{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   AIVLYSYELGDAB J","gend":1,"add":" YSTEB 244DAOR LLEB","city":"STAUNTON","state":"VA","zip":"24401-9998","dob":"1960-03-28","age":"","mstatus":"","insh":"43200210*31","cliId":"","pno":"74\/0459901-1","cno":"540\/471-1099","email":"","ename":"","eno":"","pphy":"REID, JAMES R MD","ppno":"540\/942-1200","pcpadd":"UVA PRIMARY CARE WAYNESBORO 1850 RO","pcpcity":"WAYNESBORO","pcpstate":"VA","pcpzip":22980,"pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"WESTERN\/ CHARLOTTESVILLE","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":["I42.9","I50.22","M99.00","R32.","N31.9","N17.9","NO DATA","I12.9","E87.5","D64.9","I10.","I49.5","V54.11","F33.42","H25.13","H40.013","H04.123","D31.32","M25.511","Z96.611","Z48.89","M25.611","M62.81","M25.411","M25.512","U07.1","Z09.","Z96.612","Z47.1","M25.532","J01.01","J30.1","M17.0","J34.2","Z95.810","M24.811","Z01.810","D50.8","I51.7","I51.9","T84.028A","E03.9","K21.9","M19.90","Z87.01","Z23.","I42.8","I80.02","Z86.718","Z79.82","Z79.899","Z79.891","Z88.6","Z88.1","Z88.3","Z91.030","Z91.040","Z88.5","Z88.0","Z88.2","Z88.8","Z91.048","S42.242P","I13.0","I50.20","N18.4","E28.2","E89.0","G89.29","F32.9","F41.9","E66.01","Z48.01","I80.3","I87.2","M79.604","M79.605","R73.9","E78.2","R26.89","M70.41","M70.42","M25.561","M25.562","R53.1","R06.02","M77.11","S00.461A","F51.01","G89.18","M25.9","M15.9","N18.9","E55.9","R22.43","N18.3","E79.0","N06.8","L03.313","F11.90","J34.3","D63.1","S42.291P","R26.2","I25.5","I49.9","M89.49","M54.5","M79.7","F41.8","L98.9","E78.5","J01.10","I49.3","V54.12","M54.9","V58.89","J18.9","Z96.619","M25.572","M79.89","B02.29","Z01.818","R63.5","Z95.0","R05.9","J02.9","R09.81","R50.9","R09.89","Z20.822","M25.50","G89.4","W18.30XA","M75.82","M79.662","Z68.42","M10.9","D53.9","Z79.890","J20.9","R19.7","E53.8","Z98.84","M87.021","M19.011","S42.202D","M19.111","G56.02","J40.","R06.00","R10.9","K83.1","L60.8"],"date":["2021-04-05","2021-11-04","2022-10-11","2022-10-03","2022-10-03","2020-10-14","2022-05-12","2021-09-15","2021-08-04","2021-08-02","2022-09-01","2022-02-22","2021-11-04","2021-09-07","2021-10-20","2021-10-20","2021-10-20","2021-10-20","2021-11-29","2021-11-29","2021-11-29","2021-11-29","2021-11-29","2021-11-29","2021-11-29","2022-08-11","2020-06-18","2020-07-02","2021-08-23","2021-09-20","2020-10-29","2020-07-22","2021-07-06","2021-03-29","2021-08-16","2021-03-04","2021-08-16","2021-08-02","2021-06-30","2021-06-30","2021-09-15","2021-09-15","2021-09-15","2021-09-15","2021-09-15","2021-12-31","2022-06-13","2020-07-02","2020-01-27","2020-02-26","2020-01-27","2020-01-27","2020-01-27","2020-01-27","2020-01-27","2020-01-27","2020-01-27","2020-01-27","2020-01-27","2020-01-27","2020-01-27","2020-01-27","2020-07-02","2021-08-23","2020-07-02","2021-08-04","2020-07-02","2021-08-23","2021-07-06","2020-07-02","2020-07-02","2021-08-23","2020-07-02","2020-06-01","2020-03-30","2020-04-22","2020-04-01","2020-03-30","2020-11-04","2020-06-01","2020-06-01","2020-06-01","2020-06-01","2020-06-01","2020-06-01","2021-10-27","2021-11-04","2021-06-22","2021-06-22","2021-09-15","2020-01-23","2020-01-23","2020-01-23","2020-01-23","2020-04-01","2020-09-01","2020-09-01","2021-08-04","2020-12-28","2021-07-06","2021-03-29","2021-08-23","2021-08-11","2021-08-23","2021-08-23","2021-08-23","2021-08-23","2021-08-23","2021-08-23","2021-08-23","2020-02-10","2020-05-06","2020-06-22","2021-08-12","2021-09-20","2021-11-04","2022-04-21","2021-11-04","2022-04-21","2020-02-05","2020-02-05","2022-05-12","2021-09-14","2021-10-27","2021-10-27","2022-04-21","2022-08-08","2022-02-07","2022-08-08","2022-08-08","2022-08-08","2020-01-07","2020-03-04","2020-01-13","2020-01-13","2020-01-27","2020-02-26","2020-02-26","2020-02-26","2020-02-26","2020-03-04","2020-03-16","2020-03-16","2020-03-16","2021-06-03","2021-06-03","2021-07-06","2021-08-12","2021-09-20","2021-12-27","2021-12-27","2020-04-22","2020-04-22","2020-04-22"],"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":[]},{"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":[["","65862053820","LEVOFLOXACIN","TAB 