{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   ASERETRELEEHW D","gend":1,"add":"NIATNOF 2232A TPA EVA E","city":"CHARLOTTESVILLE","state":"VA","zip":"22903-9998","dob":"1968-02-25","age":"","mstatus":"","insh":"17300210*88","cliId":"","pno":"12\/4341198-8","cno":"","email":"","ename":"","eno":"","pphy":"SCHECTMAN, JOEL M MD","ppno":"434\/924-1931","pcpadd":"1222 JEFFERSON PARK AVE","pcpcity":"CHARLOTTESVILLE","pcpstate":"VA","pcpzip":22903,"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":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M47.816","NO DATA","M54.16","E11.65","R19.7","M54.5","G89.29","N39.41","M54.14","M62.838","R07.89","L30.9","H40.053","F32.1","F41.9","G47.33","M54.41","E11.8","Z00.00","M54.42","B35.1","I10.","E11.9","R60.0","Z23.","L82.1","L29.9","L85.3","L21.9","S82.831A","M25.562","Z79.891","L60.2","H04.123","E78.5","Z79.84","Z79.899","N89.8","M54.40","V54.16","E03.9","R30.0","K59.00","R19.5","Z12.11","M72.2","R10.11","M77.41","M77.42","M47.817","G43.B0","K64.8","K57.30","F33.1","R42.","R55.","W18.39XA","Y93.G3","Y92.000","R26.2","M62.81","M25.512","M19.011","J45.909","E11.319","E78.2","K21.9","E66.9","M79.2","M79.601","B37.9","F32.9","L24.2","B00.9","N39.0","D31.32","M54.17","M51.27","M48.07","M51.37","G47.30","Z86.2","M25.511","M54.10","N89.9","N75.0","F11.10","R10.31","M51.36","R53.81","S39.92XA","W18.30XA","B35.3"],"date":["2021-04-26","2021-12-21","2020-01-07","2021-09-30","2020-09-14","2021-04-29","2021-12-21","2021-12-16","2021-02-17","2021-02-17","2021-02-17","2021-02-17","2021-09-24","2021-03-04","2021-03-04","2021-12-21","2021-09-30","2021-04-29","2021-03-04","2021-09-30","2021-09-08","2021-12-21","2021-12-02","2021-06-03","2021-10-28","2021-11-09","2021-11-09","2021-11-09","2021-11-09","2021-12-23","2021-12-23","2021-12-02","2020-07-08","2021-09-24","2021-04-23","2021-09-14","2021-09-14","2020-09-10","2021-08-02","2021-12-21","2021-12-21","2020-01-30","2021-07-08","2020-05-29","2020-02-18","2020-03-05","2021-08-03","2020-07-08","2020-07-08","2021-12-21","2021-09-30","2020-05-29","2020-05-29","2021-08-03","2021-11-23","2021-11-23","2021-11-23","2021-11-23","2021-11-23","2021-12-21","2021-12-21","2021-12-21","2021-12-21","2021-12-21","2021-12-21","2021-12-21","2021-12-21","2021-12-21","2020-01-07","2020-07-09","2021-04-29","2021-04-29","2021-08-23","2021-08-23","2021-08-23","2021-09-24","2020-01-28","2020-01-28","2020-01-28","2020-01-28","2021-04-23","2021-04-23","2020-04-10","2020-04-10","2019-04-29","2019-04-29","2019-07-17","2019-07-17","2019-07-16","2019-08-05","2019-05-14","2019-05-14","2019-11-22"],"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":[["","","TRAMADOL"," TRAMADOL ","90","Select","Select",""],["","","LISINOPRIL"," LISINOPRIL ","30","Select","Select",""],["","","GABAPENTIN","CAP 300MG","","Select","Select",""],["","","LORATADINE"," LORATADINE ","30","Select","Select",""],["","","VICTOZA"," VICTOZA ","3","Select","Select",""],["","","FLUCONAZOLE","TAB 150MG","","Select","Select",""],["","","GLIPIZIDE"," GLIPIZIDE ","60","Select","Select",""],["","","TRULICITY"," TRULICITY ","2","Select","Select",""],["","","ROSUVASTATIN"," ROSUVASTATIN ","30","Select","Select",""],["","","LATANOPROST"," LATANOPROST ","2","Select","Select",""],["","","DICLOFENAC","GEL 