{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" ACISSEJYELNEH M","gend":1,"add":"     ENAL TSERCGNIRPS 941                         ","city":"STAUNTON                 ","state":"VA","zip":"24401-9998","dob":"1947-02-05","age":"","mstatus":"","insh":"10114587","cliId":"","pno":"4404563708","cno":"","email":"","ename":"","eno":"","pphy":"HOSTETTER, SAMUEL A","ppno":5403373710,"pcpadd":"24 GLOUCESTER RD,  STE 522","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":"APT 103                                           ","add3":"","madd1":"149 SPRINGCREST LANE                              ","madd2":"APT 103                                           ","madd3":"","mcity":"STAUNTON                 ","mstate":"VA","mzip":"24401-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M54.16","N13.5","N19","F43.20","L30.8","L57.8","L81.4","L82.1","D22.5","M54.6","M79.10","G89.29","R68.83","R10.84","R19.00","R06.02","J20.9","E87.1","I25.10","I11.0","I50.9","Z95.1","Z87.891","F31.9","Z79.899","Z96.0","Z88.5","F43.23","M79.18","I50.42","I25.2","I08.1","I27.20","J44.9","E78.2","Z95.810","B35.1","L60.0","M79.674","M79.675","R35.0","N32.89","F41.9","G47.00","Q62.11","L71.8","Z12.83","R20.8","L82.0","L53.8","L29.8","R31.0","R52","I50.22","R10.30","R39.15","R53.1","I25.5","I48.0","E78.5","Z00.00","J18.9","R09.02","R11.2","K25.9","R14.0","Z98.890","R11.0","R21","R94.4","N13.39","L43.8","Z03.818","J40","R05.9","T83.122A","Y73.2","Q62.39","J43.9","K59.00","R09.81","Z11.59","M25.561","W19.XXXA","T14.8XXA","M25.562","L08.9","N39.3","Z96.1","Z98.41","Z98.42","H04.123","N13.1","I25.119","I50.23","Z20.822","A08.4","Z01.812","I48.91","I47.2","I73.00","Z99.81","I10","K21.9","Z95.0","Z79.82","Z88.1","Z88.8","R10.9","N30.10","R53.83","L30.9","R05","N13.8","I80.8","M79.89","Z79.01","R10.31","N39.0","K29.00","N13.30","H01.001","H01.004","A41.9","I95.9","K29.70","K52.9","I47.9","Z01.818","Z46.6","N20.0","K31.89","K92.0","R07.89","R11.10","Z01.810","R71.0","K59.04","R93.89","R74.8","R31.9","R63.6","R60.9","R19.7"],"date":["2022-04-28","2022-05-02","2022-07-25","2022-07-29","2022-03-21","2022-03-21","2022-03-21","2022-03-21","2022-03-21","2022-04-28","2022-04-28","2022-04-28","2021-06-23","2021-12-09","2021-06-23","2021-06-23","2021-06-23","2022-05-13","2022-05-13","2021-12-09","2022-05-13","2022-05-02","2021-12-09","2021-12-09","2021-12-09","2021-10-08","2021-12-09","2021-10-01","2021-07-08","2021-07-08","2021-10-06","2021-07-08","2021-07-08","2021-07-23","2021-07-08","2022-05-13","2022-05-20","2022-05-20","2022-05-20","2022-05-20","2021-07-13","2021-10-15","2021-10-23","2021-07-13","2021-06-17","2021-05-26","2021-05-26","2021-07-15","2021-07-15","2021-07-15","2021-07-15","2021-09-10","2021-09-10","2022-07-27","2021-06-30","2021-06-30","2021-09-17","2022-05-13","2022-05-13","2022-05-13","2022-05-13","2021-10-23","2021-10-23","2021-09-20","2021-09-20","2021-09-17","2021-09-06","2021-09-28","2021-09-28","2022-05-18","2022-05-18","2021-07-15","2021-06-23","2021-06-23","2021-12-16","2021-10-08","2021-10-08","2021-06-23","2022-05-02","2022-05-02","2022-05-02","2022-05-02","2022-01-26","2022-01-26","2022-01-26","2022-01-26","2022-01-26","2022-08-03","2022-04-14","2022-04-14","2022-04-14","2022-04-14","2022-05-18","2022-05-13","2021-10-23","