{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"RUTH JONES","gend":1,"add":"306 61\/2 STREET SW","city":"CHARLOTTESVLE","state":"VA","zip":"22903-9998","dob":"1948-12-16","age":"","mstatus":"","insh":11012306,"cliId":"8N18MK1NY59","pno":4342028641,"cno":8042480140,"email":"","ename":"","eno":"","pphy":"GAZEWOOD, JOHN DAY","ppno":4349245348,"pcpadd":"1221 Lee Street 1st Floor, ","pcpcity":"Charlottesville","pcpstate":"VA","pcpzip":229080001,"pcpcounty":"","pcpid":"P0060040","pcpname":"UVA PRIMARY CARE CENTER","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"N","ano":"","add2":"","add3":"","madd1":"306 61\/2 STREET SW","madd2":"","madd3":"","mcity":"CHARLOTTESVLE","mstate":"VA","mzip":"22903-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["J44.9","C50.919","E04.1","Z12.31","Z85.118","Z80.3","Z13.820","J70.1","K21.0","R06.02","R10.9","R07.9","R10.84","K22.9","R50.9","Z92.21","Z74.3","J44.1","J96.21","F17.200","R06.00","J96.22","F17.210","C34.90","E11.9","I50.30","G89.29","Z92.3","J43.2","C34.10","R09.02","I27.20","R91.8","R10.32","Z23","H43.812","H52.7","H25.13"],"date":["2021-06-01","2021-06-24","2020-03-12","2020-03-12","2020-08-20","2020-03-12","2020-03-12","2020-03-18","2020-03-18","2021-05-07","2020-03-18","2020-05-30","2020-12-18","2020-03-18","2020-03-18","2020-05-30","2020-05-30","2020-05-31","2020-05-30","2020-07-31","2020-05-30","2020-05-30","2020-05-30","2020-05-30","2021-05-17","2020-05-30","2020-05-30","2020-05-30","2021-05-07","2020-08-20","2020-07-31","2021-05-07","2020-08-20","2020-12-18","2021-04-20","2021-05-17","2021-05-17","2021-05-17"],"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":[["","60505258008","ATORVASTATIN","TAB 40MG","","Select","Select",""],["","67877022305","GABAPENTIN","CAP 300MG","","Select","Select",""],["","597007541","SPIRIVA","CAP HANDIHLR","","Select","Select",""],["","59310057922","PROAIR HFA","AER ","","Select","Select",""],["","93317431","ALBUTEROL SUL","FAT E","","Select","Select",""],["","173069600","ADVAIR DISKU","AER 250\/50","","Select","Select",""],["","487950125","ALBUTEROL","NEB 0.00083","","Select","Select",""],["","55111015810","OMEPRAZOLE","CAP 20MG","","Select","Select",""],["","66993058597","FLUTIC\/SALME","AER 250\/50","","Select","Select",""],["","85113204","PROVENTIL","AER HFA","","Select","Select",""],["","591544310","PREDNISONE","TAB 20MG","","Select","Select",""],["","68180016106","AZITHROMYCIN","TAB 500MG","","Select","Select",""],["","67877032005","IBUPROFEN","TAB 600MG","","Select","Select",""],["","60505258008","ATORVASTATIN ","TAB 40MG","30","Select","Select",""],["","67877022305","GABAPENTIN ","CAP 300MG","120","Select","Select",""],["","59310057922","PROAIR ","AER ","8.5","Select","Select",""],["","67877032005","IBUPROFEN ","TAB 600MG","30","Select","Select",""],["","597007541","SPIRIVA ","CAP HANDIHLR","90","Select","Select",""],["","487950125","ALBUTEROL ","NEB 0.00083","75","Select","Select",""],["","173069600","ADVAIR ","AER 250\/50","60","Select","Select",""],["","66993058597","FLUTIC\/SALME ","AER 250\/50","180","Select","Select",""],["","55111015810","OMEPRAZOLE ","CAP 20MG","30","Select","Select",""],["","85113204","PROVENTIL ","AER HFA","6.7","Select","Select",""],["","68180016106","AZITHROMYCIN ","TAB 500MG","1","Select","Select",""],["","591544310","PREDNISONE ","TAB 20MG","8","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":""}]}]}