    ","pcpstate":"VA","pcpzip":229801663,"pcpcounty":"","pcpid":"P0110997","pcpname":"AUGUSTA HEALTH INTERNAL MEDICINE WAYNESBORO","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"2619   SCOTTS BOTTOM  ROAD                                  ","madd2":"                                                            ","madd3":"","mcity":"DILLWYN                       ","mstate":"VA","mzip":"23936-2706","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["O99.89","M54.9","Z3A.28","O99.213","E66.01","O34.219","Z3A.29","Z03.74","Z34.83","O99.210","Z23","Z34.82","O09.293","Z68.41","O09.893","O09.93","Z3A.31","O99.810","Z3A.34","O60.03","Z3A.35","Z36.89","O34.211","Z3A.36","Z3A.37","Z3A.38","Z3A.39","Z37.0","D62","O90.81","O62.2","O99.214","O77.0","O99.344","F41.9","O99.62","O99.284","E28.2","N85.8","O82","Z39.2","F41.8","Z71.89","Z71.3","R06.02","J18.1","O90.89","J90","R00.1","R03.0","Z87.891","R07.9","R91.8","R93.89","R06.09","G47.19","Z78.9","M79.661","R79.89","R51","Z00.129","B37.0","R59.0","J45.909","Z30.41","D50.0","R59.9","B34.9","J11.1","R50.9","K92.0","L98.9","F32.9","R10.31","R10.13","L08.9","R30.0","N39.0","R11.0","E86.0","F12.90","Z20.828","R11.2","F33.1","K80.20","K83.8","R10.11","K76.0","K80.70","K80.01","R10.10","W19.XXXA","K82.1","Z79.51","Z79.899","Z98.891","Z80.8","Z83.3","Z82.49","K80.10","K80.12","R16.0","K80.00","S09.90XA","S19.9XXA","M47.812","M54.2","T50.995A","Z00.00","Z11.4","Z12.4","Z30.011","F41.0","T50.905A","A59.9"],"date":["2019-01-03","2019-01-03","2019-01-03","2019-03-11","2020-10-13","2019-03-19","2019-01-09","2019-01-07","2019-01-07","2019-01-07","2021-10-15","2019-01-07","2019-02-20","2021-04-28","2019-01-09","2019-02-27","2019-01-24","2019-01-28","2019-02-14","2019-02-14","2019-02-20","2019-02-14","2019-03-19","2019-02-27","2019-03-05","2019-03-11","2019-03-19","2019-03-19","2019-03-19","2019-03-19","2019-03-19","2019-03-19","2019-03-19","2019-03-19","2020-08-23","2019-03-19","2019-03-19","2021-04-28","2019-03-19","2019-03-19","2019-03-19","2021-04-28","2021-04-28","2021-10-15","2019-03-26","2019-03-29","2019-03-26","2019-06-28","2019-03-26","2019-03-26","2020-10-12","2019-03-26","2019-06-28","2021-08-20","2019-07-01","2021-08-20","2021-08-20","2019-03-29","2019-03-29","2019-05-02","2019-05-13","2019-05-13","2021-08-13","2021-08-20","2021-04-28","2021-04-28","2021-09-10","2020-02-28","2020-02-28","2020-02-28","2020-05-25","2020-05-25","2020-08-23","2020-05-25","2020-05-25","2020-05-25","2020-06-08","2020-06-08","2020-06-08","2020-08-23","2020-08-23","2020-08-23","2020-08-23","2021-10-29","2020-10-12","2020-10-12","2020-10-12","2020-10-10","2020-10-10","2020-10-12","2020-10-12","2020-10-12","2020-10-12","2020-10-12","2021-04-21","2020-10-12","2020-10-12","2020-10-12","2020-10-12","2020-10-13","2020-10-12","2020-10-12","2020-10-13","2020-10-13","2020-10-13","2020-10-13","2020-10-20","2021-04-21","2021-04-28","2021-04-28","2021-06-04","2021-07-16","2021-07-24","2021-07-24","2021-09-10"],"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":[["","43598016630","OLANZAPINE","10MG","30","Select","Select",""],["","65862052890","VENLAFAXINE","75MG ER","30","Select","Select",""],["","00173068220","VENTOLIN","","18","Select","Select",""],["","31722072630","MONTELUKAST","10MG","30","Select","Select",""],["","00093227534","AMOX\/K","875-125","14","Select","Select",""],["","65862018730","ONDANSETRON","4MG","10","Select","Select",""],["","00555901658","SPRINTEC","28 DAY","28","Select","Select",""],["","10702002601","PHENTERMINE","15MG","30","Select","Select",""],["","00093100301","BUSPIRONE","15MG","60","Select","Select",""],["","23155010205","METFORMIN","500MG","120","Select","Select",""],["","66993001968","ALBUTEROL","HFA","18","Select","Select",""],["","00173088210","BREO","200-25","60","Select","Select",""],["","23155065201","METRONIDAZOL","500MG","14","Select","Select",""],["","00093005805","TRAMADOL","50MG","5","Select","Select",""],["","68180087613","NORETHINDRON","0.35MG","28","Select","Select",""],["","65162074510","PROMETHAZINE","12.5MG","20","Select","Select",""],["","16714081901","OSELTAMIVIR","75MG","10","Select","Select",""],["","67877032005","IBUPROFEN","600MG","45","Select","Select",""],["","43547040011","CYCLOBENZAPR","10MG","14","Select","Select",""],["","42806016005","HYDROXYZ","25MG","40","Select","Select",""],["","59746017509","PREDNISONE","20MG","24","Select","Select",""],["","43598016630","OLANZAPINE ","TAB 10MG","30","Select","Select",""],["","65862052890","VENLAFAXINE ","CAP 75MG ER","30","Select","Select",""],["","00173068220","VENTOLIN ","AER ","18","Select","Select",""],["","31722072630","MONTELUKAST ","TAB 10MG","30","Select","Select",""],["","00093227534","AMOX\/K ","TAB 875-125","14","Select","Select",""],["","65862018730","ONDANSETRON ","TAB 4MG","10","Select","Select",""],["","00555901658","SPRINTEC ","TAB 28 DAY","28","Select","Select",""],["","10702002601","PHENTERMINE ","CAP 15MG","30","Select","Select",""],["","00093100301","BUSPIRONE ","TAB 15MG","60","Select","Select",""],["","23155010205","METFORMIN ","TAB 500MG","120","Select","Select",""],["","66993001968","ALBUTEROL ","AER HFA","18","Select","Select",""],["","00173088210","BREO ","INH 200-25","60","Select","Select",""],["","23155065201","METRONIDAZOL ","TAB 500MG","14","Select","Select",""],["","00093005805","TRAMADOL ","TAB 50MG","5","Select","Select",""],["","68180087613","NORETHINDRON ","TAB 0.35MG","28","Select","Select",""],["","65162074510","PROMETHAZINE ","TAB 12.5MG","20","Select","Select",""],["","16714081901","OSELTAMIVIR ","CAP 75MG","10","Select","Select",""],["","67877032005","IBUPROFEN ","TAB 600MG","45","Select","Select",""],["","43547040011","CYCLOBENZAPR ","TAB 10MG","14","Select","Select",""],["","42806016005","HYDROXYZ ","TAB 25MG","40","Select","Select",""],["","13107003134","MIRTAZAPINE ","TAB 15MG","30","Select","Select",""],["","59746017509","PREDNISONE ","TAB 20MG","24","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","",""],["N\/A","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":""}]}]}