{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JESSICA RILEY","gend":1,"add":"23 HILLTOP TERRACE","city":"STAUNTON ","state":"VA","zip":"24401-9998","dob":"1994-06-27","age":"","mstatus":"","insh":11008080,"cliId":"5UV8M48MY44","pno":5404872004,"cno":5404879200,"email":"","ename":"","eno":"","pphy":"SEATON, SCOTT M","ppno":5409421200,"pcpadd":"15 Pratts Run,Ste 103","pcpcity":"Waynesboro  ","pcpstate":"VA","pcpzip":229806606,"pcpcounty":"","pcpid":"P0060086","pcpname":"UVA WAYNESBORO PRIMARY CARE","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"","add2":"","add3":"","madd1":"23 HILLTOP TERRACE","madd2":"","madd3":"","mcity":"STAUNTON ","mstate":"VA","mzip":"24401-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["F32.89","F41.8","L03.012","A54.9","Z11.3","N89.8","R11.2","G40.909","Z79.899","Z88.8","Z88.3","N39.0","R39.9","G40.89","R29.810","R56.9","R00.0","E87.2","Z20.2","Z04.89","Z86.69","F43.23","F33.0","R25.1","T42.4X6A","G40.309","G40.319","G40.911","E87.6","R45.1","R41.0","R11.10","B36.0","R25.3","F44.9","R40.4","A59.03","I95.9","R53.1","R50.9","Z03.818","G40.311","R30.0","D72.829","G40.411","G40.804","Z82.0","I10","F32.9","Z88.1","M25.572","W19.XXXA","S93.402A","X50.0XXA","X50.9XXA","Y93.01","S99.912A","M79.661","N18.9","Z72.820","Z98.891","Z87.442","Z83.3","Z82.49","Z80.3","Z80.0","F41.9","I49.8","R11.0","R42","E04.1","Z23","G40.419","R06.83","R35.0","R51.9","Z63.0","R32","R41.3","I47.1","R21","R06.02","R39.15","Z20.828","R53.83","F43.9","G40.409","K13.79","R41.82","Z98.51","T42.76XA","Z91.138","G40.919","T42.5X6A","Z51.81","R26.81","T43.591A","Y92.009","T43.221A","T50.901A","R26.2","Z91.81","N76.0","R30.9","R10.10","R10.9","H55.09","R27.0","H53.149","H53.8","Z87.820","H81.10","R47.81","H81.11","H53.2","H92.01","R55","R10.2","F99","M79.605","Z00.00","H92.03","R20.0","W01.0XXA","L03.011","J18.9","E86.0","E66.9","Z68.32","Z87.01","R29.6","H55.00","M25.512","H50.43","R26.89","W18.30XA","Y92.240","G40.219","Z01.818","Z45.49","Z45.42","R07.89","Z88.6"],"date":["2021-08-30","2020-01-02","2020-01-04","2020-02-13","2020-01-09","2020-01-09","2021-07-16","2021-09-25","2021-09-25","2021-09-25","2021-05-19","2021-07-16","2020-01-09","2021-02-28","2020-01-13","2021-04-13","2021-05-03","2020-01-13","2020-02-07","2020-01-17","2021-05-03","2020-07-07","2020-01-31","2020-02-27","2020-02-27","2021-09-07","2021-11-23","2020-07-07","2021-07-01","2020-04-22","2020-04-22","2021-05-03","2021-08-30","2020-05-07","2020-05-07","2020-06-01","2020-06-01","2020-06-01","2021-07-16","2020-06-08","2020-11-18","2020-07-07","2021-06-05","2021-03-07","2021-03-07","2020-07-07","2020-07-07","2020-07-13","2021-09-25","2020-07-13","2020-07-22","2020-07-22","2020-07-22","2020-07-22","2020-07-22","2020-07-22","2020-07-22","2020-07-23","2020-07-28","2020-07-28","2020-07-28","2020-07-28","2020-07-28","2020-07-28","2020-07-28","2020-07-28","2021-09-25","2020-07-28","2020-07-30","2021-07-28","2019-10-09","2020-09-11","2021-03-23","2021-01-22","2019-10-18","2021-07-28","2019-11-01","2019-11-01","2019-11-10","2019-11-10","2020-11-18","2020-11-18","2021-06-05","2020-11-18","2021-01-19","2020-12-03","2021-01-01","2021-01-19","2021-04-10","2021-02-28","2021-03-11","2021-04-13","2021-11-23","2021-04-13","2021-04-07","2021-07-16","2021-04-13","2021-04-10","2021-04-13","2021-04-10","2021-05-17","2021-07-16","2021-04-21","2021-04-21","2021-05-03","2021-06-05","2021-05-03","2021-05-03","2021-05-03","2021-07-28","2021-05-03","2021-05-17","2021-05-17","2021-05-17","2021-05-18","2021-05-19","2021-05-17","2021-06-05","2021-06-05","2021-06-07","2021-06-07","2021-06-29","2021-07-01","2021-07-16","2021-07-16","2021-03-07","2021-03-07","2021-03-07","2021-03-07","2021-03-07","2021-07-28","2021-07-28","2021-07-01","2021-07-28","2021-07-01","2021-07-01","2021-07-01","2021-09-10","2021-09-10","2021-09-17","2021-09-17","2021-09-26","2021-09-25"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","",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":[["","69452015220","ETHOSUXIMIDE","CAP 