{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" GARY MORRIS","gend":0,"add":"772 PROSPECT AVENUE","city":"CHARLOTTESVILLE","state":"VA","zip":"22903-3931","dob":"1969-03-03","age":"","mstatus":"","insh":10049682,"cliId":"","pno":"8046916712, 8046916712","cno":8045904250,"email":"","ename":"","eno":"","pphy":"HAWKINS, ANDREW RICHARD","ppno":"               ","pcpadd":"29 Jefferson Ct, ","pcpcity":"Zion Crossroads","pcpstate":"VA","pcpzip":229429602,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP - VIRGINIA PREMIER","program":"MEDICAID","lob":"MLTSS","region":"WESTERN","aligned":"","ano":"","add2":"APT A","add3":"","madd1":"772 PROSPECT AVENUE","madd2":"APT A","madd3":"","mcity":"CHARLOTTESVILLE","mstate":"VA","mzip":"22903-3931","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I50.9","I15.9","I50.23","R68.89","I25.10","I10","R77.8","I47.1","E78.5","R06.02","F17.213","E11.22","I50.21","F14.10","N18.3","R74.8","N18.4","N17.9","N18.9","I13.10","E87.6","E11.9","R07.9","J44.1","R06.9","I42.8","J44.9","F17.210","Z09","G62.9","Z23","I13.0","I24.9","I25.2","Z79.899","Z88.5","Z91.013","Z79.82","I20.9","F17.200","R11.2","R19.7","R10.11","R10.33","R10.13","R10.9","I50.42","K76.6","D64.9","E86.1","F12.90","G89.29","I27.21","I50.82","N49.2","L02.215","I20.0","E87.1","I50.31","I48.92","I42.0","I50.22","K59.04","Z13.31","M1A.0710","N12","R55","R94.5","K76.1","I50.20","M51.86","M54.5","M54.9","V49.50XA","M25.511","E11.65","I47.2","E87.3","I24.8","R07.89","G89.4","M10.9","G47.30","Z79.84","Z95.810","Z91.81","R09.89","K31.89","R18.8","K82.8","K76.89","R94.31","R42","I48.91","R60.9","I34.0","I50.813","I36.1","N18.32","J30.2","I42.9","I50.43","D63.8","E66.9","I44.7","M79.89","I50.1","I51.7","I11.0","M25.50","R00.0","M54.2","D72.829","K63.89","R16.0","I70.0","I70.8","I21.4","K74.60","Z53.29","R79.89","Z53.8","Z72.0","E87.5","G47.33","F11.20","Z95.0","R01.2","Z87.898","K76.0","R05","R10.84","K21.9","Z20.828","Z79.51","R06.00","R11.0","T40.5X1A","I95.2","T50.8X5A","M1A.9XX0","R60.0","M79.604","M79.605","M19.011","S39.82XA","S49.91XA","V89.2XXA","M25.462","D16.22","R22.43","I87.2","E11.40","D63.1","J45.901","R06.2","R61","J81.1","M10.061","I25.5","N35.814","R33.8","I48.0","I44.30","I45.9","I21.19","R50.9","M17.12","I21.9","M51.34","E78.00","R22.33","M10.062","R06.89","R52","R11.11","M17.11","M25.461","M25.561","I95.9","N13.8","N39.0","I44.0","I21.A1","T39.395A","N52.9","E87.70","M25.562","Z91.19","F19.20","I27.20","M12.9","I49.8","Z91.89","R60.1","Z91.011","R06.82","R63.4","R74.0","N35.812","R39.14","N40.1","Z20.9","R14.0"],"date":["2020-08-26","2021-02-03","2021-04-02","2020-09-22","2020-05-17","2021-04-02","2019-05-13","2021-04-16","2020-10-01","2020-11-12","2019-06-09","2020-06-13","2020-05-22","2019-06-15","2020-08-18","2020-07-24","2020-07-28","2020-10-01","2020-10-01","2019-06-22","2020-07-10","2020-10-02","2020-06-26","2021-02-03","2020-07-24","2021-03-24","2021-01-12","2020-06-18","2019-10-16","2019-12-26","2020-09-22","2021-03-26","2019-11-05","2020-06-13","2020-11-12","2020-03-07","2020-03-07","2020-06-13","2019-12-07","2020-06-13","2020-05-08","2020-05-