{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"STEPHEN CAMPBELL","gend":0,"add":"374 FLATWOOD ROAD","city":"AMHERST","state":"VA","zip":"24521-3859","dob":"1976-02-14","age":"","mstatus":"","insh":8210103,"cliId":"","pno":4342775132,"cno":4342775132,"email":"","ename":"","eno":"","pphy":"COLEMAN, JASON CHANNING","ppno":4349469565,"pcpadd":"2100 WILBORN AVE, ","pcpcity":"SOUTH BOSTON","pcpstate":"VA","pcpzip":245921628,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"374 FLATWOOD ROAD","madd2":"                                                            ","madd3":"","mcity":"AMHERST","mstate":"VA","mzip":"24521-3859","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I48.91","E87.6","D64.9","E83.42","I48.0","R07.9","Z86.718","Z72.0","S09.90XA","M54.2","W01.198A","Y93.89","Y92.89","S16.1XXA","K21.9","Z86.711","F17.210","Z79.82","Z79.899","L03.114","A41.9","R65.20","E87.2","Z11.59","I49.9","R53.1","K44.9","K22.5","G47.30","I47.1","R42","F17.200","I95.9","E87.1","I89.0","K40.90","K21.0","Z28.21","Z23","I26.99","Z98.890","I82.4Z1","I82.411","N50.811","N50.812","G47.33","R39.12","N20.0","R10.31","D50.9","K29.70","R09.81","R51","J01.00","R11.2","M79.89","S69.92XA","I82.401","I82.431","I87.9","M79.604","R52","M54.89","M54.5","R45.851","F10.10","S19.9XXA","M47.812","R40.4","R56.9","M79.603","R60.9","R19.09","L03.818","K57.30","R30.9","R10.30","A04.8","R19.7","Z68.23","F10.129","F32.9","I10","L03.119","M62.838","R10.9","Z82.49","R00.0","R00.2","R06.02","H92.09","Z79.01","Z87.11","M25.422","R59.0","R60.0","D72.829","Z72.89","Z83.3","M19.071","I82.4Z9","R41.82","R19.00","Z71.6","R06.89","R61","K59.00","R55"],"date":["2021-04-22","2020-03-17","2020-05-18","2020-03-17","2021-05-06","2020-03-06","2020-03-06","2020-05-04","2019-11-14","2019-11-14","2019-11-14","2019-11-14","2019-11-14","2019-11-14","2021-04-22","2020-05-18","2021-04-22","2021-04-22","2021-04-22","2020-04-22","2020-03-17","2020-03-17","2020-03-17","2020-05-15","2019-03-12","2020-03-11","2021-04-22","2019-12-11","2020-03-06","2020-03-06","2020-03-06","2020-03-06","2020-03-11","2020-03-17","2020-03-11","2020-05-22","2020-07-09","2020-04-22","2020-04-22","2021-05-06","2020-06-10","2020-06-10","2020-10-16","2020-07-09","2020-07-09","2021-03-16","2021-03-17","2021-04-22","2021-03-17","2019-03-27","2020-01-14","2020-01-14","2020-01-14","2020-02-07","2020-02-07","2020-03-11","2020-03-11","2020-10-06","2020-10-06","2021-04-01","2021-04-01","2021-04-22","2021-04-22","2021-04-22","2019-06-16","2019-06-16","2019-11-14","2019-11-14","2020-03-11","2020-03-11","2020-03-11","2020-03-11","2020-04-15","2020-04-10","2021-02-05","2021-02-05","2021-04-22","2019-03-27","2019-03-27","2019-03-27","2019-06-16","2019-06-16","2020-02-13","2020-05-04","2020-08-03","2021-04-22","2020-05-18","2019-03-12","2019-09-25","2020-01-14","2020-01-14","2020-05-18","2020-01-14","2020-03-11","2020-03-11","2020-03-11","2020-03-14","2020-05-18","2020-05-18","2021-04-01","2019-10-03","2020-03-11","2020-04-15","2020-10-16","2021-04-22","2019-05-20","2021-02-05","2021-05-06"],"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":[["","65162052110","PROMETHAZINE ","TAB 25MG","30","Select","Select",""],["","59651000305","OMEPRAZOLE ","CAP 40MG","30","Select","Select",""],["","67877032005","IBUPROFEN ","TAB 600MG","40","Select","Select",""],["","68180018008","CEFADROXIL ","CAP 500MG","28","Select","Select",""],["","57664047758","METOPROL ","TAB 50MG","60","Select","Select",""],["","00003089421","ELIQUIS ","TAB 5MG","180","Select","Select",""],["","65862050320","AMOX\/K ","TAB 875-125","14","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","20","Select","Select",""],["","16571020210","DICLOFENAC ","TAB 50MG DR","28","Select","Select",""],["","42858010201","OXYCOD\/APAP ","TAB 5-325MG","8","Select","Select",""],["","00054001225","FLECAINIDE ","TAB 150MG","60","Select","Select",""],["","57237001401","TAMSULOSIN ","CAP 0.4MG","30","Select","Select",""],["","00093005805","TRAMADOL ","TAB 50MG","30","Select","Select",""],["","65162019050","NAPROXEN ","TAB 500MG","10","Select","Select",""],["","60505264807","TIZANIDINE ","CAP 2MG","14","Select","Select",""],["","57237002901","AMOXICILLIN ","TAB 875MG","20","Select","Select",""],["","00172392670","DIAZEPAM ","TAB 5MG","10","Select","Select",""],["","60258017101","MAG ","TAB 400MG","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":""}]}]}