{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"  SEMAJELAH R ","gend":0,"add":"XOB OP4286 ","city":"CHARLOTTESVILLE","state":"VA","zip":"22906-9998","dob":"1964-10-02","age":"","mstatus":"","insh":"48200210*04","cliId":"","pno":"08\/4343958-6","cno":"","email":"","ename":"","eno":"","pphy":"HELENIUS, IRA M MD","ppno":"434\/924-1931","pcpadd":"1222 JEFFERSON PARK AVE 3RD FLOOR","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":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G47.33","J43.9","J45.998","E11.9","M25.561","G89.29","L40.9","L98.9","H02.831","H25.13","H52.03","H02.834","H52.4","E78.00","E87.5","F11.90","Z68.36","J42.","J44.9","J98.4","E53.8","R21.","Z79.899","L60.3","L57.0","L30.8","H52.203","K42.9","M17.11","M54.5","E66.01","J30.1","Z87.891","I10.","Z68.41","M10.9","K45.8","F32.9","E78.5","B35.1","R79.89","M25.511","J43.8","F63.81","F41.9","K29.70","Z00.00","R06.02","L82.0"],"date":["2021-09-16","2021-05-10","2021-05-10","2021-09-16","2021-09-16","2021-09-16","2021-03-11","2021-02-05","2021-05-13","2021-05-13","2021-05-13","2021-05-13","2021-05-13","2021-09-16","2021-09-16","2021-09-16","2021-09-16","2021-09-16","2021-12-22","2021-12-22","2021-06-03","2020-11-18","2020-01-08","2020-02-05","2020-11-18","2019-05-16","2019-09-18","2021-10-08","2020-01-16","2020-01-16","2020-01-24","2020-01-16","2020-04-20","2020-01-24","2020-01-24","2021-06-03","2021-08-06","2019-04-25","2019-07-05","2021-01-06","2019-11-21","2021-03-11","2021-06-03","2021-03-11","2021-06-03","2021-06-03","2019-06-25","2020-04-20","2020-11-18"],"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":[["","","METFORMIN","TAB 500MG ER","","Select","Select",""],["","","FEXOFENADINE"," FEXOFENADINE ","30","Select","Select",""],["","","OXYCOD\/APAP","TAB 5-325MG","","Select","Select",""],["","45802070000","TACROLIMUS","OIN 0.001","30","Select","Select",""],["","","ALLOPURINOL","TAB 100MG","","Select","Select",""],["","","SYMBICORT"," SYMBICORT ","10","Select","Select",""],["","68462019005","NAPROXEN","TAB 500MG","60","Select","Select",""],["","","SPIRIVA"," SPIRIVA ","4","Select","Select",""],["","","PROAIR"," PROAIR ","8","Select","Select",""],["","","CYANOCOBALAM"," CYANOCOBALAM ","10","Select","Select",""],["","00781223410","OMEPRAZOLE","CAP 40MG","30","Select","Select",""],["","66993087761","CALCIPOTRIEN","CRE 0.00005","60","Select","Select",""],["","","LISINOPRIL","TAB 10MG","","Select","Select",""],["","70000036105","24HR","TAB 180MG","30","Select","Select",""],["","","ATORVASTATIN"," ATORVASTATIN ","30","Select","Select",""],["","59267100002","PFIZER","INJ COVID-19","0","Select","Select",""],["","08290309571","3ML","MIS 23GX1\"","50","Select","Select",""],["","","BUSPIRONE"," BUSPIRONE ","60","Select","Select",""],["","","VENLAFAXINE"," VENLAFAXINE ","30","Select","Select",""],["","","BUDES\/FORMOT","AER 160-4.5","","Select","Select",""],["","","COLCHICINE","TAB 0.6MG","","Select","Select",""],["","45802005535","TRIAMCINOLON","OIN 0.001","30","Select","Select",""],["","68682011102","PIMECROLIMUS","CRE 0.01","60","Select","Select",""],["","70461032103","FLUCLVX","INJ 2021-22","0","Select","Select",""],["","00187510102","ELIDEL","CRE 0.01","60","Select","Select",""],["","","MELOXICAM","TAB 7.5MG","","Select","Select",""],["","","COLCRYS","TAB 0.6MG","","Select","Select",""],["","","AUG","OIN 0.0005","","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":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["","1"],"comment":["",""],"sub":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"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":""}]}]}