{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DAVID R BENNETT","gend":0,"add":"517 BEALS LN","city":"SCOTTSVILLE ","state":"VA","zip":"24590-9998","dob":"1939-03-17","age":"","mstatus":"","insh":11002921,"cliId":"2QJ5YC8CV82","pno":4342862269,"cno":4342862269,"email":"","ename":"","eno":"","pphy":"BALLEW, KENNETH A ","ppno":4349241622,"pcpadd":"415 Ray C Hunt Dr, ","pcpcity":"Charlottesville ","pcpstate":"VA","pcpzip":229032980,"pcpcounty":"","pcpid":"P0060016","pcpname":"UNIVERSITY PHYSICIANS CHARLOTTESVILLE CLINC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"","add2":"","add3":"","madd1":"517 BEALS LN","madd2":"","madd3":"","mcity":"SCOTTSVILLE ","mstate":"VA","mzip":"24590-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["E10.65","M54.5","E78.00","E87.1","K59.00","D50.0","A41.9","E83.42","D64.9","Z92.89","E11.42","Z79.4","E11.9","I50.9","J90","I51.7","I49.3","I10","G89.29","N31.9","Z46.6","I12.9","E11.22","N18.3","N40.1","N13.8","R26.2","M17.12","K75.81","K74.69","E66.9","K22.70","K21.9","Z68.34","Z79.82","R32","L29.9","M62.81","E11.40","K85.00","K74.60","N18.6","H52.7","H25.13","R60.0","Z96.0","R33.9","Z87.440","S81.802A","I63.50","D50.9","D51.9","E78.5","G47.00","H91.10","M54.9","N30.90","R06.02","R23.3","Z79.2","Z79.899","X58.XXXA","T83.011A","R10.30","N17.9","T83.498A","T83.198A","R52","Z86.39","D69.6","I15.1","D63.8","N28.89","Z97.4","D63.1","J30.2","N31.2","M79.89","I87.2","R22.43","D50.8","N18.4","R30.0","E10.40","E11.00","N25.81","E11.65","E79.0","E86.9","R33.8","I50.82","E10.22","N18.9","N18.30","N28.1","K21.01","Y84.6","G92","T83.511A","D68.9","L03.116","N39.0","D62","I13.0","K72.90","N18.32","K92.1","I27.21","K21.00","K92.0","K44.9","K92.2","R16.1","R41.82","K22.10","E11.3299","K59.04","Z97.8","L03.115","R31.0","R31.9","N40.0","Z74.3","K76.6","Z23","S81.801D","Z48.00","N18.31","E11.621","L97.519","G93.40","K72.00","G31.09","R40.4","R11.2","Z20.822","G93.41","J30.9","E07.9","E55.9","I48.91","E70.89","J44.9","I73.9","R69","Z12.89","E11.3293","M79.674","F02.80","Z20.89","R82.998","I50.22","L97.512","E11.69","G62.9","I95.9","R53.1","T83.091A","R53.83","Y73.2","I63.9","R07.9","I34.0"],"date":["2018-10-04","2020-09-11","2018-02-09","2018-02-09","2018-02-09","2018-10-10","2018-02-09","2018-02-09","2021-08-13","2018-02-09","2021-03-30","2021-07-19","2021-09-01","2020-10-27","2018-03-06","2021-09-27","2018-03-13","2021-09-01","2018-03-14","2020-04-24","2021-03-01","2021-07-19","2021-07-19","2020-09-29","2021-08-01","2020-10-26","2021-08-01","2020-04-24","2021-09-01","2021-03-05","2020-04-24","2020-10-26","2021-04-01","2020-04-24","2020-04-24","2018-04-12","2018-05-22","2021-08-01","2021-08-19","2018-08-14","2021-09-01","2018-08-14","2018-04-23","2018-04-23","2021-03-05","2021-06-15","2021-06-15","2021-01-01","2020-05-07","2020-05-15","2021-07-30","2021-03-31","2021-09-01","2018-05-22","2018-05-22","2018-05-22","2018-05-22","2021-09-24","2018-05-22","2018-05-22","2021-03-15","2020-06-20","2020-06-20","2020-06-20","2021-09-01","2020-06-20","2020-06-20","2020-06-20","2018-07-03","2020-10-08","2018-08-23","2018-07-12","2018-08-23","2021-03-01","2021-08-13","2018-07-24","2021-09-01","2021-03-05","2021-09-01","2020-08-05","2021-02-10","2020-12-30","2021-06-17","2018-08-21","2018-08-21","2020-09-29","2021-01-13","2021-03-30","2020-09-29","2020-09-29","2018-10-04","2018-10-04","2021-08-24","2021-09-01","2018-10-12","2020-10-26","2020-10-26","2020-10-26","2021-09-24","2020-10-26","2020-10-26","2021-09-24","2020-10-29","2020-10-26","2020-10-29","2020-10-27","2020-11-13","2020-10-27","2020-10-27","2020-10-28","2020-10-27","2021-01-15","2020-10-27","2021-03-05","2020-10-29","2021-07-16","2020-11-13","2021-05-28","2020-12-11","2021-01-01","2021-03-15","2021-01-01","2021-01-01","2021-04-15","2021-01-15