{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"THRESIA   L BULLOCK","gend":1,"add":"5233 RIDGE ROAD                                             ","city":"SPOTSYLVANIA                  ","state":"VA","zip":"22551-6338","dob":"1986-06-22","age":"","mstatus":"","insh":4196737,"cliId":"","pno":5408414745,"cno":"","email":"","ename":"","eno":"","pphy":"DOWDELL, KIMBERLY J                                         ","ppno":4349242472,"pcpadd":"415 Ray C Hunt Dr                                           ,Ste 2100                                                    ","pcpcity":"Charlottesville               ","pcpstate":"VA","pcpzip":229032980,"pcpcounty":"","pcpid":"","pcpname":"UNIVERSITY PHYSICIANS CHARLOTTESVILLE CLINC","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"CENTRAL","aligned":"","ano":"","add2":"5233 RIDGE ROAD                                             ","add3":"","madd1":"5233 RIDGE ROAD                                             ","madd2":"                                                            ","madd3":"","mcity":"SPOTSYLVANIA                  ","mstate":"VA","mzip":"22551-6338","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G43.909","M79.2","M54.2","M25.519","M79.12","M79.18","M50.20","M50.30","M47.812","G56.00","T17.908D","R05","R13.10","R09.82","M79.10","M99.81","M48.02","G56.02","J38.7","K21.9","R13.12","R49.0","R13.19","M53.9","E66.9","R53.83","K59.00","R11.0","R52","R10.13","E78.2","R63.5","E66.01","F41.9","I10","R68.81","R10.9","K44.9","M79.7","J45.20","E78.00","Z68.42","F50.9","F06.31","E89.40","Z01.419","Z12.72","Z01.818","Z79.899","R06.02","G47.33","J45.21","Z01.810","K08.9","J45.40","H69.83","G89.18","Z01.812","Z01.83","Z20.822","J45.909","Z90.710","Z87.891","K76.0","E78.5","K29.50","K29.51","G47.30","Z98.84","R10.84","R11.10","M25.551","M25.552","M25.559","M54.5","M70.61","G89.29","K90.9","Z68.37","Z88.5","Z68.35","Z68.30","M70.71","J01.00","U07.1","Z20.828","L03.012","M79.645","I73.00","Z86.69","R20.9","R51.9","I67.1","I67.9","E55.9","Z68.26","R22.32","R63.4","S05.02XA","H57.12","H57.89","H53.8","W45.8XXA"],"date":["2020-01-07","2020-02-18","2020-02-18","2020-02-18","2022-11-22","2021-11-23","2020-02-18","2020-01-07","2020-01-07","2020-01-07","2020-04-21","2020-04-21","2021-05-26","2020-01-11","2020-01-14","2020-01-15","2020-01-15","2020-01-15","2020-01-28","2020-09-16","2020-04-21","2020-01-28","2020-01-28","2020-02-18","2020-11-19","2020-11-19","2020-04-21","2020-06-02","2020-04-21","2020-06-02","2020-12-21","2021-04-15","2021-01-15","2020-05-14","2020-11-16","2020-05-29","2022-04-28","2021-01-14","2021-01-14","2021-01-06","2021-01-14","2021-01-14","2020-07-01","2020-07-01","2020-07-16","2020-07-16","2020-07-16","2020-11-05","2020-09-16","2020-09-18","2021-01-02","2020-10-19","2020-11-05","2020-11-05","2020-11-05","2020-12-29","2021-02-11","2021-01-08","2021-01-06","2021-01-08","2021-01-14","2021-01-14","2022-06-10","2021-01-14","2021-01-14","2021-01-14","2021-01-14","2021-01-14","2022-04-28","2021-02-11","2021-02-11","2021-09-16","2021-04-19","2021-04-19","2021-04-19","2022-07-12","2021-04-19","2022-04-28","2021-04-29","2021-05-26","2021-05-26","2021-08-10","2021-09-16","2022-07-29","2021-10-05","2021-10-05","2022-01-18","2022-01-18","2022-01-18","2022-01-18","2022-01-18","2022-03-16","2022-03-16","2022-03-16","2022-04-28","2022-04-28","2022-06-01","2022-06-01","2022-07-15","2022-07-15","2022-07-15","2022-07-15","2022-07-15"],"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":[["","68180012202","CEPHALEXIN","CAP 500MG","40","Select","Select",""],["","67877057130","ESOMEPRA","CAP 20MG DR","28","Select","Select",""],["","59762500801","MISOPROSTOL","TAB 200MCG","56","Select","Select",""],["","51672128902","NYSTATIN","CRE 100000","30","Select","Select",""],["","45802091987","CETIRIZINE","TAB 10MG","90","Select","Select",""],["","24208091055","ERYTHROMYCIN","OIN 5MG\/GM","3.5","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","12","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","48","Select","Select",""],["","65862050320","AMOX\/K","TAB 875-125","20","Select","Select",""],["","00781713883","ESTRADIOL","DIS 0.0375MG","8","Select","Select",""],["","10702002801","PHENTERMINE","CAP 30MG","30","Select","Select",""],["","70700026330","LANSOPRAZOLE","CAP 30MG DR","30","Select","Select",""],["","50428031180","SALINE","SPR 0.0065","44","Select","Select",""],["","00955100410","ENOXAPARIN","INJ 40\/0.4ML","5.6","Select","Select",""],["","42858030101","HYDROMORPHON","TAB 2MG","30","Select","Select",""],["","43547028810","BUPROPION","TAB 100MG SR","60","Select","Select",""],["","45802065078","LORATADINE","TAB 10MG","30","Select","Select",""],["","00169280015","SAXENDA","INJ 18MG\/3ML","15","Select","Select",""],["","08290320122","BD  PEN NEEDL","MIS 32GX4MM","100","Select","Select",""],["","00093310905","AMOXICILLIN","CAP 500MG","28","Select","Select",""],["","00116200116","CHLORHEX","SOL 0.0012","16","Select","Select",""],["","49483060450","IBUPROFEN","TAB 800MG","28","Select","Select",""],["","42858010201","OXYCOD\/APAP","TAB 5-325MG","24","Select","Select",""],["","00378064110","PREDNISONE","TAB 10MG","20","Select","Select",""],["","65162099208","DOTTI","DIS 0.0375MG","8","Select","Select",""],["","00172572960","FAMOTIDINE","TAB 40MG","30","Select","Select",""],["","68462010530","ONDANSETRON","TAB 4MG","12","Select","Select",""],["","45802086803","POLYETH","POW 3350 NF","510","Select","Select",""],["","00536116361","MUCUS","TAB 600MG ER","180","Select","Select",""],["","68382013814","TOPIRAMATE","TAB 25MG","120","Select","Select",""],["","00173071820","FLOVENT","AER 44MCG","10.6","Select","Select",""],["","65862056090","PANTOPRAZOLE","TAB 40MG","30","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":""}]}]}