{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" ECINREBREGNUOY","gend":1,"add":"             378 XOB .O.P                         ","city":"GRETNA                   ","state":"VA","zip":"24557-0873","dob":"1934-08-22","age":"","mstatus":"","insh":"00111977","cliId":"","pno":"5643425836","cno":"","email":"","ename":"","eno":"","pphy":"BROCHERO, ALFONSO D","ppno":5407693964,"pcpadd":"7768 WILLIAMSON RD,","pcpcity":"Roanoke","pcpstate":"VA","pcpzip":240194343,"pcpcounty":"","pcpid":"","pcpname":"UNIVERSAL HEALTH CORPORATION","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"","add2":"PO BOX 873                                        ","add3":"","madd1":"P.O. BOX 873                                      ","madd2":"PO BOX 873                                        ","madd3":"","mcity":"GRETNA                   ","mstate":"VA","mzip":"24557-0873","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z13.1","E11.8","E11.42","E11.9","D50.0","R42","K92.2","F03.90","I65.1","Z79.02","Z79.84","H90.5","E61.1","R27.0","I10","K59.00","E78.5","Z80.3","Z80.8","Z82.3","Z82.49","Z82.5","Z83.3","Z79.899","R51","R91.8","R53.1","I51.7","R19.5","Z71.9","H40.1113","I50.9","H81.4","D50.9","M19.90","K21.9","I50.32","E11.36","Z68.1","H25.13","H40.1234","H52.03","J18.9","J06.9","R05","J98.4","E78.00","R53.83","M25.551","S39.012A","M54.5","X50.9XXA","R29.898","H90.3","H93.293","M62.81","M54.41","M79.604","H81.49","H40.1134","M16.11","M21.611","H25.12","K22.2","M79.606","M54.2","D62","K44.9","R26.9","Z20.822","I95.9","G89.29","J30.9","K92.1","I95.1","E55.9","E11.59","B35.1","R11.0","R00.0","Z87.19","D64.9","Z79.82","R60.9","R63.5","H40.1124","H25.11","H40.1130","Z23","Z71.89","H81.10","R82.998","I25.10","Z87.39","Z74.09","Z79.52","R41.3","A41.9","W19.XXXA","G93.41","F05","N12","B96.20","E11.22","N18.30","R93.5","S63.502A","R10.31","N30.10","R93.2","S69.92XA","M18.12","Z02.2","M54.50","M54.9","S32.010A","R10.9","S39.92XA","M47.816","R29.890","M43.16","S79.911A","M48.56XA","R41.841","N39.0","G93.40","R26.2","W19.XXXD","M25.539","Z11.59","R26.81","R55","R29.818","K62.5","R51.9","R29.6","H61.21","G89.11","Y99.8","U07.1","J02.9"," ","E78.2","R06.09","Z68.25"],"date":["2021-08-02","2022-03-01","2020-01-07","2022-11-16","2022-07-27","2022-11-16","2022-04-30","2022-11-16","2022-04-09","2021-12-01","2022-03-05","2021-01-27","2020-01-28","2020-02-11","2022-04-21","2022-04-07","2022-04-09","2020-02-02","2020-02-02","2020-02-02","2020-02-02","2020-02-02","2020-02-02","2021-12-01","2020-02-02","2020-03-14","2020-02-02","2020-02-02","2021-02-20","2020-02-06","2022-02-17","2020-02-27","2020-12-25","2020-02-27","2022-05-11","2022-11-16","2021-12-01","2020-02-27","2020-02-27","2021-07-02","2021-03-30","2021-03-12","2020-03-14","2020-03-18","2020-03-14","2020-03-14","2020-08-05","2020-04-28","2022-05-11","2020-05-13","2020-05-13","2020-05-13","2020-05-28","2020-09-14","2020-09-14","2022-04-12","2020-06-10","2020-06-03","2019-09-28","2021-07-02","2022-03-10","2021-07-07","2021-09-21","2021-08-09","2021-08-07","2021-08-07","2022-04-30","2021-08-09","2021-08-07","2022-03-10","2022-03-15","2022-03-05","2021-08-07","2021-09-01","2022-03-11","2021-09-01","2022-03-23","2022-03-23","2022-03-05","2021-08-19","2021-08-23","2022-04-09","2022-03-23","2021-09-08","2021-09-08","2021-12-01","2021-10-08","2021-10-08","2019-10-31","2019-11-19","2019-12-31","2019-12-31","2021-12-01","2021-12-01","2021-12-01","2021-12-01","2022-02-21","2022-04-08","2022-05-11","2022-03-05","2022-03-05","2022-04-09","2022-03-05","2022-03-05","2022-03-05","2022-04-09","2022-03-05","2022-03-05","2022-03-05","2022-03-05","2022-03-08","2022-03-08","2022-03-08","2022-03-10","2022-03-10","2022-04-21","2022-03-10","2022-03-10","2022-03-10","2022-03-10","2022-03-10","2022-03-10","2022-04-20","2022-04-09","2022-04-12","2022-04-09","2022-04-09","2022-04-09","2022-04-09","2022-04-09","2022-06-27","2021-08-07","2022-06-27","2021-08-07","2021-08-07","2022-04-08","2022-06-27","2022-05-11","2022-05-11","2022-10-13","2022-10-13","2022-11-16","2022-11-16","2022-11-16","2022-11-16"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}}]},{"t":"Covid Screening","q":[{"a":[]}]},{"t":"Self-Assessment and Social History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":{"indx":[false,false],"comment":["",""],"score":["",""]}},{"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":[["","43547027509","DONEPEZIL","TAB 5MG","30.00","Select","Select",""],["","16729021816","CLOPIDOGREL","TAB 75MG","90","Select","Select",""],["","62175061743","PANTOPRAZOLE","TAB 40MG","90","Select","Select",""],["","51224002070","METFORMIN","TAB 500MG","45","Select","Select",""],["","16729004417","ATORVASTATIN","TAB 10MG","90","Select","Select",""],["","00069034530","PAXLOVID","TAB 300-100","30","Select","Select",""],["","16571066001","MECLIZINE","TAB 12.5MG","60","Select","Select",""],["","59762033302","LATANOPROST","SOL 0.00005","2.5","Select","Select",""],["","65862064163","AZITHROMYCIN","TAB 250MG","4","Select","Select",""],["","67877032005","IBUPROFEN","TAB 600MG","30","Select","Select",""],["","61314012605","KETOROLAC","SOL 0.005","5","Select","Select",""],["","60758011905","PREDNISOLONE","SUS 1% OP","5","Select","Select",""],["","69315030805","CIPROFLOXACN","SOL 0.3% OP","5","Select","Select",""],["","49884081401","MIDODRINE","TAB 2.5MG","90","Select","Select",""],["","64380080406","RANITIDINE","TAB 300MG","90","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":""}]}]}