{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"G ADILAHKDUAD MALU","gend":1,"add":"HSKREB N 6542A TPA DR ERI","city":"CHARLOTTESVILLE","state":"VA","zip":"22901-9998","dob":"1968-09-21","age":"","mstatus":"","insh":"38200210*55","cliId":"","pno":"82\/4345120-2","cno":"434\/249-1115","email":"","ename":"","eno":"","pphy":"CURRY, MATTHEW MD","ppno":"434\/924-5348","pcpadd":"1221 LEE ST","pcpcity":"CHARLOTTESVILLE","pcpstate":"VA","pcpzip":22908,"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":["NO DATA","R13.10","L03.90","L28.1","R14.0","K21.9","V58.89","M25.512","M54.2","S29.012A","U07.1","R05.","G43.411","K21.0","S39.012A","Z23.","N95.0","F41.8","G43.109","R10.2","M54.41","M54.42","G89.29","E53.8","D50.0","R20.0","G43.709","R20.2","F41.1","G43.419","L65.0","K80.20","N20.0","F43.9","L29.9","R25.2","G93.3","M72.2","B95.8","R10.13","K31.7","K31.89","K29.40","R21.","Z11.59","R10.11","K29.50","K22.8","R12.","Z01.810","Z20.822","K76.0","K80.21","F33.1","R50.9","R19.7","M54.9","S16.1XXA","M79.652","Z00.00","G43.101","K80.10","J02.9","F41.9","R87.613","E78.2","E55.9","G43.C0","Z12.39","R10.84","Z78.0","N93.9","F43.0","G43.809","F43.12","L70.0","L81.0","L73.9","Z63.79","R07.0","Z88.9","L50.9","R42.","R41.0","R53.83","G44.89","R51.","R68.89","B86.","Z91.89","R53.1","E78.5","M54.5","F43.10","F43.21","R87.612","R56.9","L70.5","J11.1","R06.02","M79.671","L85.3","E66.9","M79.672","Z68.31","K29.90","R11.2","R10.9","R05.8","Z86.16","M79.642","M50.31","M47.812","M79.602","Z12.11","R31.21","D72.829","G89.4","R30.0","R05.2"],"date":["2022-05-06","2021-11-11","2021-03-25","2021-10-22","2021-10-19","2021-12-16","2022-05-06","2021-08-30","2021-08-30","2021-08-30","2021-09-12","2021-09-12","2020-02-10","2020-07-27","2020-11-17","2022-07-19","2020-12-24","2020-11-17","2021-03-02","2020-11-17","2020-11-17","2022-07-19","2022-07-19","2021-01-19","2021-01-19","2022-07-28","2021-03-16","2022-07-28","2021-08-11","2021-12-06","2021-12-06","2020-02-07","2020-06-24","2021-10-19","2021-06-07","2021-06-29","2021-10-19","2022-03-24","2021-10-22","2022-07-19","2021-12-03","2021-12-03","2021-12-16","2020-01-27","2020-05-12","2020-11-02","2020-09-01","2020-05-21","2020-05-21","2020-02-07","2022-08-24","2020-09-01","2020-02-11","2020-02-11","2020-06-02","2020-06-02","2021-03-16","2021-03-16","2021-09-03","2021-10-19","2020-02-10","2020-03-11","2020-04-28","2020-04-28","2020-01-14","2020-01-14","2020-09-01","2020-09-01","2020-09-01","2020-11-02","2020-11-02","2019-08-21","2019-06-19","2019-08-29","2019-01-10","2019-03-05","2019-06-07","2019-08-21","2019-08-21","2019-08-21","2019-09-05","2019-09-05","2019-10-23","2019-06-24","2019-06-24","2019-06-24","2019-10-03","2019-10-18","2019-07-02","2019-07-02","2019-10-07","2019-11-06","2019-01-07","2019-01-10","2019-03-12","2019-03-27","2019-10-18","2019-06-07","2019-02-12","2019-02-12","2022-05-06","2022-03-24","2022-03-24","2022-07-19","2022-03-24","2022-06-29","2022-07-20","2022-06-29","2022-10-05","2022-10-05","2022-07-28","2022-07-19","2022-07-19","2022-07-19","2022-07-19","2022-07-19","2022-07-19","2022-05-06","2022-09-19","2022-09-19"],"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":[["","00536117201","ACETAMIN","TAB 