{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"  ATTENAVECIRP M ","gend":1,"add":" EERHT 1531DAOR TPOHC","city":"KENTS STORE","state":"VA","zip":"23084-9998","dob":"1963-05-21","age":"","mstatus":"","insh":"63300210*52","cliId":"","pno":"35\/4345239-1","cno":"434\/202-9304","email":"","ename":"","eno":"","pphy":"LYONS, ELIZABETH A MD","ppno":"434\/924-2472","pcpadd":"415 RAY C HUNT DR STE 2100","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":["M25.531","M65.332","R07.9","R06.02","R06.2","R77.8","J81.0","F32.9","B20.","F14.21","U07.1","J96.01","J81.1","I50.9","I50.32","Z20.822","I10.","R79.89","Z53.29","M77.01","G56.21","F19.10","G89.29","R11.0","Z23.","I50.21","Z95.5","I50.30","E87.6","V62.84","NO DATA","J45.909","I25.10","I25.2","F17.210","I11.0","F14.10","R45.1","R74.8","J30.9","E78.5","R06.00","F41.9","R00.0","R63.4","M51.37","R26.81","R26.2","M79.604","F33.1","F19.20","M79.605","F31.9","J44.9","F41.8","Z72.0","Z98.890","Z47.89","Z48.89","M54.5","R06.82","I25.5","Z66.","J44.0","B37.0","F14.20","F10.10","I16.0","Z21.","B36.9","B39.9","I08.3","I31.3","R07.81","R05.","R73.9","J84.10","R93.89","I49.1","J30.2","M79.2","I50.33","Z09.","K59.00","Z86.16","R20.2","F34.1","R06.89","H65.01","F14.23","R06.03","F14.24","Z88.5","Z90.710","Z90.722","R54.","M25.512","M25.552","G61.82","F14.259","Z00.00","M79.601","Z02.89","M65.30","K62.89","M24.131","M77.8","S63.591A","Z01.419","K62.82","M85.88","Z87.411","Z87.412","F33.41","Z79.899","R06.9","R45.7","D01.3","M79.641","H40.033","H52.7","H40.003","H04.123","I34.0","I51.7","R50.9","I50.23","I25.83","H93.8X1","I25.810","Z87.09","I42.9","I51.9","R59.1","F17.200","F19.90","Z53.21","G56.01","G62.89","G56.22","M79.642","R20.0","D64.9","Z11.3","J98.01","H83.8X1","R05.9","H92.01","I21.4","R59.0","Z86.79","R65.10","M25.551","I50.20","R06.09","M79.89","Z91.14"],"date":["2022-05-16","2020-06-18","2022-09-03","2022-10-14","2021-02-21","2022-01-07","2022-10-11","2021-08-02","2022-10-14","2021-06-23","2021-08-16","2021-08-10","2021-08-06","2022-10-14","2022-10-25","2022-09-12","2022-10-14","2022-01-07","2022-01-04","2020-06-10","2022-10-14","2022-04-14","2022-07-13","2020-08-10","2022-10-25","2021-06-14","2022-04-20","2021-07-10","2022-04-15","2021-07-10","2022-09-12","2021-07-10","2022-10-14","2022-09-03","2022-10-11","2022-09-03","2022-01-07","2021-07-11","2021-07-11","2021-08-02","2021-08-02","2022-01-06","2022-10-25","2022-10-11","2021-06-09","2021-06-15","2021-06-15","2021-06-15","2021-12-16","2022-10-14","2021-12-16","2021-12-16","2021-06-23","2022-10-14","2022-04-14","2022-10-25","2022-02-14","2020-01-09","2020-01-09","2021-08-25","2021-08-06","2021-06-11","2021-08-06","2021-08-06","2021-08-06","2021-08-06","2021-08-06","2021-08-06","2022-10-11","2021-08-06","2021-08-06","2021-08-14","2021-08-14","2021-02-23","2021-02-23","2021-02-23","2021-02-23","2021-02-23","2021-06-10","2021-06-10","2021-06-10","2021-06-15","2021-08-25","2021-08-25","2021-08-25","2020-03-17","2020-08-21","2021-08-06","2021-05-13","2021-06-10","2021-06-10","2021-06-12","2021-06-10","2021-06-10","2021-06-10","2021-08-28","2020-08-06","2020-08-06","2020-10-22","2021-06-12","2021-08-02","2022-05-16","2019-11-08","2019-11-08","2019-11-08","2019-12-09","2019-12-09","2019-12-26","2019-08-20","2019-08-20","2019-08-20","2019-08-20","2019-08-20","2019-05-21","2022-04-14","2021-08-06","2021-08-06","2019-01-08","2019-12-30","2019-09-27","2019-09-27","2019-09-27","2019-09-27","2022-04-15","2022-01-05","2022-02-16","2022-10-14","2022-04-20","2022-05-30","2022-01-06","2022-01-07","2022-01-07","2022-01-07","2022-10-25","2022-10-14","2022-10-14","2022-01-03","2022-05-16","2022-05-16","2022-05-16","2022-07-13","2022-07-13","2022-04-15","2022-10-11","2022-09-12","2022-05-30","2022-05-30","2022-05-30","2022-01-05","2022-04-14","2022-10-11","2022-02-21","2022-02-21","2022-10-11","2022-10-25","2022-10-11","2022-10-11"],"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":[["","61958250101","BIKTARVY","TAB ","30","Select","Select",""],["","","GABAPENTIN","CAP 300MG","","Select","Select",""],["","","ASPIRIN","CHW 