{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SHARON M MYERS","gend":1,"add":"1015ZION HILL ROAD","city":"KESWICK  ","state":"VA","zip":"22947-1970","dob":"1951-04-08","age":"","mstatus":"","insh":11001242,"cliId":"2R64W67ME70","pno":4344662370,"cno":4344662370,"email":"","ename":"","eno":"","pphy":"CASEY, CATHERINE F","ppno":4349245348,"pcpadd":"345 FOUR LEAF LANE,SUITE 103","pcpcity":"CHARLOTTESVILLE","pcpstate":"VA","pcpzip":229080001,"pcpcounty":"","pcpid":"P0110982","pcpname":"UVA FAMILY MEDICINE INTERNAL MEDICINE AND SPECIALT","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"","add2":"","add3":"","madd1":"1015ZION HILL ROAD","madd2":"","madd3":"","mcity":"KESWICK  ","mstate":"VA","mzip":"22947-1970","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["R53.83","E11.40","M79.7","I10","Z72.0","I21.4","K21.9","F17.210","I25.5","I25.10","E78.5","R35.0","G89.29","F17.200","Z23","E78.00","R23.8","N10","I50.22","G47.9","I42.8","R06.02","G47.00","L98.9","M25.561","J43.2","R20.0","E78.2","I49.9","E11.9","J44.9","Z95.5","I25.2","Z87.891","Z00.6","R07.81","T82.897A","T82.847A","Y71.2","F32.9","I11.0","Z79.899","Z88.5","Z88.8","Z45.018","H25.811","H01.02A","H52.7","H01.02B","H53.9","I49.3","I71.4","I77.3","K80.20","K57.30","R05","Z95.810","T82.110A","T82.118D","T82.190A","J90","J98.11","Z12.2","I50.23","J81.1","R06.00","Z20.828","A41.9","R65.21","R57.0","J96.02","I77.77","J18.9","E87.2","N17.9","E87.0","F05","I25.82","I27.20","E11.51","Z98.890","R57.8","I77.79","J96.00","Z46.59","Z46.82","R00.0","J96.22","I73.9","Z45.2","R91.8","G93.40","R41.0","Z01.810","E44.0","Z98.61","R41.841","R13.12","R26.2","M62.81","I50.32","I50.9","H26.8","H26.9","Z48.810","R53.1","L98.8","M54.5","Z91.81","J18.1","R30.0","R10.9","Z51.5","Z87.01","N28.1","R31.9","Z12.11","Z87.898","Z79.84","M25.552","M16.0","H91.10","H93.19","M54.40","R06.09","R13.10","R23.3","R25.2","Z68.27","Z79.82","R63.4","T82.9XXA","Z20.822","G31.84","F32.0","R41.3","Z71.6","H91.93","H90.3","Z13.820","Z78.0","Z11.59","Z00.00","L84","J40","R05.9","B37.2"],"date":["2019-05-17","2021-11-03","2021-07-16","2020-12-09","2019-12-17","2019-05-17","2021-07-16","2020-06-18","2021-04-28","2021-06-24","2020-12-04","2019-08-15","2020-11-20","2020-02-12","2019-08-15","2021-07-16","2019-08-28","2020-09-08","2021-10-06","2019-10-09","2021-11-07","2021-04-28","2019-11-15","2019-11-15","2020-11-20","2021-07-16","2020-11-20","2021-03-08","2020-11-30","2020-12-04","2020-12-04","2020-12-04","2020-12-04","2020-12-21","2020-12-04","2020-12-04","2020-12-07","2020-12-04","2020-12-04","2020-12-04","2020-12-04","2020-12-04","2020-12-04","2020-12-04","2020-12-05","2018-12-06","2018-12-06","2019-04-01","2018-12-06","2019-04-01","2020-12-07","2020-12-07","2020-12-07","2020-12-07","2020-12-07","2020-12-07","2021-11-07","2020-12-09","2020-12-07","2020-12-08","2020-12-09","2020-12-09","2020-12-21","2021-03-09","2020-01-17","2020-01-09","2019-12-27","2020-01-17","2020-01-17","2020-02-01","2020-01-17","2020-01-17","2020-02-01","2020-01-17","2020-01-17","2020-01-17","2020-01-17","2020-01-17","2020-02-01","2020-01-17","2020-01-17","2020-01-17","2020-02-01","2020-01-17","2020-01-27","2020-01-28","2020-01-18","2020-01-19","2020-01-19","2020-01-19","2020-01-20","2020-01-21","2020-01-31","2019-01-30","2020-02-12","2020-02-01","2020-02-01","2020-02-01","2020-02-12","2020-02-05","2020-02-01","2020-02-07","2019-02-07","2019-02-07","2019-02-08","2020-02-12","2020-02-12","2020-02-12","2020-02-12","2020-02-27","2020-02-27","2020-02-28","2020-02-27","2020-02-27","2020-02-28","2020-02-28","2018-03-09","2019-03-13","2019-03-13","2020-04-20","2020-04-24","2018-04-27","2018-04-27","2018-04-27","2018-04-27","2018-04-27","2018-04-27","2018-04-27","2018-04-27","2018-04-27","2019-05-17","2020-12-07","2021-01-22","2021-08-19","2021-08-19","2021-08-05","2021-07-16","2021-09-30","2021-09-30","2021-11-22","2021-11-22","2021-11-03","2021-11-03","2021-11-03","2021-11-03","2021-11-03","2021-11-03"],"priorHcc":["",null,"","","","","","","","","","","","","","","","","","",null,"","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",null,"","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",null,null,null,null,null,null,null,null]}},{"a":[]}]},{"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":{"indx":["","",""],"comment":["","",""],"sub":[]}},{"a":{"indx":["","",""],"comment":["","",""],"sub":[]}}]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","67877022210","GABAPENTIN","CAP 