{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"  YENALEMNOSTAW A","gend":1,"add":"RELLIM 7016 TPA TS ","city":"STAUNTON","state":"VA","zip":"24401-9998","dob":"1970-10-29","age":"","mstatus":"","insh":"75000910*712","cliId":"","pno":"3804528956","cno":5408365982,"email":"","ename":"","eno":"","pphy":"SEATON, SCOTT M MD","ppno":5409421200,"pcpadd":"1850 ROSSER AVE","pcpcity":"WAYNESBORO","pcpstate":"VA","pcpzip":"22980-9998","pcpcounty":"","pcpid":"","pcpname":"UNIVERSITY OF VIRGINIA PHYSICIANS GROUP","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"N","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R60.0","I10.","E11.9","E66.9","F32.9","E78.5","Z79.899","Z79.4","Z88.2","Z88.8","Z88.5","M25.572","E55.9","G62.9","E04.2","H81.12","S62.102D","R53.1","M25.532","M25.632","M25.642","Z91.81","L52.","R20.2","R42.","R22.43","Z51.81","M65.4","E78.2","Z72.0","R20.0","R51.9","H53.8","G56.21","G56.11","G56.01","M25.512","G89.29","M25.511","F32.89","E11.8","M79.89","F17.200","R22.2","Z79.84","Z22.7","R76.12","M51.36","M47.816","M50.30","M47.812","M16.0","H35.033","H25.13","M10.9","M43.16","F17.210","M48.02","G99.2","M54.2","M48.061","M51.26","M51.27","M47.817","Q76.49","E07.89","R29.3","R26.89","Z74.09","M54.50","M67.471"],"date":["2022-07-14","2023-04-28","2023-04-28","2022-07-10","2022-07-14","2022-07-14","2023-04-05","2023-04-28","2022-07-14","2022-07-14","2022-07-14","2022-07-10","2023-04-05","2023-04-05","2023-04-05","2022-09-13","2022-04-07","2022-07-14","2022-04-07","2022-04-07","2022-04-07","2022-04-07","2023-02-15","2022-07-09","2022-08-15","2022-07-10","2022-11-29","2022-11-03","2023-04-05","2023-04-05","2023-04-05","2022-07-14","2022-07-14","2023-01-31","2022-10-26","2023-01-31","2022-08-15","2023-04-25","2023-01-06","2022-08-15","2023-04-28","2022-08-15","2022-08-15","2022-10-07","2022-07-14","2023-02-15","2023-02-15","2023-03-07","2023-04-28","2023-03-23","2023-03-23","2023-02-01","2022-12-29","2022-12-29","2023-01-27","2023-03-07","2023-03-07","2023-04-25","2023-04-25","2023-03-07","2023-04-28","2023-03-23","2023-03-23","2023-03-23","2023-04-28","2023-04-28","2023-04-25","2023-04-25","2023-04-25","2023-04-11","2023-04-11"],"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":[["","68645058459","METFORMIN","TAB 1000MG","180","Select","Select",""],["","31722099601","HYDROCO\/APAP","TAB 5-325MG","30","Select","Select",""],["","00832105415","BACLOFEN","10 MG","90","Select","Select",""],["","68180044701","QUETIAPINE","TAB 100MG","180","Select","Select",""],["","69543012450","GLIMEPIRIDE","2 MG","180","Select","Select",""],["","68382009305","CARVEDILOL","6.25 MG","180","Select","Select",""],["","00093505698","ATORVASTATIN","TAB 10MG","90","Select","Select",""],["","69238110002","DOXYCYCL HYC","CAP 100MG","90","Select","Select",""],["","00002822259","INSULIN LISP","INJ 100\/ML","15","Select","Select",""],["","50228018010","GABAPENTIN","300 MG","360","Select","Select",""],["","70710116201","MECLIZINE","TAB 25MG","90","Select","Select",""],["","68645051054","HYDROCHLOROT","TAB 25MG","90","Select","Select",""],["","49884015676","VARENICLINE","TAB 1MG","60","Select","Select",""],["","57237001930","DULOXETINE","CAP 60MG","90","Select","Select",""],["","62332002331","FLUOXETINE","CAP 20MG","90","Select","Select",""],["","13668021730","ARIPIPRAZOLE","TAB 5MG","90","Select","Select",""],["","98302000198","COMFORT EZ","MIS 31GX8MM","300","Select","Select",""],["","98302000105","ALCOHOL PREP","PAD ","300","Select","Select",""],["","00555007102","ISONIAZID","300 