0.01","","Select","Select",""],["","","ONETOUCH"," ONETOUCH ","100","Select","Select",""],["","","LEVOTHYROXIN"," LEVOTHYROXIN ","30","Select","Select",""],["","45802014167","CICLOPIROX","SOL 0.08","7","Select","Select",""],["","43386031208","GAVILAX","POW ","238","Select","Select",""],["","","DULOXETINE"," DULOXETINE ","30","Select","Select",""],["","","ESTRADIOL"," ESTRADIOL ","42","Select","Select",""],["","50228014610","HYDROCHLOROT","CAP 12.5MG","60","Select","Select",""],["","","PIOGLITAZONE"," PIOGLITAZONE ","30","Select","Select",""],["","","OMEPRAZOLE"," OMEPRAZOLE ","30","Select","Select",""],["","","LIDOCAINE"," LIDOCAINE ","30","Select","Select",""],["","","SELENIUM"," SELENIUM ","120","Select","Select",""],["","","AMLODIPINE"," AMLODIPINE ","30","Select","Select",""],["","65162018810","NAPROXEN","TAB 250MG","28","Select","Select",""],["","","AMMONIUM","LOT 0.12","","Select","Select",""],["","","LOPERAMIDE"," LOPERAMIDE ","30","Select","Select",""],["","","ACETAMIN","TAB 500MG","","Select","Select",""],["","","CVS"," CVS ","30","Select","Select",""],["","59779050156","BACITRACIN","OIN 500\/GM","112","Select","Select",""],["","00023079815","REFRESH","DRO 0.5% OP","15","Select","Select",""],["","38703000161","BLOOD","MIS WRIST CF","1","Select","Select",""],["","68462074617","ACYCLOVIR","OIN 0.05","15","Select","Select",""],["","","ACETAMINOPHE","TAB 325MG","","Select","Select",""],["","","VENLAFAXINE"," VENLAFAXINE ","60","Select","Select",""],["","69097012203","TOPIRAMATE","TAB 25MG","180","Select","Select",""],["","00904530660","BANOPHEN","CAP 25MG","30","Select","Select",""],["","","LOW"," LOW ","30","Select","Select",""],["","","KETOCONAZOLE"," KETOCONAZOLE ","120","Select","Select",""],["","","METFORMIN"," METFORMIN ","120","Select","Select",""],["","","TRIAMCINOLON"," TRIAMCINOLON ","30","Select","Select",""],["","","MYRBETRIQ"," MYRBETRIQ ","30","Select","Select",""],["","","ASPIRIN"," ASPIRIN ","30","Select","Select",""],["","","TIZANIDINE"," TIZANIDINE ","90","Select","Select",""],["","","RESTASIS"," RESTASIS ","60","Select","Select",""],["","","SMZ\/TMP"," SMZ\/TMP ","28","Select","Select",""],["","","BD  PEN NEEDL"," BD  PEN NEEDL","100","Select","Select",""],["","","EYE"," EYE ","5","Select","Select",""],["","","FLUCLVX"," FLUCLVX ","0","Select","Select",""],["","","MELOXICAM"," MELOXICAM ","30","Select","Select",""],["","","CONTOUR"," CONTOUR ","1","Select","Select",""],["","","FREESTYLE    MIS READER"," FREESTYLE    MIS READER","1","Select","Select",""],["","","PETROLATUM"," PETROLATUM ","500","Select","Select",""],["","","GENTEAL"," GENTEAL ","36","Select","Select",""],["","","ZADITOR"," ZADITOR ","5","Select","Select",""],["","","CLOTRIMAZOLE","CRE 1% VAG","","Select","Select",""],["","","BACLOFEN","TAB 10MG","","Select","Select",""],["","","GAVILYTE-G","SOL ","","Select","Select",""],["","","NARCAN","SPR ","","Select","Select",""],["","","OZEMPIC","INJ 2\/1.5ML","","Select","Select",""],["","","ACETAMINOPHN","TAB 500MG","","Select","Select",""],["","","IBUPROFEN","TAB 400MG","","Select","Select",""],["","","AFLURIA","INJ 2020-21","","Select","Select",""],["","00173085910",""," ","100","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":""}]}]}