{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CURLESTER D JACKSON","gend":1,"add":"100 BARBOUR DR APT A ","city":"CHARLOTTESVILLE","state":"VA","zip":"22903-9998","dob":"1958-03-18","age":"","mstatus":"","insh":11014129,"cliId":"9R78RQ0XG61","pno":4342960075,"cno":4342022125,"email":"","ename":"","eno":"","pphy":"BROWN, JACQUELINE T  ","ppno":4349241984,"pcpadd":"1215 Lee St Fl 3","pcpcity":"Charlottesville","pcpstate":"VA","pcpzip":229080816,"pcpcounty":"","pcpid":"P0129563","pcpname":"UVA TRANSITIONAL CARE HOSPITAL","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"","add2":"","add3":"","madd1":"100 BARBOUR DR APT A ","madd2":"","madd3":"","mcity":"CHARLOTTESVILLE","mstate":"VA","mzip":"22903-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["Z00.00","K59.00","K21.9","E55.9","R05","J06.9","M25.511","F32.9","M19.90","B37.2","K59.04","L21.9","L30.8","F20.9","H61.23","Z79.899","H25.813","H11.133","Z12.31","F72","H25.093","H11.132"],"date":["2021-07-20","2021-07-20","2020-07-15","2021-07-20","2021-07-20","2021-07-20","2020-07-15","2021-07-20","2021-07-20","2021-07-20","2021-07-20","2021-07-20","2021-07-20","2020-07-15","2021-07-20","2021-03-11","2020-08-18","2020-08-18","2021-03-09","2021-10-06","2021-11-24","2021-11-24"],"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":[["","33332042010","AFLURIA QUAD","INJ 2020-21","","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","","Select","Select",""],["","66993068130","OLANZAPINE","TAB 5MG","","Select","Select",""],["","43547028111","ESCITALOPRAM","TAB 10MG","","Select","Select",""],["","603243832","BENZTROPINE","TAB 1MG","","Select","Select",""],["","58657070301","HALOPERIDOL","TAB 5MG","","Select","Select",""],["","51672413001","LAMOTRIGINE","TAB 25MG","","Select","Select",""],["","832046560","NYAMYC","POW 100000","","Select","Select",""],["","45802004064","SELENIUM SUL","LOT 0.025","","Select","Select",""],["","67877031901","IBUPROFEN","TAB 400MG","","Select","Select",""],["","60505082901","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","43598016430","OLANZAPINE ","TAB 5MG","31","Select","Select",""],["","603243832","BENZTROPINE ","TAB 1MG","62","Select","Select",""],["","43547028111","ESCITALOPRAM ","TAB 10MG","31","Select","Select",""],["","58657070301","HALOPERIDOL ","TAB 5MG","62","Select","Select",""],["","16714070101","LAMOTRIGINE ","TAB 100MG","62","Select","Select",""],["","33332042010","AFLURIA ","INJ 2020-21","0.5","Select","Select",""],["","67877031901","IBUPROFEN ","TAB 400MG","30","Select","Select",""],["","832046560","NYAMYC ","100000","60","Select","Select",""],["","45802004064","SELENIUM ","2.50%","120","Select","Select",""],["","33332042010","AFLURIA","2020-21","0.5","Select","Select",""],["","67877025115","TRIAMCINOLON","0.001","240","Select","Select",""],["","45802004064","SELENIUM","0.025","120","Select","Select",""],["","67877025115","TRIAMCINOLON ","CRE 0.001","240","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","",""],["Yes","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":""}]}]}