{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"HOUSTON LEE","gend":0,"add":"236 LEETOWN RD ","city":"DILLWYN  ","state":"VA","zip":"23936-9998","dob":"1974-06-03","age":"","mstatus":"","insh":11003855,"cliId":"4NG6NT8NT58","pno":4349831112,"cno":4349831112,"email":"","ename":"","eno":"","pphy":"CAMPANELLI, DAVID M  ","ppno":4349245321,"pcpadd":"25892 N James Madison Hwy","pcpcity":"New Canton  ","pcpstate":"VA","pcpzip":231232234,"pcpcounty":"","pcpid":"P0114074","pcpname":"UVA PRIMARY CARE CENTER","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"","add2":"","add3":"","madd1":"236 LEETOWN RD ","madd2":"","madd3":"","mcity":"DILLWYN  ","mstate":"VA","mzip":"23936-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["N39.0","R30.0","B37.9","L29.9","Z71.89","Z71.3","B38.9","N30.01","B96.5","B95.2","Z45.2","Z79.2","N31.9","N39.498","G82.20","F52.8","Z99.3","M79.622","R31.9","I10","E78.5","Z23","M41.9","M62.81","G47.30","R06.83","R06.89","R40.0","R53.82","G47.00","H10.45","M24.812","M67.812","M25.512","M94.8X1","R05","M75.02","L03.012","H61.21","Z11.4","N52.9","R53.83","R33.9","N39.41","Z74.09","S61.309A","Z87.440","N30.00","Z00.00","Z59.9","G82.21"],"date":["2021-07-30","2021-07-30","2019-01-04","2019-02-15","2019-06-18","2019-06-18","2019-01-04","2021-09-17","2019-01-12","2019-01-12","2019-01-12","2019-01-12","2021-07-30","2019-01-12","2021-07-30","2019-01-12","2019-01-12","2019-07-18","2019-03-08","2021-07-30","2021-03-01","2021-03-29","2019-07-18","2019-07-18","2019-09-10","2019-05-15","2019-05-15","2019-06-18","2019-05-15","2019-05-15","2020-06-01","2018-06-04","2018-06-04","2018-06-04","2018-06-04","2020-06-26","2018-07-06","2020-07-25","2018-08-30","2020-09-10","2018-10-17","2019-11-27","2020-12-04","2020-12-04","2021-03-01","2018-12-19","2021-03-01","2021-05-29","2021-06-25","2021-08-13","2021-10-15"],"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":[["","65862020299","LOSARTAN POT","TAB 50MG","","Select","Select",""],["","68682099398","DILTIAZEM","CAP 120MG ER","","Select","Select",""],["","55111012405","ATORVASTATIN","TAB 80MG","","Select","Select",""],["","69097022316","ALENDRONATE","TAB 35MG","","Select","Select",""],["","65862042005","SMZ\/TMP DS","TAB 800-160","","Select","Select",""],["","47781057701","METHENAM HIP","TAB 1GM","","Select","Select",""],["","47781030301","NITROFURANTN","CAP 100MG","","Select","Select",""],["","68462010230","FLUCONAZOLE","TAB 100MG","","Select","Select",""],["","65862007701","CIPROFLOXACN","TAB 500MG","","Select","Select",""],["","93117410","PENICILLN VK","TAB 500MG","","Select","Select",""],["","116200116","CHLORHEX GLU","SOL 0.0012","","Select","Select",""],["","228255196","DICLOFENAC","TAB 75MG DR","","Select","Select",""],["","60505001406","DILT-XR","CAP 120MG","","Select","Select",""],["","69097022316","ALENDRONATE ","TAB 35MG","12","Select","Select",""],["","65862020299","LOSARTAN ","TAB 50MG","90","Select","Select",""],["","68682099398","DILTIAZEM ","CAP 120MG ER","90","Select","Select",""],["","55111012405","ATORVASTATIN ","TAB 80MG","90","Select","Select",""],["","47781057701","METHENAM ","TAB 1GM","30","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","10","Select","Select",""],["","47781030301","NITROFURANTN ","CAP 100MG","14","Select","Select",""],["","65862017601","PENICILLN ","TAB 500MG","28","Select","Select",""],["","60505001406","DILT-XR ","CAP 120MG","90","Select","Select",""],["","65862007701","CIPROFLOXACN ","TAB 500MG","20","Select","Select",""],["","68462010230","FLUCONAZOLE ","TAB 100MG","10","Select","Select",""],["","228255196","DICLOFENAC ","TAB 75MG DR","60","Select","Select",""],["","116200116","CHLORHEX ","SOL 0.0012","473","Select","Select",""],["","69238110002","DOXYCYCL ","100MG","28","Select","Select",""],["","69238110002","DOXYCYCL","100MG","28","Select","Select",""],["","65862020299","LOSARTAN","50MG","90","Select","Select",""],["","47781057701","METHENAM","1GM","30","Select","Select",""],["","65862042005","SMZ\/TMP","800-160","10","Select","Select",""],["","65862017601","PENICILLN","500MG","28","Select","Select",""],["","00116200116","CHLORHEX","0.0012","473","Select","Select",""],["","67877021560","CEFUROXIME","250MG","20","Select","Select",""],["","67877021560","CEFUROXIME ","TAB 250MG","20","Select","Select",""],["","62037059790","CARTIA ","CAP 120\/24HR","90","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":[[["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","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":""}]}]}