100MG","","Select","Select",""],["","591040610","LISINOPRIL","TAB 5MG","","Select","Select",""],["","23155010210","METFORMIN","TAB 500MG","","Select","Select",""],["","59310057922","PROAIR HFA","AER ","","Select","Select",""],["","173086910","ANORO ELLIPT","AER 62.5-25","","Select","Select",""],["","597015290","JARDIANCE","TAB 10MG","","Select","Select",""],["","527260143","METOPROL SUC","TAB 50MG ER","","Select","Select",""],["","53746051105","SPIRONOLACT","TAB 25MG","","Select","Select",""],["","55111015810","OMEPRAZOLE","CAP 20MG","","Select","Select",""],["","68180029603","DULOXETINE","CAP 60MG","","Select","Select",""],["","54429731","FUROSEMIDE","TAB 20MG","","Select","Select",""],["","47781030301","NITROFURANTN","CAP 100MG","","Select","Select",""],["","69046856","CHANTIX","TAB 0.5MG","","Select","Select",""],["","65862006201","METOPROL TAR","TAB 25MG","","Select","Select",""],["","54327099","FLUTICASONE","SPR 50MCG","","Select","Select",""],["","17478071310","OFLOXACIN","DRO 0.3% OP","","Select","Select",""],["","61314063705","PREDNISOLONE","SUS 1% OP","","Select","Select",""],["","70010075405","METHOCARBAM","TAB 500MG","","Select","Select",""],["","93314705","CEPHALEXIN","CAP 500MG","","Select","Select",""],["","57237017190","ROSUVASTATIN","TAB 40MG","","Select","Select",""],["","65862042005","SMZ\/TMP DS","TAB 800-160","","Select","Select",""],["","60505267108","ATORVASTATIN","TAB 80MG","","Select","Select",""],["","47335090218","QUETIAPINE","TAB 25MG","","Select","Select",""],["","49281012065","FLUZONE HD","INJ PF 20-21","","Select","Select",""],["","50111043402","TRAZODONE","TAB 100MG","","Select","Select",""],["","31722063231","OSELTAMIVIR","CAP 75MG","","Select","Select",""],["","68382005005","MELOXICAM","TAB 7.5MG","","Select","Select",""],["","68180051303","LISINOPRIL ","TAB 5MG","90","Select","Select",""],["","24979003803","METOPROL ","TAB 50MG ER","90","Select","Select",""],["","59310057922","PROAIR ","AER ","8.5","Select","Select",""],["","55111015810","OMEPRAZOLE ","CAP 20MG","84","Select","Select",""],["","173086910","ANORO ","AER 62.5-25","60","Select","Select",""],["","68180029603","DULOXETINE ","CAP 60MG","90","Select","Select",""],["","67877022210","GABAPENTIN ","CAP 100MG","180","Select","Select",""],["","54429731","FUROSEMIDE ","TAB 20MG","90","Select","Select",""],["","23155010210","METFORMIN ","TAB 500MG","180","Select","Select",""],["","53746051105","SPIRONOLACT ","TAB 25MG","90","Select","Select",""],["","597015290","JARDIANCE ","TAB 10MG","90","Select","Select",""],["","47781030301","NITROFURANTN ","CAP 100MG","10","Select","Select",""],["","69046856","CHANTIX ","TAB 0.5MG","60","Select","Select",""],["","57237017190","ROSUVASTATIN ","TAB 40MG","90","Select","Select",""],["","31722063231","OSELTAMIVIR ","CAP 75MG","10","Select","Select",""],["","54327099","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","378395205","ATORVASTATIN ","TAB 40MG","90","Select","Select",""],["","49281012065","FLUZONE ","INJ PF 20-21","0.7","Select","Select",""],["","17478071310","OFLOXACIN ","DRO 0.3% OP","5","Select","Select",""],["","61314063705","PREDNISOLONE ","SUS 1% OP","5","Select","Select",""],["","68382005005","MELOXICAM ","TAB 7.5MG","7","Select","Select",""],["","70010075405","METHOCARBAM ","TAB 500MG","30","Select","Select",""],["","93314705","CEPHALEXIN ","CAP 500MG","9","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","20","Select","Select",""],["","47335090218","QUETIAPINE ","25MG","60","Select","Select",""],["","50111043402","TRAZODONE ","100MG","30","Select","Select",""],["","24979003803","METOPROL","50MG ER","90","Select","Select",""],["","59310057922","PROAIR","","8.5","Select","Select",""],["","00173086910","ANORO","62.5-25","60","Select","Select",""],["","49281012065","FLUZONE","PF 20-21","0.7","Select","Select",""],["","65862042005","SMZ\/TMP","800-160","20","Select","Select",""],["","50111078710","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""]]}},{"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":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[[["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""]]]},{"t":"Mini-Cog","q":[{"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":""}]}]}