{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"W DIVADRECIPS ","gend":0,"add":"REMAJ NIBORRECIPS NOS","city":"GORDONSVILLE","state":"VA","zip":"22942-0848","dob":"1962-02-07","age":"","mstatus":"","insh":"50012753","cliId":"","pno":"0443407359","cno":4348820687,"email":"","ename":"","eno":"","pphy":"KON, RACHEL H","ppno":8002239173,"pcpadd":"LEE STREET AND 11TH STREET SW,","pcpcity":"Charlottesville","pcpstate":"VA","pcpzip":"22908-0001","pcpcounty":"","pcpid":"","pcpname":"UVA HOSPITAL","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"ROBIN JAMERSON SPICER","add3":"","madd1":"ROBIN JAMERSON SPICER","madd2":"P O BOX 848","madd3":"","mcity":"GORDONSVILLE","mstate":"VA","mzip":"22942-0848","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M54.2","M43.6","R05","Z20.822","I10","F10.10","F17.210","F17.220","Z88.0","R51.9","R53.81","R68.89","I73.9","F17.290","Z95.828","N20.0","N39.41","Z87.442","N32.81","I77.1","Z48.812","R93.6","Z72.0","H25.11","H25.12","H25.13","Z96.1","H26.9","Z98.890","Z48.810","R60.9","R50.9","R52","L03.115","L03.119","R09.89","I70.202","I70.0","I70.213","K55.1","K76.9","I77.9","T82.898A","I70.8","I70.209","Z01.812","I45.81","I70.222","E78.5","I25.2","Z28.310","T82.858A","Z01.810","R16.0","K74.60","I81","K59.04","R39.15","R32","Z12.5","K70.9","E78.2","I71.21","J43.2","J44.1","C22.1","I71.20","Z01.818","R53.83","G89.3","R63.0","Z51.12","Z51.11","E83.42","R05.1","R05.9","R06.2","R91.8","K80.20","D69.6","R10.9","N17.9","J98.11","I77.810","R10.84","R10.30","K92.0","R60.0","N13.8","R39.9","R06.02","R13.10","R22.1","R06.1","T17.920A","Z85.05","Z11.52","K52.9","K50.018","K72.00","J45.909","K21.9","N40.0","R11.0","H91.90","R47.02","R00.0","C16.9","I21.A1","I50.20","M47.26","M43.16","M48.061","M47.817","M51.36","M51.37","R13.12","M47.816","F17.200","Z12.11"],"date":["2021-01-29","2021-01-20","2021-01-20","2023-03-26","2023-04-13","2022-05-09","2023-03-26","2021-01-20","2021-01-20","2021-01-20","2021-12-22","2021-01-20","2023-04-13","2021-01-27","2022-06-22","2021-01-28","2021-01-28","2023-02-06","2021-07-26","2022-12-21","2022-06-22","2021-07-28","2023-04-26","2021-08-19","2021-10-29","2021-08-19","2021-08-19","2021-10-29","2021-10-30","2021-10-30","2021-12-22","2023-01-27","2021-12-22","2021-12-22","2021-12-22","2023-01-23","2022-02-02","2022-04-27","2022-04-27","2022-04-27","2022-09-15","2022-05-04","2022-04-27","2022-04-27","2022-04-27","2022-11-04","2022-05-09","2022-05-09","2023-04-13","2023-03-26","2022-05-09","2022-05-09","2022-05-09","2022-10-17","2022-12-29","2022-06-16","2022-06-27","2022-06-27","2022-06-27","2022-06-27","2022-09-15","2022-10-07","2022-10-07","2022-10-07","2023-03-10","2023-05-18","2022-11-04","2023-02-09","2023-05-18","2023-05-18","2023-04-27","2023-04-27","2023-05-18","2023-01-19","2023-01-23","2023-01-23","2023-01-23","2023-01-23","2023-01-27","2023-03-23","2023-03-26","2023-01-27","2023-01-27","2023-01-27","2023-03-27","2023-01-27","2023-01-27","2023-04-27","2023-02-06","2023-02-06","2023-03-26","2023-05-18","2023-03-10","2023-03-10","2023-03-10","2023-03-26","2023-03-26","2023-03-27","2023-03-26","2023-03-26","2023-03-26","2023-03-26","2023-03-26","2023-03-26","2023-03-26","2023-03-26","2023-03-26","2023-04-05","2023-04-13","2023-05-05","2023-04-26","2023-04-26","2023-04-26","2023-04-26","2023-04-26","2023-04-26","2023-04-18","2023-04-26","2023-05-08","2023-05-08"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}}]},{"t":"Covid Screening","q":[{"a":[]}]},{"t":"Self-Assessment and Social History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"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":[["","11534016503","FOLIC ACID","TAB 1MG","30","Select","Select",""],["","00093317431","ALBUTEROL SUL","FAT E","8.5","Select","Select",""],["","00003089421","ELIQUIS","TAB 5MG","60","Select","Select",""],["","00904404073","ASPIRIN","CHW 81MG","30","Select","Select",""],["","68180072103","AMLODIPINE","TAB 10MG","30","Select","Select",""],["","60258017101","MAG OXIDE","TAB 400MG","90","Select","Select",""],["","87701040729","VITAMIN B-1","TAB 100MG","90","Select","Select",""],["","65162083366","DICLOFENAC","GEL 0.01","200","Select","Select",""],["","74312052802","MELATONIN","SUB 10MG","30","Select","Select",""],["","52817033200","CYCLOBENZAPR","TAB 10MG","30","Select","Select",""],["","47781030301","NITROFURANTN","CAP 100MG","20","Select","Select",""],["","00067815202","VOLTAREN","GEL 0.01","50","Select","Select",""],["","65862042005","SMZ\/TMP DS","TAB 800-160","14","Select","Select",""],["","61314063705","PREDNISOLONE","SUS 1% OP","5","Select","Select",""],["","61314062810","POLYMYXIN B\/","SOL TRIMETHP","10","Select","Select",""],["","50428050854","CVS PURELAX","PAK ","30","Select","Select",""],["","00904679480","ASPIRIN LOW","CHW 81MG","30","Select","Select",""],["","00254200801","COLCHICINE","TAB 0.6MG","30","Select","Select",""],["","68180096301","ALBUTEROL","AER HFA","8.5","Select","Select",""],["","00006505506","LAGEVRIO","CAP 200MG","40","Select","Select",""],["","51079030630","POLYETH GLYC","POW 3350 NF","30","Select","Select",""],["","70377002911","ATORVASTATIN","TAB 40MG","30","Select","Select",""],["","70436001002","BUPROPN HCL","TAB 150MG XL","60","Select","Select",""],["","65862085901","FAMOTIDINE","TAB 20MG","60","Select","Select",""],["","00173071620","ADVAIR HFA","AER 115\/21","12","Select","Select",""],["","68180016106","AZITHROMYCIN","TAB 500MG","3","Select","Select",""],["","76385011250","CARVEDILOL","TAB 12.5MG","60","Select","Select",""],["","70377000812","ROSUVASTATIN","TAB 20MG","30","Select","Select",""],["","00378064205","PREDNISONE","TAB 20MG","10","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":""}]}]}