{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MERCEDEZ BERRY","gend":1,"add":"1264 CLIFDEN GREENE                                         ","city":"CHARLOTTESVILLE               ","state":"VA","zip":"22901-3167","dob":"1997-01-16","age":"","mstatus":"","insh":10122684,"cliId":"","pno":4348252937,"cno":4348252937,"email":"","ename":"","eno":"","pphy":"CASTALDO, DAVID J                                           ","ppno":"","pcpadd":"885 Kempsville Rd","pcpcity":"Norfolk                       ","pcpstate":"VA","pcpzip":235023800,"pcpcounty":"","pcpid":"P9057724","pcpname":"AMELIA MEDICAL ASSOCIATES","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"UNIT 6                                                      ","add3":"","madd1":"1264 CLIFDEN GREENE                                         ","madd2":"UNIT 6                                                      ","madd3":"","mcity":"CHARLOTTESVILLE               ","mstate":"VA","mzip":"22901-3167","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R68.89","F11.20","R55","Z86.19","Z30.09","F11.23","R11.10","R10.12","R53.1","Z79.899","Z91.012","F17.200","R11.2","R40.4","O20.9","O21.9","Z3A.08","B19.20","O98.411","O99.331","Z3A.01","O26.891","R10.31","R10.9","O99.321","O21.0","Z91.030","R07.9","K52.9","R19.7","Z87.891","N30.01","R10.32","R51","M54.5","F17.290","Z79.891","R10.30","E66.9","O34.81","O23.41","O99.89","O23.11","F11.10","R10.2","Z3A.00","O23.10","N30.00","O26.91","F11.90","Z3A.10","O99.891","Z3A.12","O21.8","O99.320","Z34.80","Z11.3","Z12.4","R79.89","Z23","Z3A.13","Z34.03","Z34.82","E05.90","B00.1","Z3A.20","O34.82","N83.292","M89.9","O35.9XX0","Z36.3","Z3A.21","O35.8XX0","O21.2","Z3A.22","Z80.3","O23.12","R35.0","Z3A.24","O26.892","O98.412","O99.323","F11.21","Z3A.25","Z87.440","Z31.5","O28.3","Z3A.28","Z83.3","Z82.49","O99.322","Z3A.27","Z20.822","E28.2","O26.13","Z30.2","O26.811","Z3A.29","Z3A.33","R73.09","F12.90","Z3A.36","Z34.83","Z3A.37","O99.324","O98.42","B18.2","O99.334","Z37.0","O98.32","O76","A60.09","O99.284","E03.8","R10.84","Z39.1"],"date":["2021-02-24","2021-11-27","2020-02-28","2021-04-08","2019-01-16","2019-02-15","2021-01-26","2019-02-15","2019-08-16","2021-01-26","2019-10-06","2021-04-11","2021-01-05","2019-02-15","2019-02-22","2021-04-05","2020-09-14","2021-01-05","2019-02-28","2019-02-28","2020-09-09","2020-09-25","2020-12-13","2021-01-26","2020-10-22","2021-01-03","2019-02-28","2020-10-20","2019-08-16","2020-09-14","2021-01-26","2020-09-14","2020-12-13","2019-10-06","2019-10-06","2019-10-06","2020-10-14","2021-01-05","2020-09-09","2020-09-09","2020-09-14","2020-09-14","2020-09-25","2020-09-25","2021-01-03","2020-10-20","2020-09-25","2021-01-03","2020-09-27","2021-04-05","2020-09-27","2021-04-08","2020-10-14","2020-12-13","2020-10-20","2021-04-08","2020-10-22","2020-10-22","2020-11-19","2021-02-11","2020-10-22","2020-11-19","2021-04-12","2020-11-19","2021-04-08","2020-12-13","2020-12-13","2020-12-13","2020-12-17","2021-03-11","2020-12-17","2020-12-17","2021-04-11","2021-01-26","2020-12-26","2021-01-26","2021-01-03","2021-01-03","2021-01-03","2021-01-05","2021-01-05","2021-04-08","2021-01-05","2021-01-05","2021-01-26","2021-01-14","2021-01-14","2021-02-02","2021-01-26","2021-01-26","2021-02-11","2021-01-26","2021-01-26","2021-04-11","2021-03-11","2021-03-11","2021-02-11","2021-02-11","2021-03-11","2021-03-11","2021-04-05","2021-04-05","2021-04-12","2021-04-11","2021-04-11","2021-04-11","2021-04-11","2021-04-11","2021-04-11","2021-04-11","2021-04-11","2021-04-11","2021-04-11","2021-04-11","2021-04-11","2021-04-12"],"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":[["","59746011306","PROCHLORPER","5MG","30","Select","Select",""],["","00093314705","CEPHALEXIN","500MG","14","Select","Select",""],["","65862018730","ONDANSETRON","4MG","90","Select","Select",""],["","65862009620","CEFPODOXIME","200MG","5","Select","Select",""],["","65862044890","VALACYCLOVIR","500MG","180","Select","Select",""],["","10702000301","PROMETHAZINE","25MG","20","Select","Select",""],["","50228043605","NAPROXEN","500MG","30","Select","Select",""],["","00193731221","CONTOUR","NEXT","100","Select","Select",""],["","00193658621","MICROLET","LANCETS","100","Select","Select",""],["","00363010412","PAIN","325MG","30","Select","Select",""],["","49884068905","METOCLOPRAM","10MG","20","Select","Select",""],["","59746011306","PROCHLORPER ","TAB 5MG","30","Select","Select",""],["","00093314705","CEPHALEXIN ","CAP 500MG","14","Select","Select",""],["","65862018730","ONDANSETRON ","TAB 4MG","90","Select","Select",""],["","65862009620","CEFPODOXIME ","TAB 200MG","5","Select","Select",""],["","65862044890","VALACYCLOVIR ","TAB 500MG","180","Select","Select",""],["","10702000301","PROMETHAZINE ","TAB 25MG","20","Select","Select",""],["","50228043605","NAPROXEN ","TAB 500MG","30","Select","Select",""],["","00193731221","CONTOUR ","TES NEXT","100","Select","Select",""],["","00193658621","MICROLET ","MIS LANCETS","100","Select","Select",""],["","00363010412","PAIN ","TAB 325MG","30","Select","Select",""],["","49884068905","METOCLOPRAM ","TAB 10MG","20","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":""}]}]}