250MG","","Select","Select",""],["","456114030","VIIBRYD","TAB 40MG","","Select","Select",""],["","13668013701","ESCITALOPRAM","TAB 20MG","","Select","Select",""],["","70710113803","FLUCONAZOLE","TAB 100MG","","Select","Select",""],["","45802046564","KETOCONAZOLE","SHA 0.02","","Select","Select",""],["","228142203","LAMOTRIGINE","TAB 100MG ER","","Select","Select",""],["","378004001","CLORAZ DIPOT","TAB 7.5MG","","Select","Select",""],["","69097086107","ZONISAMIDE","CAP 100MG","","Select","Select",""],["","68382018205","BUSPIRONE","TAB 15MG","","Select","Select",""],["","47781030301","NITROFURANTN","CAP 100MG","","Select","Select",""],["","43547030203","ARIPIPRAZOLE","TAB 2MG","","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","","Select","Select",""],["","68462010530","ONDANSETRON","TAB 4MG","","Select","Select",""],["","245531911","KLOR-CON M20","TAB 20MEQ ER","","Select","Select",""],["","93101042","MUPIROCIN","OIN 0.02","","Select","Select",""],["","93321205","CLONAZEPAM","TAB 1MG","","Select","Select",""],["","65862042005","SMZ\/TMP DS","TAB 800-160","","Select","Select",""],["","68180071160","CEFDINIR","CAP 300MG","","Select","Select",""],["","50474050015","NAYZILAM","SPR 5MG","","Select","Select",""],["","13668013701","ESCITALOPRAM ","TAB 20MG","90","Select","Select",""],["","228142203","LAMOTRIGINE ","TAB 100MG ER","90","Select","Select",""],["","456114030","VIIBRYD ","TAB 40MG","90","Select","Select",""],["","70710113803","FLUCONAZOLE ","TAB 100MG","10","Select","Select",""],["","45802046564","KETOCONAZOLE ","SHA 0.02","120","Select","Select",""],["","69097086107","ZONISAMIDE ","CAP 100MG","450","Select","Select",""],["","68382018205","BUSPIRONE ","TAB 15MG","180","Select","Select",""],["","43547030203","ARIPIPRAZOLE ","TAB 2MG","90","Select","Select",""],["","378004001","CLORAZ ","TAB 7.5MG","90","Select","Select",""],["","69452015220","ETHOSUXIMIDE ","CAP 250MG","270","Select","Select",""],["","47781030301","NITROFURANTN ","CAP 100MG","10","Select","Select",""],["","59746012106","MECLIZINE ","TAB 25MG","21","Select","Select",""],["","62175061743","PANTOPRAZOLE ","TAB 40MG","90","Select","Select",""],["","68180012202","CEPHALEXIN ","CAP 500MG","6","Select","Select",""],["","68462010530","ONDANSETRON ","TAB 4MG","20","Select","Select",""],["","245531911","KLOR-CON ","TAB 20MEQ ER","7","Select","Select",""],["","93101042","MUPIROCIN ","OIN 0.02","22","Select","Select",""],["","93321205","CLONAZEPAM ","TAB 1MG","14","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","14","Select","Select",""],["","68180071160","CEFDINIR ","CAP 300MG","6","Select","Select",""],["","50111033401","METRONIDAZOL ","TAB 500MG","14","Select","Select",""],["","93310905","AMOXICILLIN ","500MG","21","Select","Select",""],["","50474050015","NAYZILAM ","5MG","2","Select","Select",""],["","00603533831","PREDNISONE ","10MG","48","Select","Select",""],["","00378004001","CLORAZ","7.5MG","90","Select","Select",""],["","62175061743","PANTOPRAZOLE","40MG","90","Select","Select",""],["","59746012106","MECLIZINE","25MG","21","Select","Select",""],["","65862042005","SMZ\/TMP","800-160","14","Select","Select",""],["","50111033401","METRONIDAZOL","500MG","14","Select","Select",""],["","00603533831","PREDNISONE","10MG","48","Select","Select",""],["","00245531911","KLOR-CON","20MEQ ER","7","Select","Select",""],["","00093310905","AMOXICILLIN","500MG","21","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","",""],["Yes","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":""}]}]}