{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"NICOLE DOBSON","gend":1,"add":"1928 LYNDHURST ROAD","city":"WAYNESBORO","state":"VA","zip":"22980-5261","dob":"1980-01-28","age":"","mstatus":"","insh":4099988,"cliId":"","pno":5404719976,"cno":5404476242,"email":"","ename":"","eno":"","pphy":"REID, JAMES R","ppno":5409421200,"pcpadd":"15 Pratts Run, Ste 103","pcpcity":"Waynesboro","pcpstate":"VA","pcpzip":229806606,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":5404476242,"add2":"APT 5","add3":"","madd1":"1928 LYNDHURST ROAD","madd2":"APT 5","madd3":"","mcity":"WAYNESBORO","mstate":"VA","mzip":"22980-5261","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F11.20","F11.21","F17.200","F10.10","F39","F43.10","F29","R74.0","K70.10","R74.8","D75.89","R68.89","G43.909","G47.00","Z11.59","R45.851","F10.20","R00.0","F10.239","F17.210","F43.20","F10.929","Z72.0","F41.9","F34.1","F33.9","F41.0","S30.0XXA","M54.5","F33.2","F43.12","F12.20","I10","Z62.810","Z91.410","B07.0","F41.1","F33.1","R06.00","F32.9","R42","F10.129","R53.83","R10.9","M54.9","W57.XXXA","F23","Z74.3","Y92.230","F19.959","T43.96XA","Z91.128","Z88.8","E87.6","S09.90XA","M54.2","F13.19","T14.90XA","Y04.2XXA","Z79.899","T42.4X2A","R07.89","R20.2","R53.1","F10.229","S39.92XA","F11.11","Z00.00","Z12.4","G89.29","Z23","Y90.2","R07.9","Y93.9","Y92.009","Z91.14","F22","R11.10","R94.5","F10.230","F10.220","M54.89","M25.561","N91.2","W01.0XXA","Y93.89","K85.00","Z91.19","Z20.828","E87.2","R10.30","N93.9","F10.231","F12.90","Z81.4","Z81.8","Z13.89","R44.0","R44.1","R10.84","M25.662","F19.10","E86.0","Z20.822","E66.9","Z68.34","E80.7"],"date":["2021-03-23","2020-08-12","2021-03-08","2020-10-01","2020-11-17","2021-05-18","2021-05-17","2020-07-29","2021-05-14","2020-10-15","2020-10-01","2021-02-24","2020-11-17","2020-11-17","2021-02-18","2021-02-21","2021-03-23","2021-03-08","2021-05-18","2021-03-16","2021-03-10","2021-05-18","2021-05-17","2021-03-23","2019-07-17","2019-07-17","2019-09-14","2019-09-14","2020-01-20","2019-11-06","2019-10-31","2019-10-31","2020-07-20","2021-03-16","2019-10-31","2019-11-02","2021-03-18","2019-11-11","2021-05-13","2020-09-29","2020-09-29","2020-10-14","2020-10-14","2021-03-08","2021-03-12","2021-05-18","2019-10-31","2019-10-31","2021-03-08","2020-07-20","2020-07-20","2020-11-08","2021-05-14","2020-07-20","2020-10-14","2020-10-14","2021-05-13","2019-09-14","2020-04-11","2021-03-16","2019-10-30","2020-04-11","2020-04-11","2020-04-11","2021-03-16","2019-09-14","2020-01-20","2020-01-20","2020-01-20","2020-01-20","2020-01-20","2020-04-11","2020-04-11","2020-04-11","2020-04-11","2020-04-11","2020-07-20","2020-09-29","2021-05-14","2021-05-14","2021-05-14","2021-03-08","2021-03-10","2021-03-08","2021-03-08","2021-03-08","2020-09-30","2020-10-14","2020-11-08","2021-05-14","2021-03-18","2021-03-16","2021-03-16","2021-03-16","2021-03-16","2019-07-17","2019-07-17","2020-07-20","2020-07-20","2020-10-13","2021-03-10","2021-05-14","2021-05-14","2021-05-14","2021-03-08","2021-03-08","2021-05-14"],"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":[["","16729013716","CLONAZEPAM ","TAB 1MG","10","Select","Select",""],["","13668000805","ZOLPIDEM ","TAB 10MG","30","Select","Select",""],["","47781030301","NITROFURANTN ","CAP 100MG","3","Select","Select",""],["","12496120803","SUBOXONE ","MIS 8-2MG","28","Select","Select",""],["","00536311201","NICOTINE ","GUM 2MG MINT","100","Select","Select",""],["","29300013501","CLONIDINE ","TAB 0.1MG","90","Select","Select",""],["","67877032101","IBUPROFEN ","TAB 800MG","30","Select","Select",""],["","00904671960","ACETAMINOPHE ","TAB 325MG","90","Select","Select",""],["","00093506101","HYDROXYZ ","TAB 25MG","20","Select","Select",""],["","10006073020","VITAMIN ","TAB 100MG","90","Select","Select",""],["","00555015902","CHLORDIAZEP ","CAP 25MG","20","Select","Select",""],["","81131077943","EQ ","TAB WOMENS","30","Select","Select",""],["","00904053913","THERA ","TAB ","30","Select","Select",""],["","57237007710","ONDANSETRON ","TAB 4MG ODT","6","Select","Select",""],["","67877022305","GABAPENTIN ","CAP 300MG","14","Select","Select",""],["","13107003105","MIRTAZAPINE ","TAB 15MG","30","Select","Select",""],["","05388062808","MELATONIN ","TAB 3MG","60","Select","Select",""],["","68180044601","QUETIAPINE ","TAB 50MG","30","Select","Select",""],["","69315012710","FOLIC ","TAB 1000MCG","30","Select","Select",""],["","00093406701","PRAZOSIN ","CAP 1MG","30","Select","Select",""],["","00904671980","ACETAMINOPHEN ","TA B 325","90","Select","Select",""],["","00456112030","VIIBRYD ","TAB 20MG","30","Select","Select",""],["","00591352530","LIDOCAINE ","PAD 0.05","30","Select","Select",""],["","80681005000","DAILY-VITE ","TAB ","30","Select","Select",""],["","00143211250","DOXYCYCL ","TAB 100MG","18","Select","Select",""],["","37205030778","WOMENS ","TAB DAILY","30","Select","Select",""],["","67618011128","COLACE ","CAP 50MG","14","Select","Select",""],["","54629007501","MULTI-VIT\/ ","TAB MINERALS","90","Select","Select",""],["","46122009575","MEGA ","WOMEN","30","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":""}]}]}