{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"S   YHTAKNAMTRAH ","gend":1,"add":" TPA AZALP 71511 TPA EVIRD","city":"STAUNTON","state":"VA","zip":"24401-9998","dob":"1964-07-04","age":"","mstatus":"","insh":"88200210*51","cliId":"","pno":"86\/0456656-8","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":["F39.","F50.81","M25.511","M62.81","V58.89","F10.10","Z76.89","M54.5","J44.9","I10.","E03.9","K21.9","G47.00","F32.9","R01.1","S49.91XA","E66.01","J45.901","R05.","S89.91XA","S89.92XA","S99.921A","W19.XXXA","Z72.0","R52.","M75.41","S82.021A","R63.2","Z79.899","F41.8","F34.9","S40.011A","S40.021A","I35.0","F17.200","R06.2","S33.5XXA","R87.619","R87.810","F51.01","J30.2","E66.9","R06.02","J01.90","M54.2","R87.610","M80.08XS","E78.5","Z11.4","Z12.31","Z78.0","R05.9","I35.2","I51.7","I34.0","M47.896","Z98.890","Z51.81","NO DATA","R60.0","M75.42","M80.00XS","F33.9","G89.29","S32.000A"],"date":["2021-08-24","2022-10-19","2020-02-13","2020-02-13","2020-02-13","2021-02-19","2020-10-15","2021-02-19","2022-03-10","2022-10-12","2022-06-30","2022-06-30","2021-02-19","2021-02-19","2021-02-19","2022-06-14","2020-01-23","2020-02-21","2020-03-12","2020-08-27","2020-08-27","2020-08-27","2020-08-27","2022-03-10","2022-06-30","2022-06-14","2020-10-07","2021-02-18","2022-10-19","2021-04-01","2022-10-19","2020-01-15","2020-01-15","2022-10-12","2022-10-12","2020-11-30","2019-04-16","2019-10-15","2019-10-15","2019-07-11","2022-03-10","2019-07-11","2019-07-11","2019-07-11","2019-07-11","2019-07-11","2022-08-11","2022-06-30","2022-06-30","2022-06-30","2022-06-30","2022-06-30","2022-10-07","2022-10-07","2022-10-07","2022-03-14","2022-03-14","2022-03-14","2022-06-06","2022-10-12","2022-06-14","2022-08-11","2022-03-10","2022-06-06","2022-06-06"],"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":[["","65862019405","FLUOXETINE","CAP 40MG","90","Select","Select",""],["","69097012403","TOPIRAMATE","TAB 100MG","60","Select","Select",""],["","68382003616","VENLAFAXINE","CAP 150MG ER","30","Select","Select",""],["","","CETIRIZINE"," CETIRIZINE ","30","Select","Select",""],["","","APAP\/CODEINE","TAB 300-30MG","","Select","Select",""],["","00088165475","OS-CAL","TAB 500-200","90","Select","Select",""],["","00591565810","CYCLOBENZAPR","TAB 10MG","12","Select","Select",""],["","00597007541","SPIRIVA","CAP HANDIHLR","90","Select","Select",""],["","","AMLODIPINE"," AMLODIPINE ","30","Select","Select",""],["","13668019030","TOLTERODINE","CAP 4MG ER","30","Select","Select",""],["","57896074201","CALCIUM\/D","TAB 500MG","30","Select","Select",""],["","80681016800","VITAMIN","TAB 25MCG","60","Select","Select",""],["","00093310905","AMOXICILLIN","CAP 500MG","21","Select","Select",""],["","","PREDNISONE","TAB 50MG","","Select","Select",""],["","","IBUPROFEN","TAB 600MG","","Select","Select",""],["","","ARIPIPRAZOLE"," ARIPIPRAZOLE ","60","Select","Select",""],["","00116200116","CHLORHEX","SOL 0.0012","473","Select","Select",""],["","","LEVOTHYROXIN"," LEVOTHYROXIN ","30","Select","Select",""],["","","PROAIR"," PROAIR ","8","Select","Select",""],["","00169413212","OZEMPIC","INJ 2\/1.5ML","2","Select","Select",""],["","","FLOVENT"," FLOVENT ","12","Select","Select",""],["","","TRAZODONE"," TRAZODONE ","20","Select","Select",""],["","","MONTELUKAST"," MONTELUKAST ","30","Select","Select",""],["","65862022801","LAMOTRIGINE","TAB 100MG","90","Select","Select",""],["","","LISINOPRIL"," LISINOPRIL ","90","Select","Select",""],["","65862032904","ALENDRONATE","TAB 70MG","4","Select","Select",""],["","70377002911","ATORVASTATIN","TAB 40MG","30","Select","Select",""],["","70954000520","OXYBUTYNIN","TAB 5MG","60","Select","Select",""],["","","PANTOPRAZOLE"," PANTOPRAZOLE ","30","Select","Select",""],["","00904546080","OYST","TAB 500MG","30","Select","Select",""],["","43547040111","FUROSEMIDE","TAB 20MG","30","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","51991074790","DULOXETINE","CAP 30MG","270","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","69097015907","MELOXICAM","TAB 15MG","30","Select","Select",""],["","13668013601","ESCITALOPRAM","TAB 10MG","30","Select","Select",""],["","","CVS","CRE 0.04","","Select","Select",""],["","","NAPROXEN","TAB 500MG","","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","48","Select","Select",""],["","00832105410","BACLOFEN","TAB 10MG","90","Select","Select",""],["","60505384801","CELECOXIB","CAP 100MG","60","Select","Select",""],["","","DOXYCYCL","CAP 100MG","","Select","Select",""],["","","CODEINE\/GG","SOL 10-100\/5","","Select","Select",""],["","24208039830","IPRATROPIUM","SPR 0.0003","90","Select","Select",""],["","","HYDROCO\/APAP","TAB 5-325MG","","Select","Select",""],["","","ALLERGY","TAB 10MG","","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":""}]}]}