{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"H   YSTAPSREDNUAS ","gend":1,"add":" HTRON 2511TEERTS NIAM","city":"CHATHAM","state":"VA","zip":"24531-2506","dob":"1960-04-10","age":"","mstatus":"","insh":"50018813","cliId":"","pno":"1743416113","cno":4347131161,"email":"","ename":"","eno":"","pphy":"SHAH, MINESH R","ppno":4347994488,"pcpadd":"19144 HIGHTWAY 29 NORTH, ","pcpcity":"CHATHAM","pcpstate":"VA","pcpzip":245310001,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":4347133476,"add2":"APT 4-E","add3":"","madd1":"1152 NORTH MAIN STREET","madd2":"APT 4-E","madd3":"","mcity":"CHATHAM","mstate":"VA","mzip":"24531-2506","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R32","R39.81","N39.46","L03.312","R21","B35.9","R05","I25.10","I10","J44.9","F17.210","Z79.899","Z95.5","E11.9","R06.02","M54.89","R22.40","N17.9","R07.9","N39.0","I50.32","R07.89","T50.1X5A","T50.2X5A","F17.200","I11.0","E87.6","E86.9","I95.9","I50.9","Z79.02","I25.118","M25.512","M54.2","Z79.84","Z88.5","J43.2","J41.1","J96.11","J30.2","R91.8","I73.9","I87.2","E78.5","R73.9","H43.813","H25.13","H52.4","Z91.018","W57.XXXS","D89.42","L29.9","K59.00","K21.9","K64.9","R13.10","Z12.11","Z86.010","M54.5","M48.061","S99.922A","S39.92XA","S79.912A","S89.92XA","S69.91XA","S99.912A","I65.29","J44.1","E11.65","H81.49","J20.9","I25.2","R90.82","Z88.0","Z88.8","Z88.6","J44.0","R51","J96.21","I50.33","E11.51","G43.909","F41.9","Z95.820","Z90.710","J96.01","I50.21","R09.02","N18.4","K57.30","Z12.2","G62.9","Z23","D72.829","M25.461","M25.561","J40","R30.0","M54.41","M79.604","R60.0","L03.116","Z88.1","R60.9","Z91.040","E78.2","E53.8","E55.9","I25.758","Z68.31","J11.1","K62.89","R10.30","R14.0","Z09","Z87.442","K29.70","K20.9","K63.5","R11.0","K31.9","L29.0","K92.2","K64.4","Z12.31","L28.0","L02.31","L29.8","B37.3","I70.213","I70.211","I70.92","I65.23","N28.9","L28.1","R53.83","R51.9","I36.1","N18.30","M54.9","Z72.0","M79.609","M47.816","M54.16","M51.36","R19.4","R10.11","R10.31","M79.89","Z99.81","N20.0","I12.9","N18.3","K60.1","Z01.818","G25.81","J96.22","R19.07","W57.XXXA","D47.09","L98.9","J31.0","L03.115","T39.395A","G89.29","F13.20","M79.661","M51.27","M51.26","R59.0","Z13.220","M94.261","I95.1","Z79.01","Z79.51","R94.4","R42","F41.8","M54.12","K64.5","R10.84","L21.8","L82.1","L30.9","L30.4","M17.11","R50.9","K59.09","E66.9","R53.1","R52","G44.89","R20.0","R53.81","M47.26","S70.01XA","S50.01XA","S80.02XA","S60.511A","S80.212A","S79.911A","M16.11","R10.13","D12.3","E11.40","R10.9","R10.2","Z87.891","W10.1XXA","Y92.480","Y93.01"],"date":["2019-12-24","2021-05-03","2021-05-03","2019-04-28","2021-02-22","2019-04-28","2021-01-24","2021-04-21","2021-04-21","2021-03-05","2021-04-08","2021-04-08","2020-12-07","2021-04-23","2020-02-10","2019-08-12","2019-08-12","2021-02-22","2021-02-21","2020-11-05","2019-08-31","2021-02-21","2019-08-23","2019-08-23","2021-03-05","2019-09-23","2021-02-19","2019-08-24","2021-02-22","2021-03-02","2021-02-27","2019-08-25","2020-03-07","2020-03-07","2021-02-19","2021-04-08","2020-12-31","2020-12-31","2020-12-31","2020-04-29","2020-12-31","2021-04-21","2021-04-21","2021-04-21","2021-04-21","2020-11-25","2020-11-25","2020-11-25","2021-02-22","2021-02-04","2021-01-21","2021-02-04","2021-04-28","2021-04-28","2021-02-17","2021-02-17","2021-02-17","2021-02-17","2021-04-30","2021-03-16","2021-04-08","2021-04-08","2021-04-08","2021-04-08","2021-04-08","2021-04-08","2021-04-21","2019-08-31","2019-02-06","2019-07-05","2019-08-31","2021-03-02","2019-07-05","2021-03-02","2021-03-02","2021-02-07","2019-08-31","2019-07-28","2019-08-31","2019-08-12","2019-08-12","2019-08-12","2019-08-30","2020-12-07","2019-08-12","2019-08-12","2019-08-12","2019-08-30","2019-09-11","2019-09-23","2020-04-01","2020-11-16","2020-10-19","2020-11-16","2021-01-14","2021-01-14","2021-01-24","2021-01-24","2021-02-27","2021-03-02","2021-03-02","2021-03-02