{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ICIRTAPXOF T A","gend":1,"add":"   YWH TFARD STRAUTS 9413                         ","city":"STUARTS DRAFT            ","state":"VA","zip":"24477-9998","dob":"1951-05-06","age":"","mstatus":"","insh":"00117451","cliId":"","pno":"5204530446","cno":5402557448,"email":"","ename":"","eno":"","pphy":"HOSTETTER, SAMUEL A","ppno":5403373710,"pcpadd":"24 GLOUCESTER RD,","pcpcity":"Stuarts Draft","pcpstate":"VA","pcpzip":244773321,"pcpcounty":"","pcpid":"","pcpname":"UVA STUARTS DRAFT FAMILY PRACTICE ASSOCIATES","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"","add2":"                                                  ","add3":"","madd1":"3149 STUARTS DRAFT HWY                            ","madd2":"                                                  ","madd3":"","mcity":"STUARTS DRAFT            ","mstate":"VA","mzip":"24477-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["D13.2","D13.1","D13.0","D12.0","K44.9","K21.9","R10.84","K92.1","K29.70","K31.9","D12.3","Q43.8","K58.9","K64.1","R19.4","R13.19","I10","E78.5","R10.9","K63.5","Z87.19","K31.89","G47.33","D32.9","D32.0","G31.9","K75.81","R74.8","E66.9","K76.0","H90.3","E03.8","E11.9","Z79.4","J98.4","R06.00","D12.6","E08.9","G56.02","M79.642","J10.1","J44.1","Z87.891","E03.9","Z88.6","Z88.8","R07.89","R06.02","J40","K43.9","G89.29","E78.00","F41.8","G62.9","D12.2","D12.4","R19.5","D17.5","K64.8","K58.1","M62.08","E66.01","Z68.37","Z80.0","C50.211","Z23","Z85.3","E89.0","F32.9","Z11.59","Z99.89","R10.10","R11.2","N20.0","E11.65","Z79.899","J44.9","Z90.49","Z90.710","Z88.5","R10.31","Z80.41","L98.9","R56.9","Z98.890","H92.01","D18.00","L82.1","L91.8","D18.02","D18.01","R32","R15.9","Z92.3","Z92.21","M54.2","G44.229","R68.84","E55.9","M50.21","M47.812","R51","Z86.011","D49.6","Z08","Z12.31","C50.911","R92.1","I62.00","J45.909","M54.9","R07.9","R10.13","K85.90","K58.0","K74.69","Z82.49","Z83.3","R11.0","R19.7","R53.1","E87.6","Z03.818","R09.81","J34.1","Z98.41","Z98.42","Z96.1","R53.83","E88.81","Z71.3","Z68.36","K52.9","H92.03","E11.8","K85.00","J41.0","R10.30","Z86.19","Z79.1","Z01.818","R10.11","R14.0","K74.0","K62.5","R05.9","Z79.891","D17.79","Z80.49","Z80.7","Z80.8","Z82.3","D33.2","I62.9","I60.9","G40.89","I60.8","R29.810","M19.90","G97.51","R20.2","S06.5X0A","T81.9XXA","G81.94","R26.9","R53.81","C50.919","E11.69","C79.32","Z48.3","Z92.89","Z68.35","G47.00","Z79.01","D23.122","Z79.890","Z79.83","Z91.011","D48.5"," "],"date":["2019-01-03","2019-01-03","2019-01-03","2021-04-19","2019-01-03","2021-08-30","2021-08-03","2019-01-03","2019-01-03","2019-01-03","2021-04-19","2019-01-03","2021-08-03","2019-01-03","2019-01-03","2019-01-03","2022-07-19","2021-08-30","2021-08-17","2021-04-19","2021-08-09","2019-01-03","2022-09-06","2020-06-04","2020-01-07","2020-01-07","2021-08-30","2020-01-09","2021-08-30","2021-05-10","2022-06-01","2019-02-15","2022-11-30","2022-11-30","2021-07-07","2021-07-07","2021-03-03","2022-03-23","2019-03-12","2019-03-12","2019-03-15","2021-11-17","2021-08-03","2022-12-09","2022-07-19","2021-08-09","2021-08-02","2019-03-14","2019-03-20","2021-05-04","2021-08-17","2022-08-01","2022-03-23","2021-04-05","2021-04-19","2021-04-19","2021-04-19","2021-04-19","2021-04-19","2021-04-20","2021-05-04","2022-07-28","2022-08-01","2021-05-06","2018-05-09","2021-09-23","2021-08-03","2019-06-12","2019-12-13","2018-05-09","2021-05-10","2022-07-19","2022-07-19","2021-05-10","2021-05-10","2022-07-19","2022-07-19","2021-05-10","2021-05-10","2021-08-09","2021-05-10","2022-07-05","2019-