{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"VICTORIA SHIFLETT","gend":1,"add":"95 WHISPERING PINE LANE","city":"BUMPASS                       ","state":"VA","zip":"23024-2831","dob":"1960-07-28","age":"","mstatus":"","insh":5711131,"cliId":"","pno":5402590839,"cno":5402233973,"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":"MLTSS","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"95 WHISPERING PINE LANE","add3":"","madd1":"95 WHISPERING PINE LANE","madd2":"","madd3":"","mcity":"BUMPASS                       ","mstate":"VA","mzip":"23024-2831","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F33.1","Z12.31","Z80.0","Z79.899","E11.42","I10","E78.2","J43.9","I87.8","R10.9","R31.0","J47.9","F17.200","F31.30","Z86.010","G47.33","M51.37","Z01.419","N39.46","N81.89","K57.30","M65.331","G56.01","R20.0","R20.2","R06.09","Z72.0","N30.01","R30.0","R07.89","M65.341","Z13.0","E87.1","E11.8","R80.9","E66.9","I73.9","I73.00","Z80.3","H25.13","E11.9","Z01.818","H25.9","H25.12","H25.11","F33.0","Z11.59","F17.210","Z12.2","R91.8","N32.81","N39.41","J47.0","Z23","I83.893","R06.00","J98.4","M54.42","M54.41","G89.29","M51.36"],"date":["2021-12-06","2021-01-12","2021-01-12","2021-06-16","2021-12-22","2021-12-22","2021-12-22","2021-12-02","2021-12-22","2020-02-27","2020-02-27","2020-10-27","2021-12-22","2020-10-27","2021-12-22","2021-12-02","2021-12-22","2020-02-26","2020-02-26","2020-02-26","2020-02-27","2020-07-06","2020-07-06","2020-03-05","2020-03-05","2020-05-06","2020-12-03","2020-06-03","2020-06-03","2020-06-03","2020-06-10","2021-05-25","2021-01-26","2021-09-23","2021-04-21","2021-09-23","2020-12-14","2020-12-14","2021-01-12","2021-01-22","2021-01-22","2021-01-28","2021-01-28","2021-02-01","2021-02-08","2021-08-16","2021-05-25","2021-12-02","2021-07-12","2021-07-12","2021-12-31","2021-12-31","2021-12-02","2021-09-23","2021-10-18","2021-12-02","2021-12-02","2021-12-22","2021-12-22","2021-12-22","2021-12-22"],"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":[["","43547026910","ROPINIROLE","TAB 0.5MG","30","Select","Select",""],["","68180098001","LISINOPRIL","TAB 10MG","30","Select","Select",""],["","10572010001","PEG-3350","SOL ELECTROL","4,000.00","Select","Select",""],["","60505258008","ATORVASTATIN","TAB 40MG","90","Select","Select",""],["","55111053301","DIVALPROEX","TAB 250MG ER","120","Select","Select",""],["","59651026905","GLIPIZIDE","TAB 5MG","30","Select","Select",""],["","27241015604","OXYBUTYNIN","TAB 10MG ER","30","Select","Select",""],["","00193725201","CONTOUR","KIT NEXT EZ","1","Select","Select",""],["","60505265301","TRAZODONE","TAB 50MG","30","Select","Select",""],["","43547028211","ESCITALOPRAM","TAB 20MG","135","Select","Select",""],["","10702001110","HYDROXYZ","TAB 25MG","120","Select","Select",""],["","68180035302","SERTRALINE","TAB 100MG","35","Select","Select",""],["","13107005999","APAP\/CODEINE","TAB 300-30MG","15","Select","Select",""],["","57896094101","IBUPROFEN","TAB 200MG","60","Select","Select",""],["","67877022301","GABAPENTIN","CAP 300MG","60","Select","Select",""],["","00093083205","CLONAZEPAM","TAB 0.5MG","30","Select","Select",""],["","00185012201","NITROFURANTN","CAP 100MG","10","Select","Select",""],["","00280210032","ASPIRIN","TAB 81MG EC","30","Select","Select",""],["","70010077001","METHOCARBAM","TAB 750MG","28","Select","Select",""],["","00603188016","LIDOCAINE","PAD 0.05","30","Select","Select",""],["","00173086910","ANORO","AER 62.5-25","60","Select","Select",""],["","00487950125","ALBUTEROL","NEB 0.00083","75","Select","Select",""],["","00168008031","HYDROCORT","CRE 0.025","30","Select","Select",""],["","13668059502","NYSTATIN","CRE 100000","30","Select","Select",""],["","62756014202","METFORMIN","TAB 500MG ER","60","Select","Select",""],["","00487900760","SODIUM","NEB 0.07","240","Select","Select",""],["","00363095704","NICOTINE","LOZ 4MG MINT","135","Select","Select",""],["","57599080300","FREESTY","MIS 2 READER","1","Select","Select",""],["","61314012605","KETOROLAC","SOL 0.005","5","Select","Select",""],["","64980051505","OFLOXACIN","DRO 0.3% OP","5","Select","Select",""],["","60758011910","PREDNISOLONE","SUS 1% OP","10","Select","Select",""],["","13668004501","LAMOTRIGINE","TAB 25MG","30","Select","Select",""],["","00009540001","NICOTROL","INH ","168","Select","Select",""],["","08317880128","TECHLITE","MIS LANCETS","200","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","Select","Select",""],["","49281072088","FLUBLOK","INJ 2020-21","0.5","Select","Select",""],["","16729018201","HYDROCHLOROT","TAB 12.5MG","15","Select","Select",""],["","00904672040","ACETAMIN","TAB 500MG","60","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","5","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":""}]}]}