{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ANGELA ZAMUDIO","gend":1,"add":"13174 SCOTTSMILL ROAD","city":"CULPEPER","state":"VA","zip":"22701-5640","dob":"1973-10-24","age":"","mstatus":"","insh":6957544,"cliId":"","pno":5407292536,"cno":5407292536,"email":"","ename":"","eno":"","pphy":"LAFFOND, WILLIAM T","ppno":4346541850,"pcpadd":"2503 S Seminole Trl, # 105","pcpcity":"Madison","pcpstate":"VA","pcpzip":227272690,"pcpcounty":"","pcpid":"","pcpname":"MARTHA JEFFERSON MEDICAL ASSOC","ano":"","add2":"                                                            ","add3":"","madd1":"13174 SCOTTSMILL ROAD","madd2":"                                                            ","madd3":"","mcity":"CULPEPER","mstate":"VA","mzip":"22701-5640","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"NORTHERN\/ WINCHESTER","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I50.32","R60.9","R06.09","A41.9","L03.115","A48.0","J96.01","I26.99","N17.9","I69.354","E10.52","D62","E87.1","E10.621","E10.43","L97.513","Z79.4","D64.9","E10.9","M86.9","E11.43","T78.40XA","J45.909","E11.621","Z98.890","Z89.431","L03.90","J96.91","E10.3313","Z89.511","E13.621","F11.20","Z89.519","F41.9","E13.8","F17.200","T87.43","F11.21","L97.421","Z79.899","M79.661","M54.5","I10","Z88.6","Z88.0","Z88.2","L89.893","R10.30","R31.9","T87.44","R60.0","Z45.2","Z46.82","J98.4","J96.00","E10.42","E88.09","L03.116","E11.65","M25.551","M25.552","I46.9","R91.8","Z97.8","J96.21","Z99.11","Z93.0","I95.9","E87.2","L89.159","E11.9","N39.0","R63.3","R53.83","R63.5","R01.1","Z79.82","L97.522","M86.8X7","R35.0","R30.0","E10.8","E10.51","L02.415","E11.622","L98.492","T87.89","W19.XXXA","Y92.009","E10.69","E10.65","B96.5","B95.1","K31.84","B95.61","E86.0","R19.7","R11.10","Z76.5","J18.9","L89.154","R65.21","N17.0","M62.82","L97.429","F33.0","D69.6","L03.119","R21","J98.11","J90","E87.6","N18.9","L97.509","S91.301A","M14.671","J98.2","Z47.81","Z89.611","J94.8","L97.422","G89.4","G62.9","Z86.73","F10.20","L98.491","L97.822","Z79.2","L97.529","Z79.01","Z95.828","Z88.5","Z88.8","G62.89","R73.9","M86.171","F39","F17.210","Z90.49","E10.40","G89.29","A49.01","I25.2","R40.0","R06.83","E13.628","D61.818","J96.90","L97.511","M62.81","F41.1","I63.81","I67.1","R53.1","R10.9","K59.00","R11.2","D53.9","R07.89","M79.89","Z04.3","R60.1","E11.649","R65.20","R16.2","R06.02","J81.1","R06.03","E87.5","L97.519","I96","M79.672","I63.9","L97.821","R10.84","E11.40","Z88.1","R10.817","K55.30","R94.5","Z89.512","L89.524","B37.41","F32.9","I50.9","R29.898","L97.909","L97.811","M79.604","M54.9","E55.9","L03.111","R43.9","R13.10","S88.111A","M85.872","I50.30","I11.0","E11.42","F33.9","G54.6","R04.0","F33.1","M13.80","I69.351","Z86.79","K52.9","K63.89","R09.02","R89.9","Z95.9"],"date":["2020-01-07","2021-01-13","2020-02-17","2021-03-28","2021-03-09","2020-01-15","2021-03-31","2020-02-17","2021-04-12","2021-01-30","2020-01-15","2020-01-01","2021-03-09","2021-02-12","2020-11-28","2020-01-01","2021-01-13","2021-04-12","2021-01-13","2021-01-01","2020-01-02","2020-01-02","2020-01-02","2020-10-13","2020-01-08","2020-01-08","2021-02-17","2021-02-17","2021-01-19","2021-01-05","2020-03-24","2021-03-19","2020-10-08","2021-01-21","2020-10-08","2021-01-05","2021-03-09","2020-07-28","2020-09-25","2021-01-13","2020-08-16","2020-08-16","2021-03-31","2021-01-13","2021-01-13","2021-01-13","2020-10-13","2020-11-12","2020-11-12","2021-01-02","2021-02-01","2021-04-05","2021-04-12","2021-02-10","