MG","30","Select","Select",""],["","53885014301","ONETOUCH","MIS LANCETS","300","Select","Select",""],["","42806054701","VITAMIN D","CAP 1.25MG","12","Select","Select",""],["","30768012587","VITAMIN B-6","TAB 50MG","30","Select","Select",""],["","53885000810","ONETOUCH DEL","MIS PLUS 33G","300","Select","Select",""],["","00093598627","EPINEPHRINE","INJ 0.3MG","2","Select","Select",""],["","00406012305","HYDROCODONE-A","CET AMINOPHEN 5 MG-325MG","30","Select","Select",""],["","16729022501","SPIRONOLACTON","E 2 5 MG","90","Select","Select",""],["","16729022501","SPIRONOLACT","TAB 25MG","90","Select","Select",""],["","53885004401","ONE TOUCH","KIT VERIO FL","1","Select","Select",""],["","00002822259","INSULIN LISPRO KWIKPEN U-","100 100\/ML","15","Select","Select",""],["","72578005518","DOXYCYCLINE HYCLATE","100 MG","90","Select","Select",""],["","30768012587","VITAMIN B-","6 TAB 50MG","30","Select","Select",""],["","59746017310","PREDNISONE","10 MG","20","Select","Select",""],["","68645051054","HYDROCHLOROTHIAZIDE","25 MG","90","Select","Select",""],["","69238110002","DOXYCYCL HYC CAP","100MG","90","Select","Select",""],["","68180044701","QUETIAPINE TAB","100MG","180","Select","Select",""],["","31722099601","HYDROCO\/APAP TAB","5-325MG","30","Select","Select",""],["","00002822259","INSULIN LISP INJ","100\/ML","-15","Select","Select",""],["","62332002331","FLUOXETINE CAP","20MG","90","Select","Select",""],["","68382009305","CARVEDILOL TAB","6.25MG","180","Select","Select",""],["","00555007102","ISONIAZID TAB","300MG","-30","Select","Select",""],["","53885027210","ONETOUCH TES VERIO","","300","Select","Select",""],["","53885014301","ONETOUCH MIS LANCETS","","300","Select","Select",""],["","98302000198","COMFORT EZ MIS","31GX8MM","300","Select","Select",""],["","69543012450","GLIMEPIRIDE TAB","2MG","-180","Select","Select",""],["","00832105415","BACLOFEN TAB","10MG","90","Select","Select",""],["","68645051054","HYDROCHLOROT TAB","25MG","90","Select","Select",""],["","68645058459","METFORMIN TAB","1000MG","180","Select","Select",""],["","65162010211","GABAPENTIN CAP","300MG","120","Select","Select",""],["","00093505698","ATORVASTATIN TAB","10MG","90","Select","Select",""],["","59746012106","MECLIZINE TAB","25MG","30","Select","Select",""],["","49884015676","VARENICLINE TAB","1MG","60","Select","Select",""],["","57237001930","DULOXETINE CAP","60MG","90","Select","Select",""],["","13668021730","ARIPIPRAZOLE TAB","5MG","90","Select","Select",""],["","98302000105","ALCOHOL PREP PAD","","300","Select","Select",""],["","42806054701","VITAMIN D CAP","1.25MG","12","Select","Select",""],["","53885019401","ONETOUCH KIT VERIO FL","","1","Select","Select",""],["","53885000810","ONETOUCH DEL MIS PLUS","33G","300","Select","Select",""],["","53885004401","ONE TOUCH KIT VERIO FL","","1","Select","Select",""],["","00406012305","HYDROCODONE-ACETAMINOPHEN","5 MG-325MG","30","Select","Select",""],["","98302000105","ALCOHOL PREP PADS","","300","Select","Select",""],["","00093505698","ATORVASTATIN CALCIUM","10 MG","90","Select","Select",""],["","98302000198","COMFORT EZ PEN NEEDLE","31 GX5\/16\"","300","Select","Select",""],["","00093598627","EPINEPHRINE INJ","0.3MG","2","Select","Select",""],["","16729022501","SPIRONOLACT TAB","25MG","90","Select","Select",""],["","16729022501","SPIRONOLACTONE","25 MG","90","Select","Select",""],["","68180044701","QUETIAPINE FUMARATE","100 MG","180","Select","Select",""],["","68645058459","METFORMIN HCL","1000 MG","180","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":""}]}]}