{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" ENIDRANREBREPSAJ M  ","gend":1,"add":"XOB OP1811 ","city":"LOUISA","state":"VA","zip":"23093-9998","dob":"1972-06-12","age":"","mstatus":"","insh":"89200210*24","cliId":"","pno":"88\/4345977-2","cno":"","email":"","ename":"","eno":"","pphy":"RHEA, CARRIELYN A NP","ppno":"540\/967-2011","pcpadd":"575 INDUSTRIAL AVE BOX 947","pcpcity":"LOUISA","pcpstate":"VA","pcpzip":23093,"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":["Z01.419","N94.10","D50.0","E55.9","Z98.84","E53.8","E50.9","G47.33","F32.0","J01.00","R05.8","R52.","U07.1","H66.002","J45.909","J02.9","H66.003","J30.89","R09.82","E03.9","Z12.39","I67.9","R51.9","M79.2","M54.16","M47.816","M62.838","M50.30","M43.12","M54.5","NO DATA","R19.7","J02.0","R11.0","G43.709","R05.","B36.0","L03.311","G43.101","E66.01","R53.83","M54.2","M54.41","Z48.89","Z98.890","H40.023","T83.32XA","R68.89","L29.9","M79.89","T45.4X5A","Z01.818","K21.9","I10.","R51.","R93.0","E23.6","Z85.850","E03.8","N93.8","D50.9","E78.2","F41.8","Z90.710","D72.819","N89.8","S86.912A","G43.009","G93.2","N92.1","N84.0","Z30.430","S89.92XA","E66.9","J20.9","T78.40XA","R22.43","R22.33","C73.","V58.89","M25.511","M25.519","S49.91XA","M25.561","M25.571","M79.671","G89.29","Z23."],"date":["2020-06-08","2020-06-08","2022-09-29","2022-04-25","2022-09-29","2022-09-29","2022-04-25","2021-08-20","2022-09-29","2021-10-20","2021-10-20","2021-10-20","2021-10-26","2021-10-26","2021-10-26","2020-04-20","2020-04-20","2020-04-20","2020-04-20","2022-09-29","2020-06-08","2021-02-09","2022-07-25","2021-02-09","2021-05-25","2021-10-13","2021-10-13","2021-05-25","2021-05-25","2021-05-25","2021-12-20","2020-02-29","2020-02-29","2020-02-29","2020-06-02","2020-01-11","2020-05-27","2020-05-27","2020-07-07","2021-02-04","2022-04-25","2022-06-03","2022-02-16","2019-04-12","2019-05-14","2019-11-20","2019-01-31","2019-03-23","2019-04-09","2019-10-22","2019-04-08","2019-01-09","2019-01-09","2019-10-22","2019-08-15","2019-03-29","2019-05-14","2019-05-14","2019-05-14","2019-03-06","2019-05-22","2019-05-14","2019-05-14","2019-05-14","2019-05-22","2019-06-27","2019-10-22","2019-02-27","2022-07-25","2019-06-27","2019-01-10","2019-01-10","2019-09-25","2019-10-22","2019-04-01","2019-04-09","2019-04-09","2019-04-09","2019-09-05","2022-07-27","2022-07-25","2022-05-20","2022-06-10","2022-02-16","2022-02-16","2022-02-16","2022-07-25","2022-11-16"],"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":[["","55111017915","TIZANIDINE","TAB 2MG","20","Select","Select",""],["","68462035701","POT  CHLORIDE","CAP 10MEQ ER","120","Select","Select",""],["","43598081115","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","69452015120","VITAMIN","CAP 50000UNT","4","Select","Select",""],["","00591544305","PREDNISONE","TAB 20MG","15","Select","Select",""],["","00406012305","HYDROCO\/APAP","TAB 5-325MG","20","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","69238184001","LEVOTHYROXIN","TAB 200MCG","30","Select","Select",""],["","00363056317","ASPIRIN","TAB 81MG EC","90","Select","Select",""],["","11917004958","HYDROCORT","CRE 0.01","28","Select","Select",""],["","29300013001","HYDROCHLOROT","CAP 12.5MG","30","Select","Select",""],["","52817033200","CYCLOBENZAPR","TAB 10MG","30","Select","Select",""],["","00316022130","NYSTATIN","CRE 100000","30","Select","Select",""],["","62037071001","POT  CL MICRO","TAB 10MEQ CR","120","Select","Select",""],["","00245531711","KLOR-CON","TAB 10MEQ ER","120","Select","Select",""],["","69238110205","IBUPROFEN","TAB 600MG","30","Select","Select",""],["","00527133001","BACLOFEN","TAB 10MG","20","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","49884093547","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","75834017001","ZINC","OIN 0.2","28","Select","Select",""],["","10135065263","B-12","TAB 1000MCG","30","Select","Select",""],["","11534016503","FOLIC","TAB 1MG","11","Select","Select",""],["","00378427677","VALACYCLOVIR","TAB 1GM","21","Select","Select",""],["","68462034690","LEVOCETIRIZI","TAB 5MG","90","Select","Select",""],["","00310737220","BUDES\/FORMOT","AER 80-4.5","10","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","","EMGALITY","INJ 120MG\/ML","","Select","Select",""],["","68462019005","NAPROXEN","TAB 500MG","60","Select","Select",""],["","59746000106","METHYLPRED","TAB 4MG","39","Select","Select",""],["","65162062711","TRAMADOL","TAB 50MG","30","Select","Select",""],["","68180029506","DULOXETINE","CAP 30MG","90","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","10","Select","Select",""],["","","AMOX\/K","TAB 875-125","","Select","Select",""],["","","CEFDINIR","CAP 300MG","","Select","Select",""],["","00186037220","SYMBICORT","AER 80-4.5","10","Select","Select",""],["","00904759080","FEROSUL","TAB 325MG","60","Select","Select",""],["","00781577626","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","65862020199","LOSARTAN","TAB 25MG","30","Select","Select",""],["","63481068447","VOLTAREN","GEL 0.01","100","Select","Select",""],["","68382014005","TOPIRAMATE","TAB 100MG","60","Select","Select",""],["","00093354143","ESTRADIOL","CRE 0.0001","42","Select","Select",""],["","00363010412","PAIN","TAB 325MG","60","Select","Select",""],["","","CEPHALEXIN","CAP 500MG","","Select","Select",""],["","00904671546","RANITIDINE","TAB 75MG","60","Select","Select",""],["","","MUCUS","TAB 400MG","","Select","Select",""],["","","LORATADINE","TAB 10MG","","Select","Select",""],["","","KETOCONAZOLE","CRE 0.02","","Select","Select",""],["","","AIMOVIG","INJ 70MG\/ML","","Select","Select",""],["","","SALINE","SPR 0.0065","","Select","Select",""],["","59762374202","MEDROXYPR","TAB 10MG","30","Select","Select",""],["","00527169505","BUT\/APAP\/CAF","TAB ","30","Select","Select",""],["","00054418125","DEXAMETHASON","TAB 1MG","24","Select","Select",""],["","59746011506","PROCHLORPER","TAB 10MG","30","Select","Select",""],["","00406055201","OXYCODONE","TAB 5MG","15","Select","Select",""],["","55111068305","IBU","TAB 600MG","30","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","Select","Select",""],["","00904671960","ACETAMINOPHE","TAB 325MG","30","Select","Select",""],["","64380071306","BENZONATATE","CAP 200MG","20","Select","Select",""],["","45802086803","POLYETH","POW 3350 NF","510","Select","Select",""],["","10702001150","HYDROXYZ","TAB 25MG","24","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":""}]}]}