{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CHARLES L MILLS","gend":0,"add":"571 BELLE MEADE RD","city":"BUMPASS","state":"VA","zip":"22903-3410","dob":"1955-02-16","age":"","mstatus":"","insh":11013198,"cliId":"3FE7K81WU56","pno":5402232248,"cno":"","email":"","ename":"","eno":"","pphy":"CALLENDER, DAVID M","ppno":4349241774,"pcpadd":"1222 Jefferson Park Ave","pcpcity":"Charlottesville","pcpstate":"VA","pcpzip":229033410,"pcpcounty":"","pcpid":"P9443045","pcpname":"UVA DEPARTMENT OF DENTISTRY","plan":"VPHP - VIRGINIA PREMIER","program":"MEDICARE","lob":"DSNP","region":"WESTERN\/CHARLOTTESVILLE","aligned":"Y","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"BUMPASS","mstate":"VA","mzip":"23024-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["M48.02","R09.02","I50.9","R73.9","N18.3","I48.91","G89.18","I48.0","D69.6","F19.939","R41.82","I13.0","G93.49","G47.33","E78.5","G89.29","I25.5","I25.10","I87.2","F10.10","Z79.01","Z79.82","R42","S09.90XA","M54.2","Z98.890","W18.30XA","R40.0","R25.2","Z99.89","S19.9XXA","Z98.1","R60.9","Z95.810","G93.40","F13.239","I10","R53.1","R26.2","I50.30","I87.8","Z47.89","R73.03","E66.9","M10.9","L03.113","H33.22","G89.4","M43.12","M53.82","M47.816","M54.5","Z95.0","H25.13","H35.372","Z86.69","H52.7","R06.83","R53.82","E66.01","Z68.42","I49.5","R06.02","R80.1","N25.81","R39.9","N17.9","N18.9","I83.93","L57.0","Z85.828","L81.4","L57.8","Q27.9","L21.9","L73.8","L08.89","L03.116","L02.416","L98.9","M79.18","N18.30","M79.644","Z11.59","Z23","M18.11","Z09","I50.22","J98.9","M65.4","M79.643","R25.1","T14.8XXA","I42.2","Z45.9","T82.897A","Z45.02","R00.0","Z66","N18.31","Z87.891","Z86.14","F10.99","Z20.822","Z91.81","I51.7","Z95.2","R60.0","R11.0","J01.90","R09.82","I47.1","J81.1","J18.9","A41.9","K76.0","I71.4","J96.01","U07.1","N49.2","Z68.41","R07.89","R07.9","G44.89","B37.49","B49","E86.0","R79.89","R06.2","R11.2","J96.21","D72.829","B35.6","N40.1","R35.0","I49.1","I45.9","R00.1","J96.90","I77.810","I28.1","K57.92","R10.9","Z86.79","I12.9","K57.32","I77.819","L30.9","G62.9","F33.9","I11.0","H52.10","H28","R33.9","J30.9","E66.1"],"date":["2021-04-13","2021-04-22","2021-03-01","2020-05-01","2020-08-13","2021-04-22","2020-05-01","2020-06-17","2021-04-28","2020-06-17","2020-05-12","2021-04-22","2020-05-12","2021-04-29","2021-05-20","2020-07-09","2021-05-20","2021-05-10","2021-01-11","2020-05-12","2021-05-16","2020-05-12","2021-04-07","2020-05-12","2020-06-17","2020-05-13","2020-05-13","2020-05-13","2020-05-13","2020-05-13","2020-05-13","2021-04-13","2020-08-20","2021-05-16","2020-05-28","2020-05-14","2021-03-18","2020-06-17","2020-06-17","2020-06-17","2020-06-17","2020-06-17","2021-02-05","2020-06-17","2021-04-22","2020-05-28","2020-07-14","2021-05-20","2020-06-09","2020-06-09","2020-09-24","2020-07-09","2021-04-28","2020-07-14","2020-07-14","2020-07-14","2020-07-14","2020-07-24","2020-07-24","2021-04-26","2021-02-05","2021-04-22","2021-04-22","2021-03-18","2020-08-13","2021-03-18","2021-04-26","2020-08-13","2020-08-20","2020-08-20","2020-08-20","2020-08-20","2020-08-20","2020-08-20","2020-08-20","2020-08-20","2020-08-20","2020-08-20","2020-08-20","2020-08-20","2020-09-24","2021-05-20","2020-10-13","2020-10-12","2020-10-12","2020-10-13","2020-10-13","2021-05-10","2020-10-23","2020-10-26","2021-01-11","2021-02-26","2021-02-05","2021-05-10","2021-02-28","2021-03-01","2021-03-01","2021-02-28","2021-02-28","2021-03-18","2021-05-16","2021-02-28","2021-02-28","2021-02-28","2021-02-28","2021-05-10","2021-03-01","2021-03-18","2021-04-22","2021-04-19","2021-04-19","2021-05-20","2021-04-22","2021-04-22","2021-04-22","2021-04-22","2021-04-22","2021-04-28","2021-05-20","2021-04-26","2021-04-26","2021-02-28","2021-02-28","2021-02-28","2021-04-22","2021-04-22","2021-04-22","2021-04-22","2021-04-22","2021-04-22","2021-04-22","2021-04-22","2021-04-28","2021-04-22","2021-04-22","2021-04-24","2021-04-24","2021-04-27","2021-04-29","2021-05-10","2021-05-10","2021-05-20","2021-05-16","2021-05-16","2021-05-16","2021-05-17","2021-05-20","2020-10-10","2020-10-10","2020-10-10","2020-10-10","2020-10-10","2020-10-10","2020-10-10","2020-10-10","2020-10-10"],"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":[["","65862059805","TAMSULOSIN","CAP 