81MG","","Select","Select",""],["","00173069600","ADVAIR","AER 250\/50","60","Select","Select",""],["","69315011610","FUROSEMIDE","TAB 20MG","60","Select","Select",""],["","68462010530","ONDANSETRON","TAB 4MG","30","Select","Select",""],["","50111043301","TRAZODONE","TAB 50MG","30","Select","Select",""],["","53746051110","SPIRONOLACT","TAB 25MG","30","Select","Select",""],["","70377000812","ROSUVASTATIN","TAB 20MG","90","Select","Select",""],["","65162004710","OXYCODONE","TAB 5MG","10","Select","Select",""],["","51991074790","DULOXETINE","CAP 30MG","60","Select","Select",""],["","65862049101","QUETIAPINE","TAB 100MG","30","Select","Select",""],["","67877057305","BENZONATATE","CAP 100MG","40","Select","Select",""],["","45802057178","FEXOFENADINE","TAB 180MG","30","Select","Select",""],["","68180098103","LISINOPRIL","TAB 20MG","30","Select","Select",""],["","69452015120","VITAMIN","CAP 50000UNT","4","Select","Select",""],["","00603188016","LIDOCAINE","PAD 0.05","30","Select","Select",""],["","68382009405","CARVEDILOL","TAB 12.5MG","60","Select","Select",""],["","00832532511","POT  CL MICRO","TAB 20MEQ ER","180","Select","Select",""],["","69238131109","PREGABALIN","CAP 50MG","100","Select","Select",""],["","13107000130","MIRTAZAPINE","TAB 7.5MG","30","Select","Select",""],["","66993058597","FLUTIC\/SALME","AER 250\/50","60","Select","Select",""],["","16729008110","NALTREXONE","TAB 50MG","90","Select","Select",""],["","68382039801","POT  CHLORIDE","TAB 20MEQ ER","30","Select","Select",""],["","00597007541","SPIRIVA","CAP HANDIHLR","90","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","20","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","","PROCTO-MED","CRE HC 2.5%","","Select","Select",""],["","68382065005","ISOSORB","TAB 30MG ER","90","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","10631040701","PROCTOSOL","CRE 0.025","28","Select","Select",""],["","10702000709","CYCLOBENZAPR","TAB 10MG","45","Select","Select",""],["","50383058716","NYSTATIN","SUS 100000","750","Select","Select",""],["","07610015832","CA","TAB 315\/200","60","Select","Select",""],["","00555032304","HYDROXYZ","CAP 25MG","120","Select","Select",""],["","49483034010","ACETAMIN","TAB 325MG","90","Select","Select",""],["","00078077720","ENTRESTO","TAB 49-51MG","60","Select","Select",""],["","00310621030","FARXIGA","TAB 10MG","30","Select","Select",""],["","00093216568","NALOXONE","SPR ","2","Select","Select",""],["","70710160901","BACLOFEN","TAB 5MG","30","Select","Select",""],["","43598044828","NICOTINE","DIS 21MG\/24H","28","Select","Select",""],["","00597015290","JARDIANCE","TAB 10MG","30","Select","Select",""],["","23155000810","HYDROCHLOROT","TAB 25MG","30","Select","Select",""],["","59746017509","PREDNISONE","TAB 20MG","8","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","50428037837","CVS","TAB 8.6-50MG","60","Select","Select",""],["","00143211205","DOXYCYCL","TAB 100MG","14","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","00781194339","AMOX-POT","TAB ER","14","Select","Select",""],["","00093738656","VENLAFAXINE","CAP 150MG ER","30","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","10","Select","Select",""],["","","POLYETH","POW 3350 NF","","Select","Select",""],["","00574705012","BISACODYL","SUP 10MG","30","Select","Select",""],["","00406051201","OXYCOD\/APAP","TAB 5-325MG","93","Select","Select",""],["","65862085901","FAMOTIDINE","TAB 20MG","60","Select","Select",""],["","00054414622","CLOTRIMAZOLE","TRO 10MG","70","Select","Select",""],["","","PENICILLN","TAB 500MG","","Select","Select",""],["","67877032105","IBUPROFEN","TAB 800MG","30","Select","Select",""],["","43199003701","LABETALOL","TAB 100MG","60","Select","Select",""],["","","CHLORTHALID","TAB 25MG","","Select","Select",""],["","00527145006","DRONABINOL","CAP 2.5MG","60","Select","Select",""],["","00071101668","LYRICA","CAP 150MG","120","Select","Select",""],["","00378025701","HALOPERIDOL","TAB 1MG","15","Select","Select",""],["","59779016218","SENNA","TAB 8.6-50MG","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":""}]}]}