{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" ALEGNASIVAD C","gend":1,"add":"             EVA GNIK 712                         ","city":"WAYNESBORO               ","state":"VA","zip":"22980-9998","dob":"1968-10-19","age":"","mstatus":"","insh":"10114404","cliId":"","pno":"7404522021","cno":4344097383,"email":"","ename":"","eno":"","pphy":"REID, JAMES R","ppno":5409421200,"pcpadd":"15 PRATTS RUN STE A01,","pcpcity":"Waynesboro","pcpstate":"VA","pcpzip":229806606,"pcpcounty":"","pcpid":"","pcpname":"UVA WAYNESBORO PRIMARY CARE","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"","add2":"                                                  ","add3":"","madd1":"217 KING AVE                                      ","madd2":"                                                  ","madd3":"","mcity":"WAYNESBORO               ","mstate":"VA","mzip":"22980-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K52.9","R11.2","E87.1","E87.6","T78.3XXA","R22.0","L29.9","R51.9","M79.89","Z79.899","Z90.49","Z90.710","Z98.51","Z91.030","K43.2","K66.0","K21.9","M79.7","F32.9","F41.9","F12.90","Z87.39","Z03.818","R10.84","R50.9","L25.9","R21","R19.7","Z20.828","Z87.42","R11.10","Z13.820","Z78.0","S39.012A","M54.5","M79.605","X50.0XXA","X50.3XXA","Y93.E6","M47.817","M81.0","Z12.4","Y92.239","T50.915A","R10.9","M25.551","M25.552","R55","R42","R20.2","F43.21","M51.37","A04.5","Z79.1","Z79.52","Z20.822","K42.9","Z00.00","Z12.31","B37.3","T40.695A","R00.0","N95.1","E66.9","Z98.890","F32.A","R11.0","R10.13","J30.1","R10.30","G89.29","K92.1","R10.32","K62.5","Z86.010","G89.18","M19.90","Z87.19","Z88.5","R14.0","D13.1","D12.6","M79.662","M94.0","R07.81","M16.12","Z88.6","N64.4","R07.9","G47.00","K21.00","G89.28","R07.82"," "],"date":["2022-06-09","2022-06-07","2021-05-15","2021-05-15","2021-06-05","2022-01-08","2021-06-05","2021-08-05","2021-05-16","2022-10-17","2022-09-30","2022-05-26","2021-05-16","2022-06-07","2021-06-04","2021-06-04","2022-06-07","2021-06-04","2021-06-04","2022-10-27","2022-10-27","2021-06-04","2021-05-13","2022-06-09","2021-05-13","2020-07-05","2020-07-05","2022-06-07","2020-11-09","2020-11-09","2022-06-07","2020-06-02","2020-06-02","2020-09-18","2021-01-24","2022-09-30","2020-09-18","2020-09-18","2020-09-18","2021-01-24","2020-09-18","2021-05-21","2021-06-05","2021-06-05","2022-06-07","2021-07-27","2022-09-30","2022-01-08","2022-01-08","2022-01-08","2021-01-21","2021-01-24","2021-05-13","2021-05-13","2021-05-13","2022-06-07","2021-05-06","2021-05-06","2021-08-04","2021-05-21","2021-06-05","2022-01-08","2021-01-14","2021-05-12","2021-07-27","2022-06-07","2022-10-27","2022-05-26","2022-04-21","2022-04-29","2022-05-26","2022-06-09","2022-04-29","2022-04-29","2022-06-07","2022-06-07","2022-06-07","2022-06-07","2022-10-17","2022-06-09","2022-06-07","2022-06-07","2022-09-30","2022-10-17","2022-10-17","2022-09-30","2022-10-17","2022-10-17","2022-10-17","2022-10-27","2022-10-27","2022-10-27","2022-10-17","2022-10-27"],"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":[["","00093598627","EPINEPHRINE","INJ 0.3MG","2","Select","Select",""],["","00378668910","PANTOPRAZOLE","TAB 40MG","90","Select","Select",""],["","65862039010","ONDANSETRON","TAB 4MG ODT","15","Select","Select",""],["","55111015810","OMEPRAZOLE","CAP 20MG","90","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","48","Select","Select",""],["","69097084507","CYCLOBENZAPR","TAB 5MG","21","Select","Select",""],["","16571020106","DICLOFENAC","TAB 75MG DR","10","Select","Select",""],["","00093005805","TRAMADOL","TAB 50MG","10","Select","Select",""],["","66993068130","OLANZAPINE","TAB 5MG","90","Select","Select",""],["","00228202950","ALPRAZOLAM","TAB 0.5MG","15","Select","Select",""],["","42571013725","KETOROLAC","SOL 0.005","5","Select","Select",""],["","00143312601","DICYCLOMINE","CAP 10MG","90","Select","Select",""],["","43386035701","HYDROCO\/APAP","TAB 7.5-325","8","Select","Select",""],["","00378064205","PREDNISONE","TAB 20MG","18","Select","Select",""],["","42858030101","HYDROMORPHON","TAB 2MG","10","Select","Select",""],["","00555088602","ESTRADIOL","TAB 1MG","90","Select","Select",""],["","65862050320","AMOX\/K","TAB 875-125","20","Select","Select",""],["","50111056001","TRAZODONE","TAB 50MG","30","Select","Select",""],["","65162019050","NAPROXEN","TAB 500MG","10","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","76385012350","METHOCARBAM","TAB 500MG","20","Select","Select",""],["","70710113908","FLUCONAZOLE","TAB 150MG","1","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":["",""],"sub":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""],[""]],"sub":[]}}},{"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":""}]}]}