{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ANGELA BERRY","gend":1,"add":"250 RANKIN LANE","city":"STUARTS DRAFT","state":"VA","zip":"24477-2809","dob":"1975-04-29","age":"","mstatus":"","insh":7945545,"cliId":"","pno":5402949211,"cno":5402949211,"email":"","ename":"","eno":"","pphy":"SNYDER, JOHN A","ppno":5402457870,"pcpadd":"2927 STUARTS DRAFT HIGHWAY, SUITE 101","pcpcity":"STUARTS DRAFT","pcpstate":"VA","pcpzip":244772796,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"250 RANKIN LANE","madd2":"                                                            ","madd3":"","mcity":"STUARTS DRAFT","mstate":"VA","mzip":"24477-2809","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M79.644","Z30.432","K04.7","F17.210","M54.5","M25.552","W01.0XXD","I69.354","I12.9","N18.3","Z98.890","R30.9","B37.3","J20.9","H65.03","M70.72","Z01.419","R10.9","R11.2","Z86.73","J45.909","E78.5","Z84.1","Z72.0","Z79.82","Z79.899","K08.89","M16.12","M85.652","N83.202","N83.201","I69.959","F32.9","R35.1","Z23","M15.9","F41.9","F17.200","N83.209","R61","M54.17","M70.62","G81.14","R26.1","M13.80","M46.1","N95.1","Z12.31","Z11.51","J30.9","F39","E78.2","E55.9","N18.2","D63.1","M75.22","S43.012A","M79.622","M25.512","M25.612","I69.334","G89.29","M19.90","I10","Z86.69","J22","R06.2","Z83.3","Z88.0","K12.0","K02.9","J45.901","R93.7","E83.9","M89.9","E79.0","M51.86","M51.87","M18.9","I63.9","N18.9","Z88.8","F17.209","M79.602","M06.9","F41.1","R80.1","Z87.891","Z00.00","Z12.4","Z80.9","E66.9","M77.12"],"date":["2019-01-19","2019-09-05","2021-02-12","2021-02-08","2020-09-30","2021-02-10","2020-01-16","2020-01-16","2020-09-15","2020-09-15","2020-01-16","2020-09-14","2020-09-14","2019-05-25","2019-05-25","2019-07-20","2019-09-04","2019-12-02","2019-12-02","2020-01-08","2021-02-10","2020-12-29","2019-12-02","2020-01-08","2019-12-02","2019-12-02","2020-01-08","2020-02-20","2020-02-20","2020-06-11","2020-02-20","2020-12-03","2020-09-30","2020-09-29","2020-09-29","2020-12-29","2021-02-10","2020-12-03","2020-02-27","2020-02-27","2020-04-28","2020-09-29","2021-01-22","2021-01-22","2020-09-29","2020-09-29","2019-09-04","2021-02-09","2019-09-04","2019-09-25","2020-07-06","2021-02-08","2020-09-15","2020-09-15","2020-09-15","2021-02-10","2021-01-22","2021-02-10","2021-02-10","2021-02-10","2021-02-10","2021-02-10","2021-02-10","2021-02-10","2021-02-10","2019-08-20","2019-08-20","2019-08-30","2020-01-08","2020-12-14","2020-12-14","2019-08-11","2019-09-25","2020-03-05","2020-03-05","2020-03-05","2020-04-02","2020-04-02","2020-09-30","2020-09-30","2020-01-08","2020-01-08","2020-09-30","2021-01-06","2021-02-08","2021-02-08","2019-06-03","2019-06-05","2020-12-03","2019-08-29","2020-12-03","2020-12-03","2020-12-03"],"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":[["","70377000315","SIMVASTATIN ","TAB 20MG","30","Select","Select",""],["","65862001330","SERTRALINE ","TAB 100MG","30","Select","Select",""],["","46122038576","24","SPR ALLERGY","16.9","Select","Select",""],["","68001036105","MONTELUKAST ","TAB 10MG","30","Select","Select",""],["","68382005005","MELOXICAM ","TAB 7.5MG","30","Select","Select",""],["","00591555610","PROPRANOLOL ","TAB 40MG","60","Select","Select",""],["","00173068220","VENTOLIN ","AER ","18","Select","Select",""],["","65162010150","GABAPENTIN ","CAP 100MG","90","Select","Select",""],["","76204060060","IPRATROPIUM\/ ","SOL ALBUTER","360","Select","Select",""],["","64980043150","OXYBUTYNIN ","TAB 5MG","30","Select","Select",""],["","69452015120","VITAMIN ","CAP 50000UNT","4","Select","Select",""],["","00406012310","HYDROCO\/APAP ","TAB 5-325MG","42","Select","Select",""],["","43547028950","BUPROPION ","TAB 150MG SR","60","Select","Select",""],["","76204020025","ALBUTEROL ","NEB 0.00083","225","Select","Select",""],["","00069046956","CHANTIX ","TAB 1MG","56","Select","Select",""],["","42571025201","CLINDAMYCIN ","CAP 300MG","28","Select","Select",""],["","00591024010","LORAZEPAM ","TAB 0.5MG","2","Select","Select",""],["","00143980305","DOXYCYCL ","CAP 100MG","14","Select","Select",""],["","00054001829","PREDNISONE ","TAB 20MG","10","Select","Select",""],["","51672130200","TERCONAZOLE ","CRE 0.008","20","Select","Select",""],["","00093321205","CLONAZEPAM ","TAB 1MG","1","Select","Select",""],["","57237004199","PENICILLN ","TAB 500MG","40","Select","Select",""],["","00363020105","NICOTINE ","LOZ 2MG CINN","144","Select","Select",""],["","64980032005","TRIAMCINOLON ","PST DEN 0.1%","5","Select","Select",""],["","68001000501","METHYLPRED ","TAB 4MG","21","Select","Select",""],["","70010075405","METHOCARBAM ","TAB 500MG","30","Select","Select",""],["","69097052444","DICLOFENAC ","GEL 0.01","200","Select","Select",""],["","41167580005","NASACORT ","SPR 55MCG\/AC","16.9","Select","Select",""],["","00781577626","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","51862006301","DIAZEPAM ","TAB 5MG","1","Select","Select",""],["","00456074613","AERCHMBR ","MIS LRG MASK","1","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":""}]}]}