08","2020-05-12","2020-01-10","2020-09-22","2020-08-18","2020-05-08","2020-07-25","2020-05-08","2020-05-08","2020-05-17","2020-05-08","2020-05-08","2020-05-08","2020-05-22","2020-05-22","2020-06-22","2020-07-25","2020-07-13","2020-11-12","2020-07-12","2021-04-16","2020-08-18","2020-08-18","2021-02-03","2020-08-18","2021-03-24","2020-09-22","2020-09-22","2021-01-12","2021-02-01","2021-02-01","2021-02-01","2021-02-01","2021-02-01","2020-07-06","2019-03-21","2019-03-25","2019-03-21","2020-06-18","2019-04-10","2020-05-17","2020-05-17","2019-04-23","2020-07-25","2019-04-23","2019-09-30","2020-05-13","2020-07-27","2020-06-19","2020-06-18","2020-07-13","2020-07-11","2020-07-25","2020-07-13","2020-07-30","2020-07-26","2020-07-26","2021-03-26","2021-02-03","2020-07-06","2020-05-13","2019-06-18","2019-06-15","2019-06-15","2020-07-02","2019-08-01","2020-10-08","2020-07-13","2020-01-06","2020-06-18","2020-01-22","2020-01-22","2020-05-08","2020-07-07","2020-05-08","2020-05-08","2020-06-26","2020-06-26","2020-07-02","2020-07-06","2020-09-04","2020-10-01","2019-05-11","2020-03-07","2019-05-13","2020-11-12","2019-06-05","2019-07-15","2020-02-07","2020-03-07","2020-05-13","2020-06-13","2020-06-18","2020-06-13","2020-07-13","2020-06-18","2020-06-18","2020-06-18","2020-06-18","2020-07-13","2020-07-06","2020-07-06","2020-07-06","2021-02-01","2021-02-01","2021-02-01","2021-02-01","2019-02-16","2019-02-16","2019-02-21","2019-02-21","2020-07-06","2020-07-25","2019-05-10","2019-05-10","2019-05-10","2019-08-31","2020-05-22","2020-06-19","2020-07-08","2020-07-11","2020-07-13","2020-07-13","2020-07-13","2020-07-13","2019-02-15","2019-02-15","2019-02-15","2019-02-15","2019-02-15","2019-02-20","2019-02-22","2020-07-24","2020-07-24","2020-05-08","2020-05-21","2020-05-21","2020-05-21","2020-06-26","2020-07-06","2020-07-25","2020-07-10","2020-07-25","2020-07-25","2021-02-25","2019-02-20","2019-02-20","2019-03-21","2019-05-10","2019-06-05","2020-05-17","2020-06-24","2020-11-12","2019-06-05","2019-09-30","2019-11-05","2020-05-12","2020-05-12","2020-07-13","2020-07-07","2020-07-11","2020-07-24","2020-07-24"],"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":[]},{"a":[]}]},{"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":[["","68382022705","AMIODARONE ","TAB 200MG","90","Select","Select",""],["","00003089421","ELIQUIS ","TAB 5MG","60","Select","Select",""],["","00574027505","POT  CHLORIDE","TAB 10MEQ ER","90","Select","Select",""],["","59779046708","ASPIRIN ","CHW 81MG","30","Select","Select",""],["","00085720601","DULERA ","AER 100-5MCG","13","Select","Select",""],["","00093081001","NORTRIPTYLIN ","CAP 10MG","30","Select","Select",""],["","00185013005","BUMETANIDE ","TAB 2MG","240","Select","Select",""],["","00006011231","JANUVIA ","TAB 50MG","30","Select","Select",""],["","00093317431","ALBUTEROL ","FAT E","8.5","Select","Select",""],["","59310057922","PROAIR ","AER ","8.5","Select","Select",""],["","00378395277","ATORVASTATIN ","TAB 40MG","30","Select","Select",""],["","76385011350","CARVEDILOL ","TAB 25MG","60","Select","Select",""],["","66758019001","KLOR-CON ","TAB 20MEQ ER","30","Select","Select",""],["","59651000305","OMEPRAZOLE ","CAP 40MG","90","Select","Select",""],["","00591565810","CYCLOBENZAPR ","TAB 10MG","24","Select","Select",""],["","57237001401","TAMSULOSIN ","CAP 0.4MG","60","Select","Select",""],["","23155000201","HYDRALAZINE ","TAB 25MG","90","Select","Select",""],["","00378013710","ALLOPURINOL ","TAB 100MG","60","Select","Select",""],["","65162057310","BETHANECHOL ","TAB 25MG","56","Select","Select",""],["","68382065005","ISOSORB ","TAB 30MG ER","30","Select","Select",""],["","68001024704","ONDANSETRON ","TAB 8MG ODT","20","Select","Select",""],["","00254200801","COLCHICINE ","TAB 0.6MG","60","Select","Select",""],["","10702001801","OXYCODONE ","TAB 5MG","6","Select","Select",""],["","45802065087","LORATADINE ","TAB 10MG","90","Select","Select",""],["","70000052601","STOOL ","TAB 8.6-50MG","30","Select","Select",""],["","65862007701","CIPROFLOXACN ","TAB 500MG","14","Select","Select",""],["","53489012005","DOXYCYCL ","TAB 100MG","2","Select","Select",""],["","00054327099","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","00378064110","PREDNISONE ","TAB 10MG","30","Select","Select",""],["","65862050301","AMOX\/K ","TAB 875-125","10","Select","Select",""],["","00536589588","NICOTINE ","DIS 14MG\/24H","28","Select","Select",""],["","49884072703","DOXYCYC ","CAP 100MG","10","Select","Select",""],["","53746051110","SPIRONOLACT ","TAB 25MG","45","Select","Select",""],["","42858010201","OXYCOD\/APAP ","TAB 5-325MG","12","Select","Select",""],["","00093221001","SUCRALFATE ","TAB 1GM","60","Select","Select",""],["","70377000812","ROSUVASTATIN ","TAB 20MG","30","Select","Select",""],["","99073013001","FREESTYLE    MIS LANCETS","MIS LANCETS","100","Select","Select",""],["","57896020401","ACETAMINOPHE ","TAB 500MG","50","Select","Select",""],["","00527512570","LACTULOSE ","SOL 10GM\/15","473","Select","Select",""],["","00378235193","ESOMEPRA ","CAP 40MG DR","2","Select","Select",""],["","49348098053","SM ","TAB 81MG EC","30","Select","Select",""],["","47781047013","OSELTAMIVIR ","CAP 75MG","10","Select","Select",""],["","00254301008","OMEGA-3-ACID ","CAP 1GM","30","Select","Select",""],["","69097094312","GABAPENTIN ","CAP 300MG","60","Select","Select",""],["","00832532511","POT  CL MICRO","TAB 20MEQ ER","30","Select","Select",""],["","66689000802","NYSTATIN ","SUS 100000","60","Select","Select",""],["","58657050016","CODEINE\/GG ","SOL 10-100\/5","60","Select","Select",""],["","00378617201","METOLAZONE ","TAB 2.5MG","60","Select","Select",""],["","68180051202","LISINOPRIL ","TAB 2.5MG","60","Select","Select",""],["","65162019050","NAPROXEN ","TAB 500MG","60","Select","Select",""],["","00085113204","PROVENTIL ","AER HFA","6.7","Select","Select",""],["","00536124710","SENEXON-S ","TAB 8.6-50MG","30","Select","Select",""],["","00603020922","MAG ","TAB 400MG","30","Select","Select",""],["","00527135401","HYDROMORPHON ","TAB 4MG","10","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","",""],["N\/A","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","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":""}]}]}