","2021-03-02","2021-03-02","2021-03-02","2021-04-23","2021-04-23","2021-04-23","2021-04-23","2021-04-23","2019-01-07","2019-09-23","2021-04-28","2021-01-04","2019-08-27","2019-11-19","2019-09-23","2019-09-23","2019-09-23","2019-11-19","2019-09-23","2021-01-04","2019-10-02","2021-01-04","2020-10-20","2021-01-04","2020-11-02","2021-01-04","2020-11-10","2020-12-07","2020-12-07","2020-12-07","2020-12-07","2021-04-21","2021-01-04","2021-01-24","2021-02-22","2021-02-22","2021-02-22","2021-02-27","2021-02-22","2021-03-02","2021-04-30","2021-04-30","2021-04-30","2019-02-26","2019-03-31","2021-03-31","2021-02-24","2019-08-30","2019-11-19","2021-02-22","2019-11-19","2019-12-13","2019-12-13","2020-11-16","2019-08-13","2021-01-04","2021-01-25","2021-02-04","2021-02-04","2021-02-04","2021-02-07","2021-02-22","2021-02-22","2021-02-22","2021-02-24","2021-03-16","2021-03-16","2021-05-06","2019-12-04","2021-01-20","2021-02-21","2021-02-21","2021-02-21","2021-02-22","2019-07-17","2019-07-17","2020-06-19","2019-11-11","2019-11-19","2020-09-15","2020-09-15","2020-09-15","2020-09-15","2020-11-21","2019-01-07","2019-03-25","2019-06-27","2019-07-05","2019-07-05","2019-07-28","2019-07-28","2020-06-19","2021-02-20","2021-04-08","2021-04-08","2021-04-08","2021-04-08","2021-04-08","2021-04-08","2021-04-08","2019-09-23","2019-09-23","2019-09-23","2019-11-19","2021-02-19","2021-04-01","2021-04-08","2021-04-08","2021-04-08"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}},{"a":[]}]},{"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":[]}]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","27808003503","HYDROCO\/APAP ","TAB 5-325MG","21","Select","Select",""],["","63868093510","MAG ","SOL LEMON","296","Select","Select",""],["","00591292754","LEVALBUTEROL ","AER 45\/ACT","15","Select","Select",""],["","68462047201","POT  CL MICRO","TAB 20MEQ ER","60","Select","Select",""],["","00378668910","PANTOPRAZOLE ","TAB 40MG","60","Select","Select",""],["","31722088530","ROSUVASTATIN ","TAB 40MG","30","Select","Select",""],["","61442012210","FAMOTIDINE ","TAB 40MG","60","Select","Select",""],["","00456120230","LINZESS ","CAP 290MCG","30","Select","Select",""],["","70069000510","CYANOCOBALAM ","INJ 1000MCG","1","Select","Select",""],["","57237018490","PRAMIPEXOLE ","TAB 1MG","30","Select","Select",""],["","55111032205","GLIMEPIRIDE ","TAB 4MG","45","Select","Select",""],["","00597007541","SPIRIVA ","CAP HANDIHLR","30","Select","Select",""],["","16729021816","CLOPIDOGREL ","TAB 75MG","30","Select","Select",""],["","10702001050","HYDROXYZ ","TAB 10MG","90","Select","Select",""],["","59746000106","METHYLPRED ","TAB 4MG","42","Select","Select",""],["","43547040711","CLONAZEPAM ","TAB 1MG","63","Select","Select",""],["","50228017805","GABAPENTIN ","TAB 800MG","90","Select","Select",""],["","57237010199","METOPROL ","TAB 50MG","60","Select","Select",""],["","45802065087","LORATADINE ","TAB 10MG","30","Select","Select",""],["","59310057922","PROAIR ","AER ","8.5","Select","Select",""],["","50111091701","TORSEMIDE ","TAB 20MG","60","Select","Select",""],["","71093013304","METFORMIN ","TAB 850MG","60","Select","Select",""],["","72140003147","AQUAPHOR ","OIN ","396","Select","Select",""],["","57664050389","TIZANIDINE ","TAB 4MG","90","Select","Select",""],["","00135024202","NICORETTE ","GUM 4MGFRUIT","100","Select","Select",""],["","00487950125","ALBUTEROL ","NEB 0.00083","75","Select","Select",""],["","67877057305","BENZONATATE ","CAP 100MG","90","Select","Select",""],["","10702000310","PROMETHAZINE ","TAB 25MG","20","Select","Select",""],["","57896098110","ASPIRIN ","TAB 81MG EC","30","Select","Select",""],["","67877019810","AMLODIPINE ","TAB 5MG","30","Select","Select",""],["","00193731150","CONTOUR ","TES NEXT","50","Select","Select",""],["","67405060301","FLUCONAZOLE ","TAB 150MG","1","Select","Select",""],["","55111028050","LEVOFLOXACIN ","TAB 500MG","7","Select","Select",""],["","33342032915","TRIAMCINOLON ","CRE 0.001","15","Select","Select",""],["","13925015901","LIDOCAINE ","CRE 0.03","141.75","Select","Select",""],["","63824000815","MUCINEX ","TAB 600MG ER","60","Select","Select",""],["","59762330403","NITROGLYCERN ","SUB 0.4MG","25","Select","Select",""],["","00054001729","PREDNISONE ","TAB 10MG","21","Select","Select",""],["","00186037020","SYMBICORT ","AER 160-4.5","10.2","Select","Select",""],["","45802000403","HYDROCORT ","CRE 0.025","28","Select","Select",""],["","50383026730","CLOBETASOL ","CRE 0.0005","30","Select","Select",""],["","68180012202","CEPHALEXIN ","CAP 500MG","14","Select","Select",""],["","51293081001","PHENAZOPYRID ","TAB 100MG","6","Select","Select",""],["","33332041910","AFLURIA ","INJ 2019-20","0.5","Select","Select",""],["","00002803101","GLUCAGON ","KIT 1MG","1","Select","Select",""],["","42571025201","CLINDAMYCIN ","CAP 300MG","28","Select","Select",""],["","00185005501","METOLAZONE ","TAB 5MG","15","Select","Select",""],["","55111012705","CIPROFLOXACN ","TAB 500MG","14","Select","Select",""],["","57896045506","SENNA ","TAB 8.6-50MG","30","Select","Select",""],["","67405055055","DOXYCYCL ","TAB 100MG","14","Select","Select",""],["","00310461612","BREZTRI ","AER SPHERE","10.7","Select","Select",""],["","00143993905","AMOXICILLIN ","CAP 500MG","30","Select","Select",""],["","64764024060","AMITIZA ","CAP 24MCG","56","Select","Select",""],["","47781047013","OSELTAMIVIR ","CAP 75MG","10","Select","Select",""],["","00185012201","NITROFURANTN ","CAP 100MG","6","Select","Select",""],["","68382035305","BUPROPN ","TAB 150MG XL","28","Select","Select",""],["","43386031214","GAVILAX ","POW ","510","Select","Select",""],["","43547028110","ESCITALOPRAM ","TAB 10MG","30","Select","Select",""],["","57237023305","SMZ-TMP ","TAB 800-160","20","Select","Select",""],["","53746027205","SMZ\/TMP ","TAB 800-160","14","Select","Select",""],["","43386009561","FLUOCINONIDE ","OIN 0.0005","60","Select","Select",""],["","00378312501","DOXEPIN ","CAP 25MG","30","Select","Select",""],["","21922000909","DICLOFENAC ","GEL 0.01","100","Select","Select",""],["","29300022705","METRONIDAZOL ","TAB 500MG","20","Select","Select",""],["","00597014030","TRADJENTA ","TAB 5MG","30","Select","Select",""],["","00168009930","KETOCONAZOLE ","CRE 0.02","30","Select","Select",""],["","43547040010","CYCLOBENZAPR ","TAB 10MG","30","Select","Select",""],["","68382070718","DOXYCYC ","CAP 100MG","14","Select","Select",""],["","69396001420","MICONAZOLE ","CRE 0.02","30","Select","Select",""],["","00456315467","AEROCHAMBER ","MIS PLUS","1","Select","Select",""],["","45802005911","NYSTATIN ","CRE 100000","30","Select","Select",""],["","45802043411","CLOTRIMAZOLE ","CRE 0.01","30","Select","Select",""],["","00168005760","BETAMETH ","LOT 0.0005","60","Select","Select",""],["","50111078751","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","00173086910","ANORO ","AER 62.5-25","60","Select","Select",""],["","69452015120","VITAMIN ","CAP 50000UNT","4","Select","Select",""],["","67877021560","CEFUROXIME ","TAB 250MG","28","Select","Select",""],["","41167017201","ICY ","PAD 4-1%","15","Select","Select",""],["","65862052730","VENLAFAXINE ","CAP 37.5 ER","30","Select","Select",""],["","59746012106","MECLIZINE ","TAB 25MG","20","Select","Select",""],["","65862018730","ONDANSETRON ","4MG","10","Select","Select",""],["","00143122710","DICYCLOMINE ","20MG","28","Select","Select",""],["","31722070530","VALACYCLOVIR ","1GM","10","Select","Select",""],["","00186077660","BRILINTA ","60MG","60","Select","Select",""]]}},{"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":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[[["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""]]]},{"t":"Mini-Cog","q":[{"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":""}]}]}