{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"  WEHTTAMNRUOB D ","gend":0,"add":"HCOL 411RD ENAL ","city":"LOUISA","state":"VA","zip":"23093-9998","dob":"1967-06-29","age":"","mstatus":"","insh":"14200210*86","cliId":"","pno":"06\/0457702-3","cno":"","email":"","ename":"","eno":"","pphy":"FETCHO, STEVE NP","ppno":"434\/297-7140","pcpadd":"650 PETER JEFFERSON PKWY STE 290","pcpcity":"CHARLOTTESVILLE","pcpstate":"VA","pcpzip":22911,"pcpcounty":"","pcpid":"","pcpname":"UNIVERSITY OF VIRGINIA PHYSICIANS GROUP","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G35.","M54.5","G89.29","M25.551","R06.02","R20.0","R20.2","I77.1","I70.293","Z23.","M79.2","Z11.59","M47.816","NO DATA","G89.4","M96.1","R19.5","J43.2","M71.21","M79.605","M79.604","R90.82","J44.1","R00.0","M54.41","M54.16","R07.89","R06.00","R07.9","R06.9","R06.2","R53.1","R25.2","I10.","F32.89","F17.200","R73.9","H53.8","D31.41","H52.203","H52.4","H25.13","H01.009","M51.36","R63.4","R10.13","F17.210","G47.33","R41.0","N17.9","E86.0","E87.5","M62.82","R45.1","R41.82","E87.2","E78.2","E55.9","K21.9","Z72.0","J02.9","G62.9","E87.1","E79.0","E83.30","N18.3","E87.3","F09.","G93.41","A41.9","R13.12","T17.908A","E11.9","R40.2411","F41.9","F32.9","Z91.89","Z91.14","Z91.81","H90.5","H90.3","H93.12","G93.49","E46.","E87.0","E87.4","G81.14","E78.5","E83.39","E86.1","E87.8","E88.81","G89.21","M54.42","I69.398","M62.81","G93.40","G31.84","F32.2","D12.3","K57.30","J43.9","D12.6","Z71.6","I63.9","M25.512","G95.9","J44.9","M50.30","M47.26","R00.2","I73.9","Z86.010","Z86.73","G25.81","K63.5","Z00.00","Z87.891","Z12.11","R12."],"date":["2022-08-26","2021-05-25","2022-11-03","2021-05-25","2022-05-05","2022-01-18","2022-01-18","2021-11-23","2021-11-23","2022-07-13","2022-07-13","2021-09-17","2022-04-04","2022-07-13","2022-06-08","2022-06-08","2021-10-20","2022-05-11","2021-08-19","2021-11-23","2022-05-05","2021-10-07","2021-12-22","2021-12-22","2022-06-08","2022-07-13","2022-05-05","2022-05-11","2021-12-22","2021-12-22","2021-12-22","2020-03-02","2020-03-02","2022-08-26","2020-03-02","2022-06-01","2020-03-02","2020-07-16","2020-07-16","2020-07-16","2020-07-16","2020-07-16","2020-07-16","2022-04-04","2022-10-13","2021-10-11","2022-10-13","2022-08-11","2019-07-02","2019-07-24","2019-06-30","2019-07-07","2022-08-26","2019-06-30","2019-07-24","2019-07-02","2019-10-14","2019-10-14","2022-08-26","2022-10-13","2019-10-14","2019-12-02","2019-07-02","2019-07-02","2019-06-30","2019-07-02","2019-07-02","2019-08-12","2019-07-07","2019-07-07","2019-07-07","2019-07-07","2019-07-07","2019-06-30","2019-07-24","2019-07-24","2019-07-24","2019-07-24","2019-07-24","2019-03-11","2019-03-11","2019-03-11","2019-06-30","2019-06-30","2019-06-30","2019-06-30","2019-06-30","2019-06-30","2019-06-30","2019-06-30","2019-06-30","2019-06-30","2019-03-19","2019-03-19","2019-03-19","2019-03-19","2019-07-02","2019-09-16","2019-09-16","2022-08-26","2022-08-26","2022-08-26","2022-08-26","2022-06-08","2022-07-13","2022-11-03","2022-01-12","2022-05-11","2022-04-04","2022-06-01","2022-05-05","2022-05-05","2022-08-26","2022-05-05","2022-10-13","2022-10-13","2022-02-07","2022-05-11","2022-07-13","2022-08-26"],"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":{"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":[["","00597007541","SPIRIVA","CAP