2021-03-03","2021-03-09","2021-03-09","2021-03-23","2021-04-12","2021-03-23","2021-03-23","2021-04-12","2021-04-12","2021-04-10","2021-04-12","2021-04-12","2021-04-12","2021-04-12","2021-04-12","2021-04-12","2021-04-12","2021-04-12","2021-04-12","2020-02-20","2021-01-04","2019-12-10","2021-01-13","2020-07-21","2020-06-01","2020-02-20","2020-02-20","2020-06-10","2020-06-13","2020-11-28","2020-10-13","2020-07-10","2020-10-13","2020-11-28","2020-11-28","2020-11-28","2021-01-30","2020-11-28","2020-11-28","2020-11-28","2020-11-30","2021-01-13","2021-01-13","2021-01-13","2021-01-13","2021-03-28","2021-03-18","2021-02-02","2021-01-30","2021-01-30","2021-01-30","2021-01-30","2021-02-10","2021-02-26","2021-02-26","2021-02-18","2021-04-10","2021-03-31","2021-04-12","2019-12-26","2020-01-01","2020-01-01","2020-01-02","2020-01-15","2020-01-02","2020-01-05","2020-10-13","2020-06-11","2020-07-10","2020-09-22","2020-09-24","2020-10-13","2020-10-13","2020-10-13","2020-11-30","2021-01-05","2021-01-05","2021-01-05","2021-01-13","2021-01-05","2021-01-13","2020-01-01","2020-05-27","2021-01-13","2021-01-13","2020-11-11","2020-11-11","2020-06-11","2020-06-10","2020-09-22","2020-09-22","2020-11-29","2021-01-30","2021-02-07","2020-02-26","2020-05-08","2020-04-21","2020-09-22","2020-09-22","2021-03-09","2021-01-13","2020-11-11","2021-01-13","2020-11-11","2020-11-28","2021-01-13","2020-11-28","2021-01-30","2021-01-05","2021-01-30","2021-01-30","2021-02-01","2021-02-09","2021-03-24","2021-04-05","2020-01-02","2020-01-08","2020-07-21","2020-07-28","2020-10-06","2020-11-12","2021-01-13","2021-01-13","2021-01-13","2021-01-13","2021-02-01","2021-03-09","2021-03-09","2021-03-09","2021-03-09","2020-01-09","2020-09-29","2020-06-30","2020-07-17","2020-08-16","2020-08-16","2020-09-29","2021-01-31","2021-02-17","2021-02-18","2020-01-02","2020-01-04","2020-01-15","2020-01-15","2020-01-15","2020-01-15","2020-01-15","2020-01-15","2020-01-17","2020-02-17","2020-11-12","2020-11-12","2021-01-13","2021-01-13","2021-02-17","2021-03-28","2021-04-02"],"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":[["","12496120803","SUBOXONE ","MIS 8-2MG","14","Select","Select",""],["","00002751001","HUMALOG ","INJ 100\/ML","10","Select","Select",""],["","00003089421","ELIQUIS ","TAB 5MG","60","Select","Select",""],["","43386035801","HYDROCO\/APAP ","TAB 10-325MG","20","Select","Select",""],["","68180030360","CEFUROXIME ","TAB 500MG","28","Select","Select",""],["","68180012202","CEPHALEXIN ","CAP 500MG","30","Select","Select",""],["","50111091601","TORSEMIDE ","TAB 10MG","30","Select","Select",""],["","13107015590","PAROXETINE ","TAB 20MG","30","Select","Select",""],["","00088222033","LANTUS ","INJ 100\/ML","10","Select","Select",""],["","68180071160","CEFDINIR ","CAP 300MG","20","Select","Select",""],["","69097094312","GABAPENTIN ","CAP 300MG","90","Select","Select",""],["","68180098003","LISINOPRIL ","TAB 10MG","30","Select","Select",""],["","00378020810","FUROSEMIDE ","TAB 20MG","30","Select","Select",""],["","47781030301","NITROFURANTN ","CAP 100MG","10","Select","Select",""],["","00093101042","MUPIROCIN ","OIN 0.02","22","Select","Select",""],["","69547035302","NARCAN ","SPR ","2","Select","Select",""],["","69452015120","VITAMIN ","CAP 50000UNT","4","Select","Select",""],["","23155000201","HYDRALAZINE ","TAB 25MG","90","Select","Select",""],["","65862039010","ONDANSETRON ","TAB 4MG ODT","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":""}]}]}