{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ROBERT   L MUDD","gend":0,"add":"100 S WEST ST","city":"CULPEPER","state":"VA","zip":"22701-9998","dob":"1942-10-15","age":"","mstatus":"","insh":"900047790*01","cliId":"8M89VW7FF41","pno":"540\/727-0339","cno":"540\/727-0339","email":"","ename":"","eno":"","pphy":"GRAVATTE IV, LEROY TRICE MD","ppno":"540\/825-5951","pcpadd":"16240 BENNETT RD","pcpcity":"CULPEPER","pcpstate":"VA","pcpzip":22701,"pcpcounty":"","pcpid":100582,"pcpname":"","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"NORTHERN & WINCHESTER","aligned":"Y","ano":"Non-DSNP","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["D49.6","C34.11","Z92.89","C79.31","C32.8","F17.210","J38.7","Z92.3","Z79.01","K21.00","Z85.46","Z89.511","C76.0","I26.99","D64.9","C34.90","C44.42","R91.8","R59.9","Z51.11","E03.9","Z72.0","Z51.12","I10.","E06.9","C71.9","E11.9","N18.9","E86.0","I95.1","R63.0","Z74.8","R49.0","R63.4","G89.3","Z87.891","K40.90","R10.30","I12.9","E11.22","N18.30","E78.49","J34.89","I65.29","E78.5","Z71.2","Z29.8"],"date":["2021-05-04","2021-10-12","2021-05-04","2021-10-12","2021-08-10","2021-10-12","2021-05-04","2021-05-04","2021-09-21","2021-05-04","2021-08-10","2021-05-04","2021-10-12","2021-10-12","2021-10-12","2021-09-14","2021-05-05","2021-05-05","2021-05-05","2021-08-10","2021-06-08","2021-06-08","2021-10-12","2021-11-05","2021-06-29","2021-07-01","2021-05-04","2021-07-20","2021-08-10","2021-08-10","2021-08-10","2021-08-10","2021-08-10","2021-08-10","2021-08-10","2021-05-18","2021-10-25","2021-10-12","2021-11-05","2021-11-05","2021-11-05","2021-11-05","2021-09-14","2021-09-14","2021-08-31","2021-09-21","2021-09-21"],"priorHcc":["",null,"",null,"",null,"","",null,"","","",null,null,null,null,"","","","","","",null,null,"","","","","","","","","","","","",null,null,null,null,null,null,null,null,null,null,null]}},{"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":[["","50458057930","XARELTO ","","90","Select","Select",""],["","76385011250","CARVEDILOL","","60","Select","Select",""],["","65862035790","CLOPIDOGREL","","30","Select","Select",""],["","68180072103","AMLODIPINE BESYLATE","","30","Select","Select",""],["","70377002911","ATORVASTATIN CALCIUM ","","90","Select","Select",""],["","70377002911","ATORVASTATIN CALCIUM","","90","Select","Select",""],["","50458057930","XARELTO","","90","Select","Select",""],["","00536100901","FERROUS SULFATE","","90","Select","Select",""],["","43547035610","LISINOPRIL","","90","Select","Select",""],["","00904759160","FEROSUL","","90","Select","Select",""],["","00406055201","OXYCODONE HYDROCHLORIDE","5MG","30","Select","Select",""],["","23155000201","HYDRALAZINE HYDROCHLORIDE","25MG","180","Select","Select",""],["","76385011250","CARVEDILOL                                                            ","TAB 12.5MG","60","Select","Select",""],["","70377002911","ATORVASTATIN CALCIUM                                                  ","TAB 40MG","90","Select","Select",""],["","65862035790","CLOPIDOGREL                                                           ","TAB 75MG","30","Select","Select",""],["","50458057930","XARELTO                                                               ","TAB 20MG","90","Select","Select",""],["","68180072103","AMLODIPINE BESYLATE                                                   ","TAB 10MG","30","Select","Select",""],["","00536100901","FERROUS SULFATE                                                       ","TAB 325MG","90","Select","Select",""],["","00904759160","FEROSUL                                                               ","TAB 325MG","90","Select","Select",""],["","43547035610","LISINOPRIL                                                            ","TAB 40MG","90","Select","Select",""],["","23155000201","HYDRALAZINE HYDROCHLORIDE                                             ","TAB 25MG","180","Select","Select",""],["","00406055201","OXYCODONE HYDROCHLORIDE                                               ","TAB 5MG","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":[[["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","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":""}]}]}