500MG","60","Select","Select",""],["","45802065078","LORATADINE","TAB 10MG","30","Select","Select",""],["","55111015810","OMEPRAZOLE","CAP 20MG","30","Select","Select",""],["","51645091401","VITAMIN","TAB 1000MCG","30","Select","Select",""],["","45802004064","SELENIUM","LOT 0.025","120","Select","Select",""],["","57896010210","ACETAMINOPHE","TAB 325MG","120","Select","Select",""],["","65162006205","SUCRALFATE","SUS 1GM\/10ML","420","Select","Select",""],["","55111018015","TIZANIDINE","TAB 4MG","12","Select","Select",""],["","59267102504","PFIZER","INJ ADLT RTU","0","Select","Select",""],["","49884093547","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","57237007530","ONDANSETRON","TAB 4MG","30","Select","Select",""],["","67877057305","BENZONATATE","CAP 100MG","20","Select","Select",""],["","58657050508","GG\/DM","SYP 100-10\/5","237","Select","Select",""],["","65862052730","VENLAFAXINE","CAP 37.5 ER","90","Select","Select",""],["","63948016843","RIBOFLAVIN","TAB 400MG","30","Select","Select",""],["","69097083305","SERTRALINE","TAB 25MG","30","Select","Select",""],["","45802056202","CLINDAMYCIN","SOL 0.01","60","Select","Select",""],["","","ZONISAMIDE","CAP 25MG","","Select","Select",""],["","60258017101","MAG","TAB 400MG","90","Select","Select",""],["","","FAMOTIDINE","TAB 40MG","","Select","Select",""],["","","PANTOPRAZOLE","TAB 40MG","","Select","Select",""],["","54629409760","NAC","CAP 600MG","60","Select","Select",""],["","67877021905","CEPHALEXIN","CAP 500MG","28","Select","Select",""],["","00093117701","NEOMYCIN","TAB 500MG","28","Select","Select",""],["","","CLOBETASOL","OIN 0.0005","","Select","Select",""],["","65649030302","XIFAXAN","TAB 550MG","42","Select","Select",""],["","65162019010","NAPROXEN","TAB 500MG","30","Select","Select",""],["","51672136606","CLINDAMY\/BEN","GEL 1.2-5%","45","Select","Select",""],["","00168014630","HYDROCORT","OIN 0.025","28","Select","Select",""],["","68382013814","TOPIRAMATE","TAB 25MG","120","Select","Select",""],["","","ESOMEPRA","CAP 40MG DR","","Select","Select",""],["","","OXYCODONE","TAB 5MG","","Select","Select",""],["","70377002711","ATORVASTATIN","TAB 10MG","30","Select","Select",""],["","59779097547","PAIN","TAB 500MG","60","Select","Select",""],["","","GAVISCON","SUS ","","Select","Select",""],["","00004080085","TAMIFLU","CAP 75MG","1","Select","Select",""],["","70710101002","OSELTAMIVIR","CAP 75MG","10","Select","Select",""],["","00023869450","AZELEX","CRE 0.2","50","Select","Select",""],["","50428005345","B-12","TAB 500MCG","90","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","20","Select","Select",""],["","16729020001","BUSPIRONE","TAB 5MG","120","Select","Select",""],["","55111029209","SUMATRIPTAN","TAB 50MG","4","Select","Select",""],["","70710122600","AMITRIPTYLIN","TAB 25MG","30","Select","Select",""],["","45802026937","PERMETHRIN","CRE 0.05","60","Select","Select",""],["","67877025145","TRIAMCINOLON","CRE 0.001","60","Select","Select",""],["","00904530660","BANOPHEN","CAP 25MG","30","Select","Select",""],["","64380080307","RANITIDINE","TAB 150MG","60","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":""}]}]}