{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"H L YCARTSGNIHCTU","gend":1,"add":"      DR FAEL NEDLOG 6801                         ","city":"NATHALIE                 ","state":"VA","zip":"24577-9998","dob":"1968-03-14","age":"","mstatus":"","insh":"10115013","cliId":"","pno":"7443412421","cno":4344713081,"email":"","ename":"","eno":"","pphy":"LEINER, JOHN G","ppno":4342966161,"pcpadd":"650 PETER JEFFERSON PKWY STE 190,","pcpcity":"Charlottesville","pcpstate":"VA","pcpzip":229118844,"pcpcounty":"","pcpid":"","pcpname":"UVA RHEUMATOLOGY PANTOPS","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"","add2":"                                                  ","add3":"","madd1":"1086 GOLDEN LEAF RD                               ","madd2":"                                                  ","madd3":"","mcity":"NATHALIE                 ","mstate":"VA","mzip":"24577-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R39.81","R15.9","Z99.3","M47.12","G91.9","G95.9","M48.02","E78.00","G95.89","Z00.00","G40.201","A41.9","Z20.822","I69.354","N39.0","I10","R13.10","E83.52","G89.29","Z74.01","Q03.9","Z79.82","Z79.891","Z79.899","G93.40","R41.82","G40.901","Z87.898","R07.9","R56.9","R40.4","I63.9","R91.8","R05","R50.9","Z46.82","Z98.2","R51.9","M79.89","R26.2","Z51.5","Z71.89","G03.9","K04.7","K08.89","Z79.1","Z88.5","G40.109","M62.49","M62.81","R27.8","R48.2","R47.01","G47.30","E87.6","N89.8","Z74.09","I69.320","N90.3","N90.89","Z12.4","R29.898","R10.9","Z78.9","M25.562","M25.561","L28.0","Z98.818","G92","E87.0","E87.1","Z20.828","T42.4X5A","T39.1X5A","T40.425A","F44.5","G43.909","G93.81","M48.04","R06.02","R53.1","G93.41","R47.1","R78.81","Z98.1","Z86.73","Z86.69","R29.818","G40.909","G93.89","I63.89","M47.812","E04.9","R00.0","G81.91","Z01.818","K02.9","G40.209","F41.9","G50.1","G89.18","M50.03","R82.90","Z23","R93.0","Z92.89","G40.219","N30.00","Q03.0","G40.211","J96.01","N13.6","F32.A","R13.12","E83.39","H54.61","G40.919","N13.30","D18.03","Z46.59","J98.11","J90","Y92.230","D64.9","T42.6X1A","Z45.41","M54.9","R06.89"," ","Z91.81","R25.1","I69.351"],"date":["2022-11-10","2022-11-10","2022-11-10","2022-11-10","2022-03-08","2021-08-12","2021-04-13","2022-07-26","2022-03-23","2021-03-05","2021-08-23","2022-03-13","2021-04-13","2021-04-13","2022-03-19","2021-08-12","2022-03-18","2021-04-26","2022-07-26","2022-11-08","2022-03-19","2022-03-16","2021-04-13","2022-03-16","2022-03-11","2022-03-19","2021-04-14","2021-04-27","2022-03-13","2022-03-16","2022-03-16","2021-04-20","2022-03-08","2021-04-16","2022-03-08","2022-03-09","2022-03-16","2022-07-26","2021-04-25","2021-08-02","2021-04-27","2021-04-27","2021-05-05","2020-05-09","2020-05-09","2020-05-09","2021-08-19","2022-03-13","2021-08-12","2022-11-08","2021-08-12","2021-08-23","2022-03-16","2020-06-23","2022-03-18","2020-08-14","2020-11-16","2020-10-15","2020-10-09","2020-10-09","2020-08-14","2020-10-15","2021-08-19","2020-08-24","2020-09-01","2020-09-01","2020-10-09","2020-10-19","2020-10-24","2022-03-09","2020-10-24","2020-10-24","2020-10-24","2020-10-24","2020-10-24","2020-10-28","2020-10-24","2022-03-16","2020-10-24","2020-10-24","2022-11-08","2020-10-28","2020-10-28","2020-10-28","2022-03-09","2022-11-08","2020-10-28","2020-10-25","2022-11-08","2020-10-25","2020-10-26","2020-10-26","2020-10-26","2020-10-26","2020-10-28","2020-11-06","2020-11-11","2022-03-19","2022-03-09","2020-11-13","2020-11-13","2020-11-16","2022-08-03","2021-12-16","2020-12-21","2020-12-21","2020-12-21","2022-03-13","2022-03-13","2022-03-09","2022-03-09","2022-03-09","2022-03-09","2022-03-09","2022-03-09","2022-03-09","2022-03-11","2022-03-09","2022-03-09","2022-03-10","2022-03-09","2022-03-09","2022-03-16","2022-03-18","2022-03-16","2022-03-16","2022-03-16","2022-11-08","2022-11-10","2022-11-08","2022-11-08","2022-11-08"],"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":[["","49483060350","IBUPROFEN","TAB 600MG","30","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","90","Select","Select",""],["","69097083305","SERTRALINE","TAB 25MG","90","Select","Select",""],["","70377000315","SIMVASTATIN","TAB 20MG","90","Select","Select",""],["","00121067516","VALPROIC","SOL 250\/5ML","1,419.00","Select","Select",""],["","57664050658","METOPROL","TAB 25MG","30","Select","Select",""],["","57237004705","DIVALPROEX","TAB 250MG DR","150","Select","Select",""],["","10702025350","BUT\/APAP\/CAF","TAB ","30","Select","Select",""],["","00131541072","VIMPAT","SOL 10MG\/ML","400","Select","Select",""],["","69097012503","TOPIRAMATE","TAB 200MG","180","Select","Select",""],["","65862050320","AMOX\/K","TAB 875-125","20","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","10","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","28","Select","Select",""],["","00116200116","CHLORHEX","SOL 0.0012","473","Select","Select",""],["","59267100002","PFIZER","INJ COVID-19","0.30","Select","Select",""],["","00093220401","METOCLOPRAM","TAB 5MG","20","Select","Select",""],["","61314063136","NEO\/POLY\/DEX","OIN 0.1% OP","3.5","Select","Select",""],["","33332032001","AFLURIA","INJ 2020-21","0.5","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":""}]}]}