{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LAURIE   A RICE","gend":1,"add":"4112 TWO MILE RUN LANE","city":"ELKTON","state":"VA","zip":"22827-3516","dob":"1984-06-15","age":"","mstatus":"","insh":6925672,"cliId":"","pno":5402092310,"cno":5402092310,"email":"","ename":"","eno":"","pphy":"PERKINS, JASON F","ppno":5402981200,"pcpadd":"13737 Spotswood Trl, ","pcpcity":"Elkton","pcpstate":"VA","pcpzip":228273200,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"4112 TWO MILE RUN LANE","madd2":"                                                            ","madd3":"","mcity":"ELKTON","mstate":"VA","mzip":"22827-3516","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R30.0","R10.9","R35.0","I10","K59.00","K80.20","F17.210","Z91.14","Z87.442","Z86.73","Z79.899","Z88.8","Z88.5","Z88.0","I71.03","R07.9","R11.0","Z88.1","I71.01","F41.9","I63.9","R94.31","R79.89","R07.2","R51","Z72.0","D72.829","D64.9","I71.02","I21.4","I77.4","K55.1","I70.1","Z46.59","J96.01","F15.10","R41.0","F15.90","Z46.82","R91.8","J90","J98.11","I21.9","I95.9","J15.211","R06.89","R50.9","E63.9","F05","R93.6","Z98.890","R60.9","G95.11","G82.22","I71.00","I97.821","I63.511","Z95.2","Z48.812","N31.9","K59.2","F19.10","F10.20","R41.89","I25.10","G89.18","D62","I71.2","S50.312A","F17.200","M54.5","R10.31","R10.32","I48.91","J91.8","R45.1","J15.212","I51.7","K63.89","G47.00","Z45.2","K59.8","K59.39","Z43.1","I72.9","M54.42","M54.41","G89.29","M25.551","M25.552","I77.72","I72.6","F15.20","I63.89","G93.89","G93.0","R00.1","E87.79","F10.231","R13.12","R26.9","I69.398","R53.81","J18.9","G82.20","N17.9","E44.1","Z93.1","N83.9","S49.92XA","S59.902A","S69.92XA","W19.XXXA","Z95.5","I49.9","I77.79","I72.8","I67.1","I44.7","Z91.89","Y84.8","I21.A1","G92","I63.411","J69.0","I47.2","E87.0","J95.851","F15.23","I63.81","R14.0","I71.6","A49.01","R09.89","R03.1","R42","R19.00","N20.0","I77.9","F41.1","K02.9","F15.188","J81.1","R33.9","Z96.0","Z23","M79.89","F32.9","I63.131","R00.0","N83.8"],"date":["2019-08-15","2020-09-13","2020-12-24","2020-11-10","2020-09-24","2019-08-15","2020-11-10","2019-08-15","2019-08-15","2020-11-10","2019-08-15","2020-08-20","2020-11-10","2020-11-10","2020-10-22","2020-11-10","2020-08-21","2020-11-10","2021-04-08","2020-09-22","2020-08-22","2020-08-21","2020-08-21","2020-08-21","2020-08-21","2020-08-21","2020-08-21","2020-09-05","2020-09-18","2020-09-28","2020-08-22","2020-08-22","2020-08-26","2020-08-26","2020-10-10","2020-08-30","2020-09-22","2020-09-11","2020-09-12","2020-09-20","2020-09-22","2020-09-22","2020-09-01","2020-11-10","2020-09-01","2020-09-18","2020-09-15","2020-09-13","2020-09-13","2020-09-13","2020-09-24","2020-09-17","2020-12-01","2020-12-01","2021-04-08","2020-12-01","2020-12-01","2020-09-28","2020-09-28","2020-10-16","2020-10-10","2020-09-28","2020-09-28","2020-09-28","2020-09-28","2020-10-10","2020-10-10","2021-04-08","2019-04-04","2019-08-15","2020-09-22","2019-08-15","2020-08-20","2020-08-30","2020-08-25","2020-09-22","2020-09-03","2020-09-17","2020-09-03","2020-09-15","2020-09-19","2020-09-18","2020-09-18","2020-10-27","2021-02-05","2021-02-05","2021-02-05","2021-02-05","2021-02-05","2021-02-05","2020-09-21","2020-09-21","2020-09-21","2020-08-31","2020-08-31","2020-08-31","2020-08-31","2020-09-03","2020-08-31","2020-09-25","2020-09-22","2020-09-22","2020-09-22","2020-09-22","2020-09-18","2020-09-18","2020-09-25","2020-09-27","2020-12-30","2019-04-04","2019-04-04","2019-04-04","2019-04-04","2020-08-20","2020-08-24","2020-09-18","2020-08-24","2020-08-24","2020-09-11","2020-09-04","2020-08-20","2020-08-20","2020-08-20","2020-08-20","2020-08-20","2020-08-20","2020-08-20","2020-08-20","2020-08-20","2020-08-25","2020-09-13","2020-09-14","2020-09-15","2020-09-12","2020-09-12","2020-11-10","2020-12-24","2020-08-20","2020-09-05","2020-09-09","2020-09-09","2020-09-18","2020-09-19","2020-09-24","2020-09-24","2020-10-13","2019-04-04","2020-08-31","2020-08-25","2020-11-10","2020-12-30"],"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":[["","64380073408","HYDRALAZINE ","TAB 25MG","90","Select","Select",""],["","87701040732","GNP ","TAB 1000 PR","30","Select","Select",""],["","68001039700","FAMOTIDINE ","TAB 20MG","60","Select","Select",""],["","60258017101","MAG ","TAB 400MG","30","Select","Select",""],["","60505267108","ATORVASTATIN ","TAB 80MG","30","Select","Select",""],["","49884025601","MINOXIDIL ","TAB 2.5MG","60","Select","Select",""],["","68001038300","LABETALOL ","TAB 300MG","180","Select","Select",""],["","68001033508","LISINOPRIL ","TAB 20MG","60","Select","Select",""],["","69315012701","FOLIC ","TAB 1000MCG","30","Select","Select",""],["","68001018500","QUETIAPINE ","TAB 25MG","90","Select","Select",""],["","40985021151","B-1 ","TAB 100MG","30","Select","Select",""],["","65162062750","TRAMADOL ","TAB 50MG","40","Select","Select",""],["","68180012202","CEPHALEXIN ","CAP 500MG","14","Select","Select",""],["","68001015403","CARVEDILOL ","TAB 6.25MG","30","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","20","Select","Select",""],["","35046001130","B-12 ","SUB 1000MCG","30","Select","Select",""],["","67877019910","AMLODIPINE ","TAB 10MG","30","Select","Select",""],["","69618004610","ASPIRIN ","TAB 81MG EC","30","Select","Select",""],["","76204020025","ALBUTEROL ","NEB 0.00083","75","Select","Select",""],["","00904645780","DOK ","CAP 100MG","30","Select","Select",""],["","00536589688","NICOTINE ","DIS 21MG\/24H","28","Select","Select",""],["","60505009600","DOXAZOSIN ","TAB 8MG","60","Select","Select",""],["","65162019011","NAPROXEN ","500MG","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":""}]}]}