0.4MG","","Select","Select",""],["","68180051703","LISINOPRIL","TAB 40MG","","Select","Select",""],["","57237001999","DULOXETINE","CAP 60MG","","Select","Select",""],["","54430125","FUROSEMIDE","TAB 80MG","","Select","Select",""],["","67877022305","GABAPENTIN","CAP 300MG","","Select","Select",""],["","51862024230","AMIODARONE","TAB 400MG","","Select","Select",""],["","53489015610","ALLOPURINOL","TAB 100MG","","Select","Select",""],["","50383070016","FLUTICASONE","SPR 50MCG","","Select","Select",""],["","52817031910","BACLOFEN","TAB 5MG","","Select","Select",""],["","60505258008","ATORVASTATIN","TAB 40MG","","Select","Select",""],["","53746051110","SPIRONOLACT","TAB 25MG","","Select","Select",""],["","69097040907","METOPROL SUC","TAB 200MG ER","","Select","Select",""],["","67877012405","SILVER SULFA","CRE 0.01","","Select","Select",""],["","3089421","ELIQUIS","TAB 5MG","","Select","Select",""],["","68382009405","CARVEDILOL","TAB 12.5MG","","Select","Select",""],["","93314705","CEPHALEXIN","CAP 500MG","","Select","Select",""],["","69315090401","LORAZEPAM","TAB 0.5MG","","Select","Select",""],["","69097085902","TERBINAFINE","TAB 250MG","","Select","Select",""],["","45802005505","TRIAMCINOLON","OIN 0.001","","Select","Select",""],["","65862042005","SMZ\/TMP DS","TAB 800-160","","Select","Select",""],["","67877019910","AMLODIPINE","TAB 10MG","","Select","Select",""],["","406055201","OXYCODONE","TAB 5MG","","Select","Select",""],["","143211205","DOXYCYCL HYC","TAB 100MG","","Select","Select",""],["","67877019910","AMLODIPINE ","TAB 10MG","90","Select","Select",""],["","57237001999","DULOXETINE ","CAP 60MG","90","Select","Select",""],["","54430125","FUROSEMIDE ","TAB 80MG","90","Select","Select",""],["","67877022305","GABAPENTIN ","CAP 300MG","90","Select","Select",""],["","68180051703","LISINOPRIL ","TAB 40MG","90","Select","Select",""],["","65862059805","TAMSULOSIN ","CAP 0.4MG","30","Select","Select",""],["","69097085902","TERBINAFINE ","TAB 250MG","30","Select","Select",""],["","3089421","ELIQUIS ","TAB 5MG","180","Select","Select",""],["","53746051110","SPIRONOLACT ","TAB 25MG","90","Select","Select",""],["","69097040907","METOPROL ","TAB 200MG ER","90","Select","Select",""],["","51862024230","AMIODARONE ","TAB 400MG","90","Select","Select",""],["","53489015610","ALLOPURINOL ","TAB 100MG","90","Select","Select",""],["","60505258008","ATORVASTATIN ","TAB 40MG","90","Select","Select",""],["","67877012405","SILVER ","CRE 0.01","50","Select","Select",""],["","50383070016","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","52817031910","BACLOFEN ","TAB 5MG","150","Select","Select",""],["","68382009405","CARVEDILOL ","TAB 12.5MG","180","Select","Select",""],["","93314705","CEPHALEXIN ","CAP 500MG","28","Select","Select",""],["","143211205","DOXYCYCL ","TAB 100MG","20","Select","Select",""],["","45802005505","TRIAMCINOLON ","OIN 0.001","30","Select","Select",""],["","69315090401","LORAZEPAM ","TAB 0.5MG","90","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","14","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":[[["Select","Select","","","","","Select","",""],["Select","Select","","","","","Select","",""],["Select","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Select","Select","","","","","Select","",""],["No","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":""}]}]}