2021-12-09","2021-12-09","2021-10-15","2021-10-23","2021-10-23","2021-10-23","2021-10-23","2022-07-01","2021-09-16","2021-06-04","2021-09-06","2021-12-09","2021-12-09","2022-02-10","2022-04-28","2021-12-20","2021-12-20","2021-09-16","2021-06-04","2021-09-06","2021-09-06","2021-12-09","2021-06-07","2021-06-07","2021-09-18","2021-05-10","2021-08-09","2021-08-09","2021-09-16","2021-09-16","2021-09-16","2021-09-16","2021-09-16","2021-08-03","2021-10-21","2021-06-07","2021-09-18","2021-09-18","2021-12-09","2021-12-09","2021-09-17","2021-09-17","2021-06-01","2021-06-01","2021-09-16","2021-06-07","2021-10-06","2021-10-06","2021-12-09"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}}]},{"t":"Covid Screening","q":[{"a":[]}]},{"t":"Self-Assessment and Social History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"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":[["","00054429931","FUROSEMIDE","TAB 40MG","90","Select","Select",""],["","50458057930","XARELTO","TAB 20MG","90","Select","Select",""],["","70954000520","OXYBUTYNIN","TAB 5MG","90","Select","Select",""],["","00574014560","TROSPIUM","TAB 20MG","10","Select","Select",""],["","60505017007","PRAVASTATIN","TAB 40MG","90","Select","Select",""],["","52817032010","BACLOFEN","TAB 10MG","90","Select","Select",""],["","10702000350","PROMETHAZINE","TAB 25MG","20","Select","Select",""],["","65862018730","ONDANSETRON","TAB 4MG","20","Select","Select",""],["","72205001490","PREGABALIN","CAP 100MG","180","Select","Select",""],["","65862057490","MONTELUKAST","TAB 10MG","90","Select","Select",""],["","43547035311","LISINOPRIL","TAB 10MG","90","Select","Select",""],["","43598043611","NITROGLYCERN","SUB 0.4MG","25","Select","Select",""],["","51672130005","AMMONIUM","LOT 0.12","225","Select","Select",""],["","00310737020","BUDES\/FORMOT","AER 160-4.5","20.4","Select","Select",""],["","70756020212","AMITRIPTYLIN","TAB 25MG","30","Select","Select",""],["","60505082701","IPRATROPIUM","SPR 0.0006","15","Select","Select",""],["","57237005860","CEFUROXIME","TAB 250MG","12","Select","Select",""],["","00406324301","HYDROMORPHON","TAB 2MG","10","Select","Select",""],["","16729021616","SERTRALINE","TAB 50MG","30","Select","Select",""],["","68382013201","TAMSULOSIN","CAP 0.4MG","30","Select","Select",""],["","45802006436","TRIAMCINOLON","CRE 0.001","80","Select","Select",""],["","65862037401","ESCITALOPRAM","TAB 10MG","30","Select","Select",""],["","00093317431","ALBUTEROL","FAT E","25.5","Select","Select",""],["","60505006501","OMEPRAZOLE","CAP 20MG","90","Select","Select",""],["","68462018022","MUPIROCIN","OIN 0.02","22","Select","Select",""],["","00378363205","CARVEDILOL","TAB 6.25MG","180","Select","Select",""],["","70461012103","FLUAD","INJ 2021-22","0.5","Select","Select",""],["","00574200802","NYSTOP","POW 100000","60","Select","Select",""],["","00023916360","RESTASIS","EMU 0.0005","180","Select","Select",""],["","00781808926","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","27808003502","HYDROCO\/APAP","TAB 5-325MG","10","Select","Select",""],["","00406055201","OXYCODONE","TAB 5MG","15","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":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"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":""}]}]}