{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" JANICE M CAMPBELL","gend":1,"add":"1104 PINEHURST COURTS","city":"CHARLOTTESVILLE","state":"VA","zip":"22902-6412","dob":"1958-01-05","age":"","mstatus":"","insh":10051030,"cliId":"","pno":"4348257601, 4342188735","cno":4349796256,"email":"","ename":"","eno":"","pphy":"LEINER, JOHN G","ppno":"               ","pcpadd":"1221 Lee Street, 4th Floor","pcpcity":"Charlottesville","pcpstate":"VA","pcpzip":229080001,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP - VIRGINIA PREMIER","program":"MEDICAID","lob":"MLTSS","region":"WESTERN","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"1104 PINEHURST COURTS","madd2":"                                                            ","madd3":"","mcity":"CHARLOTTESVILLE","mstate":"VA","mzip":"22902-6412","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["C32.0","C32.1","Z43.0","J40","J43.2","J02.9","E11.42","I11.0","I50.42","E11.51","I25.10","I27.20","M62.81","I25.2","Z79.82","Z79.84","G89.29","M25.562","Z88.0","Z88.8","Z88.3","Z91.040","Z85.21","J39.2","Z93.0","C32.9","K63.9","I50.22","I10","E78.5","I25.5","I51.9","D69.6","R06.02","I34.0","E11.8","G62.9","Z87.891","E11.69","Z98.890","Z95.5","I73.9","R94.39","I65.23","A60.9","L30.9","R22.1","Z86.018","D12.4","E53.8","R07.89","R30.0","Z92.3","I49.1","R49.0","Q31.0","R13.10","J44.9","R05","K21.9","J32.9","J43.9","R93.89","Z01.810","J38.3","D12.2","R93.3","D12.3","D12.0","Z80.0","E11.9","Z79.4","G47.33","R09.89","M62.838","B37.3","B37.2","E55.9","E11.65","E03.9","Z23","Z86.010","D12.6","H25.13","H53.451","L03.032","J38.4","R06.00","J38.6","J38.01","R06.1","Z09","F41.9","G89.3","Z79.899","Z00.00","L02.611","L03.031","M79.674","L60.0","M79.675","H93.8X3","H61.21","J30.89","Z12.31","N39.41","N81.4","Z87.448","K63.5","B37.0","J38.7","R13.12","E11.3593","B37.9","J98.09","N36.2","M79.89","Z92.21","K64.9","D12.5","K62.1","J95.09","Z80.41","Z80.52","Z80.3","Z80.51","M17.12","Z87.09","G60.9","C76.0","E78.2","N76.5","M25.511","R80.9","Z91.81","R06.2"],"date":["2020-08-18","2019-05-06","2019-05-06","2019-03-01","2021-03-03","2020-06-11","2021-03-02","2019-05-06","2019-03-01","2019-05-06","2021-03-03","2019-03-01","2019-05-06","2021-03-03","2019-03-01","2019-03-01","2019-03-11","2019-03-11","2019-03-11","2019-03-11","2019-03-11","2019-03-11","2020-06-11","2019-03-19","2020-01-03","2021-04-29","2019-03-29","2020-09-02","2021-03-03","2021-03-03","2021-03-24","2021-03-03","2019-06-13","2021-03-03","2020-09-02","2019-06-13","2021-03-03","2021-03-03","2021-03-03","2021-03-03","2021-03-03","2020-11-23","2020-09-02","2020-09-02","2019-10-22","2020-01-03","2020-01-03","2020-01-13","2020-01-13","2021-04-30","2021-03-03","2020-04-14","2020-12-16","2020-09-02","2021-04-29","2021-04-29","2021-01-28","2020-11-06","2019-12-23","2019-04-22","2020-03-13","2019-12-23","2019-03-29","2021-01-12","2019-07-17","2019-04-22","2019-04-22","2019-04-22","2019-07-01","2021-03-11","2019-04-22","2021-04-27","2020-09-02","2019-05-23","2019-08-01","2019-08-01","2019-08-01","2019-10-10","2021-04-27","2021-02-04","2020-10-01","2020-01-13","2020-01-13","2020-08-18","2020-08-18","2020-10-01","2021-04-29","2021-04-29","2021-04-29","2021-04-29","2021-04-29","2021-04-30","2019-01-07","2019-05-06","2019-05-06","2019-10-30","2020-11-03","2020-11-03","2020-11-03","2020-11-23","2020-11-23","2020-12-17","2020-12-17","2020-12-17","2021-03-11","2019-12-26","2019-12-26","2019-12-26","2020-01-13","2020-06-11","2020-06-11","2020-06-11","2021-03-02","2019-06-26","2019-12-23","2019-12-26","2020-01-03","2020-01-03","2020-01-13","2020-01-13","2020-01-13","2020-06-24","2021-03-11","2021-03-11","2021-03-11","2021-03-11","2019-03-11","2021-03-03","2020-06-03","2020-09-22","2020-10-29","2019-10-01","2020-07-28","2021-02-04","2019-01-09","2019-12-23"],"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":[["","59310057922","PROAIR ","AER ","8.5","Select","Select",""],["","45802065078","LORATADINE ","TAB 10MG","30","Select","Select",""],["","00054327099","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","00006027731","JANUVIA ","TAB 100MG","30","Select","Select",""],["","00002822259","INSULIN ","INJ 100\/ML","15","Select","Select",""],["","59746000103","METHYLPRED ","TAB 4MG","21","Select","Select",""],["","68180051303","LISINOPRIL ","TAB 5MG","30","Select","Select",""],["","00378180310","LEVOTHYROXIN ","TAB 50MCG","30","Select","Select",""],["","50742061610","METOPROL ","TAB 50MG ER","30","Select","Select",""],["","70377003012","ATORVASTATIN ","TAB 80MG","30","Select","Select",""],["","00088222033","LANTUS ","INJ 100\/ML","10","Select","Select",""],["","00093317431","ALBUTEROL ","FAT E","8.5","Select","Select",""],["","00527518070","SMZ-TMP ","SUS 200-40\/5","280","Select","Select",""],["","00173086910","ANORO ","AER 62.5-25","60","Select","Select",""],["","00000000000",""," ","150","Select","Select",""],["","00487930103","SOD ","NEB 0.009","90","Select","Select",""],["","68308015215","NYSTATIN ","POW 100000","45","Select","Select",""],["","31722070530","VALACYCLOVIR ","TAB 1GM","30","Select","Select",""],["","68382075810","METFORMIN ","TAB 500MG","120","Select","Select",""],["","00378020810","FUROSEMIDE ","TAB 20MG","30","Select","Select",""],["","57599080000","FREESTY ","KIT 2 SENSOR","2","Select","Select",""],["","00002831501","HUMULIN ","INJ U-100","10","Select","Select",""],["","68462074635","ACYCLOVIR ","OIN 0.05","30","Select","Select",""],["","00378967130","IPRATROPIUM\/ ","SOL ALBUTER","180","Select","Select",""],["","00193731150","CONTOUR ","TES NEXT","50","Select","Select",""],["","24658031205","DOXYCYCL ","TAB 100MG","20","Select","Select",""],["","43598029390","PREGABALIN ","CAP 75MG","60","Select","Select",""],["","43598043611","NITROGLYCERN ","SUB 0.4MG","25","Select","Select",""],["","59746028390","PANTOPRAZOLE ","TAB 20MG","30","Select","Select",""],["","43547040611","CLONAZEPAM ","TAB 0.5MG","14","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","14","Select","Select",""],["","00597007541","SPIRIVA ","CAP HANDIHLR","30","Select","Select",""],["","70710113908","FLUCONAZOLE ","TAB 150MG","3","Select","Select",""],["","00597015290","JARDIANCE ","TAB 10MG","30","Select","Select",""],["","10702001250","HYDROXYZ ","TAB 50MG","30","Select","Select",""],["","68180012202","CEPHALEXIN ","CAP 500MG","20","Select","Select",""],["","51672130406","TERCONAZOLE ","CRE 0.004","45","Select","Select",""],["","13107008305","LORAZEPAM ","TAB 0.5MG","1","Select","Select",""],["","65162019050","NAPROXEN ","TAB 500MG","20","Select","Select",""],["","08317880128","TECHLITE ","MIS LANCETS","100","Select","Select",""],["","60505014201","GLIPIZIDE ","TAB 10MG","90","Select","Select",""],["","00054418325","DEXAMETHASON ","TAB 2MG","10","Select","Select",""],["","52268001201","SUPREP ","SOL PREP KIT","354","Select","Select",""],["","45802006435","TRIAMCINOLON ","CRE 0.001","45","Select","Select",""],["","00781185220","AMOX\/K ","TAB 875-125","14","Select","Select",""],["","60432024516","APAP\/CODEINE ","SOL 120-12\/5","120","Select","Select",""],["","69097081312","GABAPENTIN ","CAP 100MG","270","Select","Select",""],["","00116200116","CHLORHEX ","SOL 0.0012","473","Select","Select",""],["","00169413212","OZEMPIC ","INJ 2\/1.5ML","4.5","Select","Select",""],["","00378064110","PREDNISONE ","TAB 10MG","30","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":""}]}]}