{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MARY   J LEMEN","gend":1,"add":"4638 AMICUS ROAD","city":"RUCKERSVILLE","state":"VA","zip":"22968-2502","dob":"1979-08-20","age":"","mstatus":"","insh":4098196,"cliId":"","pno":4343650044,"cno":4343650044,"email":"","ename":"","eno":"","pphy":"CAMPBELL, DEBORAH L","ppno":4346542830,"pcpadd":"416 Albemarle Sq, ","pcpcity":"Charlottesville","pcpstate":"VA","pcpzip":229017400,"pcpcounty":"","pcpid":"","pcpname":"ALBEMARLE SQUARE FAMILY HEALTH","ano":"","add2":"APARTMENT B","add3":"","madd1":"4638 AMICUS ROAD","madd2":"APARTMENT B","madd3":"","mcity":"RUCKERSVILLE","mstate":"VA","mzip":"22968-2502","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"WESTERN\/ CHARLOTTESVILLE","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["S63.641A","M65.4","Z98.890","Z48.89","M79.641","K75.81","E66.01","S96.812A","M89.9","R93.7","Z47.89","M79.645","B34.9","E87.6","D72.829","R11.2","R19.7","Z20.822","M76.62","S53.21XD","S63.418A","L02.411","R22.31","E11.9","E66.9","Z68.42","Z87.891","Z88.5","Z88.0","M65.312","M65.342","S86.312D","S93.05XD","N93.9","J01.00","R11.0","R10.9","S93.402A","G89.18","M79.644","M25.531","S53.21XS","M76.72","S93.332A","M79.672","S93.02XA","M25.572","S86.312A","G43.809","R42","R55","G40.309","S69.91XA","R73.03","S52.511A","J02.0","J02.9","H92.01","M79.10","R00.0","K76.0","F17.210","M65.341","M95.8","M77.32","M77.52","S99.912A","R20.0","W19.XXXA","M25.472","S09.90XA","R27.0","R41.3","G89.29","S02.5XXA","K08.89","S93.05XA","M19.072","S93.02XD","R32","Z79.1","E11.22","G43.119","Z76.89","R41.9","G43.909","R07.2","R53.81","L03.111","W18.39XA","Z90.49","Z20.828"],"date":["2019-03-07","2019-04-08","2019-03-15","2019-03-15","2019-11-06","2020-07-16","2020-07-16","2020-07-24","2020-07-24","2020-07-24","2020-08-31","2020-11-02","2021-02-27","2021-02-27","2021-02-27","2021-02-27","2021-02-27","2021-02-27","2019-01-21","2019-04-08","2019-03-07","2019-09-14","2019-07-25","2020-10-07","2020-12-01","2019-07-25","2019-09-14","2021-02-27","2021-02-27","2020-11-02","2020-11-02","2020-10-05","2020-08-31","2020-11-03","2021-01-20","2021-02-27","2021-02-27","2019-01-07","2020-08-18","2019-09-20","2020-01-08","2019-11-06","2020-08-03","2020-07-13","2020-07-13","2020-08-18","2020-08-18","2020-08-18","2020-11-08","2020-11-08","2020-12-01","2020-12-07","2019-09-20","2019-11-23","2019-10-21","2019-11-23","2019-11-23","2019-11-23","2019-11-23","2020-12-01","2019-11-23","2021-02-27","2020-02-10","2020-07-13","2020-07-13","2020-07-13","2020-10-07","2020-10-07","2020-10-07","2020-10-07","2020-11-08","2020-11-08","2020-11-08","2020-07-13","2020-05-13","2020-05-13","2020-08-18","2020-07-24","2020-08-03","2020-11-08","2020-11-08","2020-11-08","2020-11-30","2020-11-30","2020-11-08","2020-11-08","2020-12-01","2019-09-14","2019-09-14","2020-08-18","2021-02-27","2021-02-27"],"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":[["","63304069301","CLINDAMYCIN ","CAP 300MG","30","Select","Select",""],["","65862039110","ONDANSETRON ","TAB 8MG ODT","20","Select","Select",""],["","00143122701","DICYCLOMINE ","TAB 20MG","20","Select","Select",""],["","42571017701","PIROXICAM ","CAP 20MG","14","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","14","Select","Select",""],["","69097015807","MELOXICAM ","TAB 7.5MG","30","Select","Select",""],["","10702001801","OXYCODONE ","TAB 5MG","30","Select","Select",""],["","00093005805","TRAMADOL ","TAB 50MG","10","Select","Select",""],["","68382091634","METHYLPRED ","TAB 4MG","21","Select","Select",""],["","65162074510","PROMETHAZINE ","TAB 12.5MG","20","Select","Select",""],["","10702025350","BUT\/APAP\/CAF ","TAB ","20","Select","Select",""],["","68180012202","CEPHALEXIN ","CAP 500MG","40","Select","Select",""],["","70710122600","AMITRIPTYLIN ","TAB 25MG","30","Select","Select",""],["","53746010901","HYDROCO\/APAP ","TAB 5-325MG","12","Select","Select",""],["","76385012810","METFORMIN ","TAB 500MG ER","60","Select","Select",""],["","00093117410","PENICILLN ","TAB 500MG","28","Select","Select",""],["","00603188016","LIDOCAINE ","PAD 0.05","30","Select","Select",""],["","49483060450","IBUPROFEN ","TAB 800MG","12","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":[[["Yes","Select","","","","","Select","",""],["Yes","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":""}]}]}