05-24","2020-05-22","2020-06-24","2020-05-22","2019-05-24","2019-05-24","2019-05-24","2019-05-24","2019-05-24","2019-06-03","2019-06-03","2019-06-03","2019-06-03","2020-06-24","2020-06-04","2020-06-04","2019-10-30","2020-06-24","2020-06-24","2020-06-24","2020-07-13","2020-06-24","2020-11-07","2022-07-05","2019-12-20","2022-07-05","2020-07-13","2021-09-14","2021-08-02","2021-08-17","2021-08-03","2022-07-19","2021-08-03","2021-08-03","2021-08-03","2021-08-03","2021-08-09","2022-07-19","2021-08-09","2021-08-17","2021-08-09","2020-08-14","2020-08-14","2022-08-22","2019-08-15","2022-08-22","2021-08-17","2020-08-21","2021-08-30","2021-08-30","2022-07-19","2018-09-10","2019-12-20","2021-09-23","2022-08-01","2018-10-28","2018-10-28","2018-10-28","2019-11-19","2020-12-10","2020-11-07","2019-11-14","2018-11-15","2022-03-01","2019-11-19","2019-12-02","2019-12-02","2019-12-02","2019-12-02","2019-12-02","2019-12-03","2019-12-04","2019-12-10","2019-12-20","2019-12-07","2019-12-07","2019-12-07","2019-12-07","2019-12-07","2019-12-07","2019-12-07","2019-12-18","2019-12-18","2019-12-18","2019-12-20","2019-12-18","2019-12-20","2019-12-20","2019-12-23","2022-07-28","2019-12-13","2019-12-13","2022-05-12","2022-07-19","2022-07-19","2022-07-19","2022-05-12","2022-12-09"],"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":[["","16729017201","AMITRIPTYLIN","TAB 25MG","30","Select","Select",""],["","65862019301","FLUOXETINE","CAP 20MG","60","Select","Select",""],["","00088222033","LANTUS","INJ 100\/ML","10","Select","Select",""],["","08214385034","UNIFINE","MIS 31GX3\/16","100","Select","Select",""],["","00310620530","FARXIGA","TAB 5MG","30","Select","Select",""],["","00591034705","HYDROCHLOROT","CAP 12.5MG","90","Select","Select",""],["","00781518692","LEVOTHYROXIN","TAB 125MCG","180","Select","Select",""],["","55111033390","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","00169633910","NOVOLOG","INJ FLEXPEN","12","Select","Select",""],["","00121086816","NYSTATIN","SUS 100000","150","Select","Select",""],["","08290320119","BD  PEN NEEDL","MIS 31GX5MM","100","Select","Select",""],["","16729000201","GLIMEPIRIDE","TAB 2MG","180","Select","Select",""],["","64980043701","ATENOLOL","TAB 25MG","45","Select","Select",""],["","00832532515","POT  CL MICRO","TAB 20MEQ ER","5","Select","Select",""],["","68462015713","ONDANSETRON","TAB 4MG ODT","12","Select","Select",""],["","68180096301","ALBUTEROL","AER HFA","8.5","Select","Select",""],["","00527058601","DICYCLOMINE","CAP 10MG","60","Select","Select",""],["","00378395105","ATORVASTATIN","TAB 20MG","90","Select","Select",""],["","50383070016","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","68180011409","LEVETIRACETA","TAB 750MG","180","Select","Select",""],["","68382007116","PRAVASTATIN","TAB 20MG","90","Select","Select",""],["","00781808926","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","00603533821","PREDNISONE","TAB 10MG","20","Select","Select",""],["","00172572860","FAMOTIDINE","TAB 20MG","10","Select","Select",""],["","17478007035","ERYTHROMYCIN","OIN 5MG\/GM","3.5","Select","Select",""],["","59762045001","COLESTIPOL","TAB 1GM","180","Select","Select",""],["","00781261305","AMOXICILLIN","CAP 500MG","21","Select","Select",""],["","00116200116","CHLORHEX","SOL 0.0012","473","Select","Select",""],["","00093220405","METOCLOPRAM","TAB 5MG","12","Select","Select",""],["","57237016199","OMEPRAZOLE","CAP 20MG","90","Select","Select",""],["","70710100802","OSELTAMIVIR","CAP 30MG","7","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":""}]}]}