","2021-03-01","2021-03-01","2021-05-06","2021-08-19","2021-08-19","2021-09-01","2021-03-05","2021-05-06","2021-03-05","2021-03-05","2021-05-06","2021-09-24","2021-04-01","2021-09-01","2021-08-01","2021-03-15","2021-03-15","2021-03-17","2021-03-17","2021-04-20","2021-04-15","2020-11-06","2021-05-06","2021-05-06","2021-05-06","2021-06-17","2021-06-18","2021-08-19","2021-08-19","2021-08-19","2021-07-19","2021-07-19","2021-07-20","2021-07-19","2021-07-19","2021-09-24","2021-09-24","2021-09-27"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}},{"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":[["","60505082901","FLUTICASONE","SPR 50MCG","","Select","Select",""],["","60505258008","ATORVASTATIN","TAB 40MG","","Select","Select",""],["","8290320119","BD PEN NEEDL","MIS 31GX5MM","","Select","Select",""],["","57599000101","FREESTYLE","KIT SENSOR","","Select","Select",""],["","55111012705","CIPROFLOXACN","TAB 500MG","","Select","Select",""],["","69315011710","FUROSEMIDE","TAB 40MG","","Select","Select",""],["","50383077916","LACTULOSE","SOL 10GM\/15","","Select","Select",""],["","16714083201","BUMETANIDE","TAB 1MG","","Select","Select",""],["","31722070090","LOSARTAN POT","TAB 25MG","","Select","Select",""],["","65862001801","CEPHALEXIN","CAP 250MG","","Select","Select",""],["","591554301","ALLOPURINOL","TAB 100MG","","Select","Select",""],["","88221905","LANTUS SOLOS","INJ 100\/ML","","Select","Select",""],["","56151147002","TRUE METRIX","KIT METER","","Select","Select",""],["","68180072103","AMLODIPINE","TAB 10MG","","Select","Select",""],["","169633910","NOVOLOG","INJ FLEXPEN","","Select","Select",""],["","65862056099","PANTOPRAZOLE","TAB 40MG","","Select","Select",""],["","2771559","BASAGLAR","INJ 100UNIT","","Select","Select",""],["","8290320119","BD  PEN NEEDL","MIS 31GX5MM","100","Select","Select",""],["","88221905","LANTUS ","INJ 100\/ML","15","Select","Select",""],["","42799012001","BUMETANIDE ","TAB 1MG","90","Select","Select",""],["","168009915","KETOCONAZOLE ","CRE 0.02","30","Select","Select",""],["","60505082901","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","67877019905","AMLODIPINE ","TAB 10MG","90","Select","Select",""],["","57599000101","FREESTYLE    KIT SENSOR","KIT SENSOR","2","Select","Select",""],["","60505258008","ATORVASTATIN ","TAB 40MG","30","Select","Select",""],["","55111012705","CIPROFLOXACN ","TAB 500MG","13","Select","Select",""],["","65862056099","PANTOPRAZOLE ","TAB 40MG","90","Select","Select",""],["","50383077916","LACTULOSE ","SOL 10GM\/15","946","Select","Select",""],["","93314501","CEPHALEXIN ","CAP 250MG","90","Select","Select",""],["","69315011710","FUROSEMIDE ","TAB 40MG","60","Select","Select",""],["","62332002890","LOSARTAN ","TAB 50MG","90","Select","Select",""],["","68001015303","CARVEDILOL ","TAB 3.125MG","28","Select","Select",""],["","591554301","ALLOPURINOL ","TAB 100MG","90","Select","Select",""],["","57599000200","FREESTYLE    MIS READER","MIS READER","1","Select","Select",""],["","2771559","BASAGLAR ","INJ 100UNIT","12","Select","Select",""],["","169633910","NOVOLOG ","INJ FLEXPEN","9","Select","Select",""],["","56151146001","TRUE ","TES GLUCOSE","100","Select","Select",""],["","00088221905","LANTUS","100\/ML","15","Select","Select",""],["","57599000101","FREESTYLE KIT SENSOR","SENSOR","2","Select","Select",""],["","00168009915","KETOCONAZOLE","0.02","30","Select","Select",""],["","62332002890","LOSARTAN","50MG","90","Select","Select",""],["","57599000200","FREESTYLE MIS READER","READER","1","Select","Select",""],["","68001015303","CARVEDILOL","3.125MG","28","Select","Select",""],["","56151146001","TRUE","GLUCOSE","100","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","",""],["No","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":""}]}]}