{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"NIRMALA RANASURIYA","gend":1,"add":"206 HARRIS CREEK ROAD                                       ","city":"LOUISA                        ","state":"VA","zip":"23093-4202","dob":"1965-02-23","age":"","mstatus":"","insh":10175104,"cliId":"","pno":3013393892,"cno":3013393892,"email":"","ename":"","eno":"","pphy":"HARKRADER, EDWARD R                                         ","ppno":"","pcpadd":"101 Woolfolk Ave,Ste 100","pcpcity":"Louisa                        ","pcpstate":"VA","pcpzip":230934264,"pcpcounty":"","pcpid":"P0124234","pcpname":"LOUISA FAMILY PRACTICE PLC","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"206 HARRIS CREEK ROAD                                       ","madd2":"                                                            ","madd3":"","mcity":"LOUISA                        ","mstate":"VA","mzip":"23093-4202","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["ASIAN\/PACIFIC"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["L60.3","B07.9","R10.9","R14.0","R10.33","R11.10","R10.30","R10.84","I10","M25.50","Z00.00","E78.2","R22.31","Z13.31","R92.8","H40.053","H52.03","H52.223","H52.4","H25.13","Z01.810","Z01.818","R70.0","M79.89","M25.511","G89.29","M67.911","Z23","Z12.31","M75.41","M75.81","M79.672","M72.2","M19.041","S60.311A","H35.40","H52.02","G44.52","M26.69","J45.20","H40.013","Z12.11","Z11.59","R73.03","E78.00"],"date":["2019-05-17","2019-05-17","2019-05-28","2019-05-28","2019-05-28","2019-05-28","2019-06-05","2019-06-05","2020-09-14","2021-11-23","2021-11-23","2021-11-23","2019-10-22","2020-09-14","2019-09-05","2019-09-09","2021-11-15","2021-11-15","2021-11-15","2021-11-15","2019-09-17","2019-09-17","2019-09-17","2019-09-23","2021-11-23","2021-11-23","2019-10-07","2021-11-23","2021-01-28","2020-03-03","2020-03-03","2020-09-14","2020-09-14","2021-03-02","2021-02-03","2021-02-10","2021-02-10","2021-11-23","2021-05-12","2021-05-12","2021-11-15","2021-11-23","2021-11-23","2021-11-23","2021-11-23"],"priorHcc":["","","","","","","","","",null,null,null,"","","","",null,null,null,null,"","","","",null,null,"",null,"","","","","","","","","",null,"","",null,null,null,null,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":[["","45802065078","LORATADINE","10MG","90","Select","Select",""],["","70377000415","SIMVASTATIN","40MG","90","Select","Select",""],["","60505384801","CELECOXIB","100MG","30","Select","Select",""],["","00591040710","LISINOPRIL","10MG","90","Select","Select",""],["","29300012810","HYDROCHLOROT","25MG","30","Select","Select",""],["","59779061288","ALLERGY","10MG","90","Select","Select",""],["","51672128401","TRIAMCINOLON","0.10%","30","Select","Select",""],["","67877022201","GABAPENTIN","100MG","120","Select","Select",""],["","59267100002","PFIZER","COVID-19","0.3","Select","Select",""],["","69097015807","MELOXICAM","7.5MG","90","Select","Select",""],["","69097014260","ALBUTEROL","HFA","6.7","Select","Select",""],["","69097084507","CYCLOBENZAPR","5MG","20","Select","Select",""],["","69097052444","DICLOFENAC","1%","100","Select","Select",""],["","00085113204","PROVENTIL","HFA","6.7","Select","Select",""],["","49281042050","FLUZONE","2020-21","0.5","Select","Select",""],["","45802065078","LORATADINE ","TAB 10MG","90","Select","Select",""],["","70377000415","SIMVASTATIN ","TAB 40MG","90","Select","Select",""],["","60505384801","CELECOXIB ","CAP 100MG","30","Select","Select",""],["","00591040710","LISINOPRIL ","TAB 10MG","90","Select","Select",""],["","29300012810","HYDROCHLOROT ","TAB 25MG","30","Select","Select",""],["","59779061288","ALLERGY ","TAB 10MG","90","Select","Select",""],["","51672128401","TRIAMCINOLON ","OIN 0.001","30","Select","Select",""],["","67877022201","GABAPENTIN ","CAP 100MG","120","Select","Select",""],["","59267100002","PFIZER ","INJ COVID-19","0.3","Select","Select",""],["","69097015807","MELOXICAM ","TAB 7.5MG","90","Select","Select",""],["","69097014260","ALBUTEROL ","AER HFA","6.7","Select","Select",""],["","69097084507","CYCLOBENZAPR ","TAB 5MG","20","Select","Select",""],["","69097052444","DICLOFENAC ","GEL 0.01","100","Select","Select",""],["","00085113204","PROVENTIL ","AER HFA","6.7","Select","Select",""],["","49281042050","FLUZONE ","INJ 2020-21","0.5","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":""}]}]}