{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"GERALDINE H TAYLOR","gend":1,"add":"3351 AUTUMN WINDS LANE  ","city":"CHARLOTTESVILLE","state":"VA","zip":"22903-7939","dob":"1962-11-16","age":"","mstatus":"","insh":11015677,"cliId":"5AU3CV6RE07","pno":4342963063,"cno":4346073568,"email":"","ename":"","eno":"","pphy":"DEGEORGE, KATHARINE C","ppno":4342434660,"pcpadd":"4916 Plank Rd Unit 205","pcpcity":"North Garden","pcpstate":"VA","pcpzip":229591613,"pcpcounty":"","pcpid":"P0060034","pcpname":"UVA CROSSROADS FAMILY PRACTICE","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"","add2":"","add3":"","madd1":"3351 AUTUMN WINDS LANE  ","madd2":"","madd3":"","mcity":"CHARLOTTESVILLE","mstate":"VA","mzip":"22903-7939","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["F40.01","R07.9","R55","N63.0","K59.00","N63.14","I10","E78.5","E87.1","N64.4","Z80.0","Z80.3","G43.109","F43.10","E74.39","Z79.899","R10.33","R10.13","Z72.0","I49.9","Z13.6","I70.0","F41.9","F32.9","Z53.21","R29.898"],"date":["2021-08-30","2021-08-24","2020-11-06","2020-09-09","2020-09-04","2020-09-09","2021-05-10","2021-05-10","2020-09-08","2020-09-09","2020-09-09","2020-09-09","2020-09-14","2020-10-08","2020-11-06","2020-11-06","2021-01-19","2021-01-19","2021-05-10","2021-02-08","2021-03-04","2021-03-04","2021-08-30","2021-08-30","2021-08-24","2021-11-19"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","",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":[["","93083205","CLONAZEPAM","TAB 0.5MG","","Select","Select",""],["","115165903","PROPRANOLOL","TAB 10MG","","Select","Select",""],["","70377000712","ROSUVASTATIN","TAB 10MG","","Select","Select",""],["","31722057330","ESOMEPRA MAG","CAP 40MG DR","","Select","Select",""],["","93083205","CLONAZEPAM ","TAB 0.5MG","60","Select","Select",""],["","70377000712","ROSUVASTATIN ","TAB 10MG","90","Select","Select",""],["","115165903","PROPRANOLOL ","TAB 10MG","135","Select","Select",""],["","31722057330","ESOMEPRA ","40MG DR","30","Select","Select",""],["","31722057330","ESOMEPRA","40MG DR","30","Select","Select",""],["","65862001205","SERTRALINE","50MG","90","Select","Select",""],["","65862001205","SERTRALINE ","TAB 50MG","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","",""],["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":""}]}]}