750MG","5","Select","Select",""],["","64380071206","BENZONATATE","CAP 100MG","30","Select","Select",""],["","52817033200","CYCLOBENZAPR","TAB 10MG","90","Select","Select",""],["","21922000909","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","68180096903","LEVOTHYROXIN","TAB 100MCG","30","Select","Select",""],["","29300024605","BUSPIRONE","TAB 15MG","180","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","69452015120","VITAMIN","CAP 50000UNT","1","Select","Select",""],["","31722071310","PANTOPRAZOLE","TAB 40MG","60","Select","Select",""],["","68382009405","CARVEDILOL","TAB 12.5MG","60","Select","Select",""],["","45802091987","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","29300034901","ALLOPURINOL","TAB 100MG","30","Select","Select",""],["","69452020720","CALCITRIOL","CAP 0.25MCG","15","Select","Select",""],["","68001033203","LISINOPRIL","TAB 2.5MG","30","Select","Select",""],["","31722077690","SILDENAFIL","TAB 20MG","90","Select","Select",""],["","00591315901","URSODIOL","CAP 300MG","60","Select","Select",""],["","69315011710","FUROSEMIDE","TAB 40MG","60","Select","Select",""],["","00406055201","OXYCODONE","TAB 5MG","120","Select","Select",""],["","69315012710","FOLIC","TAB 1000MCG","30","Select","Select",""],["","31722058160","DULOXETINE","CAP 20MG","120","Select","Select",""],["","57237007530","ONDANSETRON","TAB 4MG","20","Select","Select",""],["","45802011222","MUPIROCIN","OIN 0.02","22","Select","Select",""],["","33342002607","FAMCICLOVIR","TAB 500MG","21","Select","Select",""],["","00093506110","HYDROXYZ","TAB 25MG","100","Select","Select",""],["","45802010901","TRIAMCINOLON","AER 55MCG\/AC","17","Select","Select",""],["","50228035090","PREGABALIN","CAP 25MG","30","Select","Select",""],["","64380078508","PREDNISONE","TAB 20MG","5","Select","Select",""],["","00603188016","LIDOCAINE","PAD 0.05","60","Select","Select",""],["","00143211205","DOXYCYCL","TAB 100MG","20","Select","Select",""],["","63824000832","MUCINEX","TAB 600MG ER","30","Select","Select",""],["","46122002858","GNP","TAB 600MG","28","Select","Select",""],["","00173069600","ADVAIR","AER 250\/50","60","Select","Select",""],["","68001025317","FLUCONAZOLE","TAB 150MG","1","Select","Select",""],["","00054074287","ALBUTEROL","AER HFA","7","Select","Select",""],["","68001043800","LORATADINE","TAB 10MG","90","Select","Select",""],["","00574402235","BACITRACIN","OIN OP","4","Select","Select",""],["","61314062810","POLYMYXIN","SOL TRIMETHP","10","Select","Select",""],["","00093751831","FLUTIC\/SALME","AER 250\/50","60","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","65162062750","TRAMADOL","TAB 50MG","40","Select","Select",""],["","00003089321","ELIQUIS","TAB 2.5MG","28","Select","Select",""],["","57896048914","POLYETH","POW 3350 NF","238","Select","Select",""],["","69618001001","ACETAMIN","TAB 325MG","60","Select","Select",""],["","00406324301","HYDROMORPHON","TAB 2MG","20","Select","Select",""],["","57896098110","ASPIRIN","TAB 81MG EC","28","Select","Select",""],["","43598016430","OLANZAPINE","TAB 5MG","30","Select","Select",""],["","70710128505","BACLOFEN","TAB 10MG","135","Select","Select",""],["","68001039800","FAMOTIDINE","TAB 40MG","30","Select","Select",""],["","00904645780","DOK","CAP 100MG","30","Select","Select",""],["","64380080307","RANITIDINE","TAB 150MG","30","Select","Select",""],["","00378108693","COLCHICINE","TAB 0.6MG","5","Select","Select",""],["","29300022010","MONTELUKAST","TAB 10MG","90","Select","Select",""],["","00378515091","NIZATIDINE","CAP 150MG","30","Select","Select",""],["","68001000501","METHYLPRED","TAB 4MG","21","Select","Select",""],["","63481068447","VOLTAREN","GEL 0.01","100","Select","Select",""],["","63304061650","DOXYCYC","CAP 100MG","20","Select","Select",""],["","46122038576","24","SPR ALLERGY","17","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":""}]}]}