HANDIHLR","90","Select","Select",""],["","00904582489","VITAMIN","TAB 1000UNIT","30","Select","Select",""],["","00172409660","BACLOFEN","TAB 10MG","90","Select","Select",""],["","67877044460","DALFAMPRIDIN","TAB 10MG ER","60","Select","Select",""],["","","ASPIRIN","TAB 81MG EC","","Select","Select",""],["","11534016503","FOLIC","TAB 1MG","30","Select","Select",""],["","68382013201","TAMSULOSIN","CAP 0.4MG","30","Select","Select",""],["","29300042801","ZONISAMIDE","CAP 25MG","240","Select","Select",""],["","51991029301","OXCARBAZEPIN","TAB 300MG","60","Select","Select",""],["","43598044874","NICOTINE","DIS 21MG\/24H","14","Select","Select",""],["","60432026415","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","00173069500","ADVAIR","AER 100\/50","60","Select","Select",""],["","68180029506","DULOXETINE","CAP 30MG","90","Select","Select",""],["","58468021004","AUBAGIO","TAB 14MG","30","Select","Select",""],["","31722071290","PANTOPRAZOLE","TAB 20MG","90","Select","Select",""],["","16729017501","AMITRIPTYLIN","TAB 100MG","30","Select","Select",""],["","55111012290","ATORVASTATIN","TAB 20MG","90","Select","Select",""],["","10572010001","PEG-3350","SOL ELECTROL","4000","Select","Select",""],["","49348098053","SM","TAB 81MG EC","30","Select","Select",""],["","68180098001","LISINOPRIL","TAB 10MG","30","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","11877001140","BINAXNOW","KIT HOME TES","2","Select","Select",""],["","00363021807","ASPIRIN-81","CHW 81MG","90","Select","Select",""],["","58160082311","SHINGRIX","INJ 50\/0.5ML","1","Select","Select",""],["","00054032656","FLUTIC\/SALME","AER 100\/50","60","Select","Select",""],["","00378932032","WIXELA","AER 100\/50","60","Select","Select",""],["","70461032203","FLUCLVX","INJ 2022-23","0","Select","Select",""],["","68462025301","ROPINIROLE","TAB 0.25MG","30","Select","Select",""],["","65862018501","CLINDAMYCIN","CAP 150MG","30","Select","Select",""],["","33332031901","AFLURIA","INJ 2019-20","0","Select","Select",""],["","68462010905","TOPIRAMATE","TAB 100MG","180","Select","Select",""],["","68180016106","AZITHROMYCIN","TAB 500MG","3","Select","Select",""],["","66758095985","PROVENTIL","AER HFA","7","Select","Select",""],["","00054001829","PREDNISONE","TAB 20MG","10","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","29300016915","TIZANIDINE","TAB 4MG","90","Select","Select",""],["","65162046609","IBUPROFEN","TAB 800MG","90","Select","Select",""],["","","TYLENOL","TAB 500MG","","Select","Select",""],["","","IBU","TAB 800MG","","Select","Select",""],["","00591555501","PROPRANOLOL","TAB 20MG","120","Select","Select",""],["","76439030710","HYOSCYAMINE","TAB 0.125MG","15","Select","Select",""],["","00904770480","ASPIR-LOW","TAB 81MG EC","30","Select","Select",""],["","00054414622","CLOTRIMAZOLE","TRO 10MG","50","Select","Select",""],["","00406051201","OXYCOD\/APAP","TAB 5-325MG","30","Select","Select",""],["","65628020405","FIRVANQ","SOL 25MG\/ML","350","Select","Select",""],["","00008084381","PROTONIX","TAB 20MG","90","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":""}]}]}