{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" J AZILRUOBRAB","gend":1,"add":"        EUNEVA ELAD   118                         ","city":"CHARLOTTESVILLE          ","state":"VA","zip":"22903-5218","dob":"1965-09-09","age":"","mstatus":"","insh":"10119041","cliId":"","pno":"7243425260","cno":4348380603,"email":"","ename":"","eno":"","pphy":"STREETER, GREGORY SCOTT","ppno":4342439466,"pcpadd":"1015 SPRING CREEK PKWY,1221 LEE ST","pcpcity":"Zion Crossroads","pcpstate":"VA","pcpzip":229427019,"pcpcounty":"","pcpid":"","pcpname":"UVA PRIMARY AND SPECIALITY CARE ZIONS CROSS","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"","add2":"APARTMENT 203                                     ","add3":"","madd1":"811   DALE AVENUE                                 ","madd2":"APARTMENT 203                                     ","madd3":"","mcity":"CHARLOTTESVILLE          ","mstate":"VA","mzip":"22903-5218","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I11.0","I48.92","Z51.81","Z79.01","H20.9","E11.9","Z96.1","H30.21","N95.0","D86.9","H20.012","H30.91","H35.062","I51.7","R91.8","G47.33","J96.10","G47.34","M1A.0720","M54.5","G89.29","I10","I50.810","E78.5","D31.30","H43.89","D31.31","Z01.818","I48.91","I48.0","I50.9","J44.9","E66.01","I27.20","E21.3","H43.11","H35.61","I12.9","N18.30","I50.22","Z68.44","Z98.890","Z48.810","H20.11","I66.8","M17.0","H43.812","I34.0","M17.11","Z12.39","Z11.59","Z12.11","U07.1","M10.072","M25.561","M25.562","Z12.4","M10.9","E55.9","Z72.0","J18.9","I13.0","I50.32","J44.1","J44.0","N18.31","F17.200","M17.10","D25.0","J81.1","K80.20","R10.11","R10.9","Z74.3","R79.1","Z00.00","M1A.0790","D53.9","Z79.899","R73.03","M1A.0710","Z86.79","Z12.31"," ","Z23","J96.12"],"date":["2022-12-01","2022-11-08","2021-01-22","2022-11-28","2021-03-23","2021-03-30","2021-01-26","2021-04-07","2021-03-10","2021-02-16","2021-02-15","2021-03-30","2021-02-15","2021-02-16","2021-02-16","2022-11-28","2022-10-11","2021-03-03","2022-11-08","2021-03-10","2021-03-10","2022-11-28","2021-03-10","2021-04-06","2021-03-30","2021-04-07","2021-03-30","2021-07-01","2022-02-16","2022-11-30","2021-04-06","2022-02-16","2022-11-08","2022-11-28","2022-04-19","2021-04-07","2021-04-08","2021-04-07","2021-04-07","2022-11-08","2021-04-07","2021-05-14","2021-04-15","2021-04-15","2021-04-15","2021-05-12","2021-05-14","2020-06-08","2020-09-04","2020-08-06","2020-08-06","2022-11-28","2021-08-20","2020-08-26","2020-10-19","2020-10-19","2020-08-26","2020-10-19","2022-11-08","2020-10-19","2020-10-20","2020-10-19","2020-10-19","2020-10-20","2020-10-19","2022-06-15","2020-10-19","2020-10-19","2020-10-19","2020-10-20","2020-10-20","2020-10-20","2022-04-19","2020-10-20","2020-11-17","2022-11-28","2022-04-19","2022-02-16","2022-11-28","2022-11-08","2022-04-19","2022-02-16","2022-10-05","2022-12-01","2022-11-08","2022-11-28"],"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":[["","00310737020","BUDES\/FORMOT","AER 160-4.5","30.6","Select","Select",""],["","00832121600","JANTOVEN","TAB 5MG","90","Select","Select",""],["","00591040810","LISINOPRIL","TAB 20MG","90","Select","Select",""],["","24979003803","METOPROL","TAB 50MG ER","90","Select","Select",""],["","00254200801","COLCHICINE","TAB 0.6MG","30","Select","Select",""],["","59310057922","PROAIR","AER ","8.5","Select","Select",""],["","53489015610","ALLOPURINOL","TAB 100MG","135","Select","Select",""],["","00054429931","FUROSEMIDE","TAB 40MG","30","Select","Select",""],["","00054001829","PREDNISONE","TAB 20MG","21","Select","Select",""],["","65162027150","SMZ-TMP","TAB 400-80MG","60","Select","Select",""],["","00378427677","VALACYCLOVIR","TAB 1GM","30","Select","Select",""],["","16729017117","AMITRIPTYLIN","TAB 10MG","90","Select","Select",""],["","68180096301","ALBUTEROL","AER HFA","8.5","Select","Select",""],["","68180046403","SIMVASTATIN","TAB 40MG","90","Select","Select",""],["","69315030805","CIPROFLOXACN","SOL 0.3% OP","5","Select","Select",""],["","61314063710","PREDNISOLONE","SUS 1% OP","10","Select","Select",""],["","10572010001","PEG-3350","SOL ELECTROL","4,000.00","Select","Select",""],["","00310621030","FARXIGA","TAB 10MG","90","Select","Select",""],["","65162083366","DICLOFENAC","GEL 0.01","200","Select","Select",""],["","50111078710","AZITHROMYCIN","TAB 250MG","3","Select","Select",""],["","68180030360","CEFUROXIME","TAB 500MG","8","Select","Select",""],["","00186037020","SYMBICORT","AER 160-4.5","10.2","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","Select","Select",""],["","59267100002","PFIZER","INJ COVID-19","0.3","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":["",""],"sub":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""],[""]],"sub":[]}}},{"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":""}]}]}