{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"WENDY   D KEATTS","gend":1,"add":"500 PARKLAND DR","city":"DANVILLE","state":"VA","zip":"24540-9998","dob":"1964-01-14","age":"","mstatus":"","insh":"900039261*01","cliId":"","pno":"434\/710-8265","cno":"","email":"","ename":"","eno":"","pphy":"BRADNER, LISA NP","ppno":"434\/835-0105","pcpadd":"2767 FRANKLIN TURNPIKE","pcpcity":"DANVILLE","pcpstate":"VA","pcpzip":24540,"pcpcounty":"","pcpid":"","pcpname":"DANVILLE PHYSICIAN PRACTICES LLC","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"N","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/835-0295","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R10.10","Z12.11","K52.9","K57.30","M54.9","G89.29","M77.51","M25.511","R13.10","K57.90","M51.36","K29.60","K20.91","K21.9","K29.50","I10.","E78.5","G47.33","R73.03","Z01.89","E03.9","H81.13","R42.","G25.81","R10.84","R16.1","R11.0","K56.41","R79.89","R10.13","R10.11","E11.9","H52.4","F41.9","G47.30","R11.2","K31.89","R10.30","K76.89","K76.0","K59.00","M54.32","E07.9","M53.9","M46.1","K04.7","M71.22","Z01.818","Z76.89","Z01.419","Z86.711","R06.02","Z86.16","R13.0","H66.92","Z23.","Z12.31","F32.9","G47.00","E78.00","M19.90","Z79.899","M25.569"],"date":["2020-11-09","2021-10-28","2020-11-09","2021-10-26","2021-06-16","2021-04-15","2021-12-16","2020-12-11","2021-10-28","2021-08-30","2021-12-16","2021-07-15","2021-07-15","2021-10-28","2021-07-15","2021-07-15","2021-07-15","2021-10-28","2021-10-28","2021-10-28","2021-10-28","2020-09-15","2020-08-25","2020-09-30","2021-10-28","2021-10-28","2021-10-28","2020-07-01","2020-09-30","2021-10-26","2021-10-26","2021-01-04","2021-01-04","2021-07-15","2021-07-15","2021-07-15","2021-07-15","2021-10-26","2021-10-28","2021-10-28","2021-10-28","2021-11-10","2021-11-10","2021-11-10","2021-11-10","2021-01-30","2021-12-10","2020-11-03","2020-09-30","2020-09-30","2020-09-30","2021-02-24","2021-02-24","2021-10-26","2021-10-28","2021-10-28","2021-10-28","2021-10-28","2021-10-28","2020-11-09","2020-11-09","2020-11-09","2021-12-10"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}}]},{"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":[]},{"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":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","29300011201","LAMOTRIGINE                                                           ","100MG","180","Select","Select",""],["","29300015116","QUETIAPINE FUMARATE                                                   ","300MG","30","Select","Select",""],["","27808003503","HYDROCODONE\/ACETAMINOPHEN                                             ","5-325MG","60","Select","Select",""],["","10702000201","PROMETHAZINE HYDROCHLORIDE                                            ","12.5MG","60","Select","Select",""],["","00093506205","HYDROXYZINE HCL                                                       ","50MG","180","Select","Select",""],["","69238183507","LEVOTHYROXINE SODIUM                                                  ","112MCG","90","Select","Select",""],["","65862001305","SERTRALINE HYDROCHLORIDE                                              ","100MG","60","Select","Select",""],["","00093100305","BUSPIRONE HCL                                                         ","15MG","90","Select","Select",""],["","00591079510","DICYCLOMINE HYDROCHLORIDE                                             ","20MG","60","Select","Select",""],["","63868000230","QC NATURA-LAX                                                         ","3350 NF","1020","Select","Select",""],["","00378668910","PANTOPRAZOLE SODIUM                                                   ","40MG","30","Select","Select",""],["","59762040105","SUCRALFATE                                                            ","1GM","120","Select","Select",""],["","16729004517","ATORVASTATIN CALCIUM                                                  ","20MG","90","Select","Select",""],["","16571041210","CIPROFLOXACIN HYDROCHLORIDE                                           ","500MG","14","Select","Select",""],["","00093101042","MUPIROCIN                                                             ","2%","22","Select","Select",""],["","55111068405","IBU                                                                   ","800MG","30","Select","Select",""],["","65862085901","FAMOTIDINE                                                            ","20MG","30","Select","Select",""],["","66993001968","ALBUTEROL SULFATE HFA                                                 ","HFA","18","Select","Select",""],["","00093005405","BUSPIRONE HYDROCHLORIDE                                               ","10MG","60","Select","Select",""],["","42571016242","AMOXICILLIN\/CLAVULANATE POTASSIUM                                     ","875-125","20","Select","Select",""],["","00591079021","METHYLPREDNISOLONE DOSE PACK                                          ","4MG","21","Select","Select",""],["","27808003503","HYDROCODONE BITARTRATE\/ACETAMINOPHEN                                  ","5-325MG","60","Select","Select",""],["","00113030603","GOODSENSE CLEARLAX                                                    ","","510","Select","Select",""],["","57237003105","AMOXICILLIN                                                           ","500MG","14","Select","Select",""],["","65162046650","IBUPROFEN                                                             ","800MG","42","Select","Select",""],["","50804016638","GOODSENSE MAGNESIUM CITRATE                                           ","LEMON","296","Select","Select",""],["","65162074510","PROMETHAZINE HCL                                                      ","12.5MG","60","Select","Select",""],["","52817033200","CYCLOBENZAPRINE HYDROCHLORIDE                                         ","10MG","20","Select","Select",""],["","65162018910","NAPROXEN                                                              ","375MG","30","Select","Select",""]]}},{"a":[]},{"a":[]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":[]}]},{"t":"Mini-Cog","q":[{"a":[]},{"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":"","a13":""}]}]}