{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ALFRED BUSH","gend":0,"add":"183 CHINA CLAY RD                                           ","city":"STUARTS DRAFT                 ","state":"VA","zip":"24477-2546","dob":"1957-01-10","age":"","mstatus":"","insh":10051663,"cliId":"","pno":5404141610,"cno":5404141610,"email":"","ename":"","eno":"","pphy":"HOSTETTER, SAMUEL A                                         ","ppno":"","pcpadd":"24 Gloucester Rd,Ste K","pcpcity":"Stuarts Draft                 ","pcpstate":"VA","pcpzip":244773321,"pcpcounty":"","pcpid":"P0060033","pcpname":"UVA STUARTS DRAFT FAMILY PRACTICE ASSOCIATES","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"183 CHINA CLAY RD                                           ","madd2":"                                                            ","madd3":"","mcity":"STUARTS DRAFT                 ","mstate":"VA","mzip":"24477-2546","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["C15.4","C15.5","E11.649","I49.3","Z98.890","Z72.0","E11.9","Z79.4","E78.00","I10","G47.33","F17.200","K21.9","C15.9","R53.83","M17.9","Z00.00","R42","R00.8","R55","Z12.11","Z01.810","I49.9","I49.1","I34.0","I36.1","R05","Z87.891"],"date":["2019-12-10","2021-11-22","2019-03-26","2021-06-16","2019-07-10","2019-07-10","2021-11-22","2019-11-26","2019-11-26","2020-08-04","2019-11-26","2019-11-26","2019-11-26","2019-12-10","2020-08-11","2020-10-16","2021-04-02","2021-06-16","2021-04-02","2021-05-10","2021-04-02","2021-05-10","2021-05-10","2021-06-16","2021-06-16","2021-05-10","2021-09-24","2021-09-24"],"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":[]},{"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":[["","68645055354","LISINOPRIL","20MG","45","Select","Select",""],["","68001035703","METOPROL","50MG ER","30","Select","Select",""],["","00193731221","CONTOUR","NEXT","100","Select","Select",""],["","00006027754","JANUVIA","100MG","30","Select","Select",""],["","65862056090","PANTOPRAZOLE","40MG","180","Select","Select",""],["","00088221905","LANTUS","100\/ML","15","Select","Select",""],["","00193730850","BAYER","XT 50CT","100","Select","Select",""],["","63304090090","FENOFIBRATE","54MG","90","Select","Select",""],["","69097052444","DICLOFENAC","1%","100","Select","Select",""],["","50383066730","LIDO\/PRILOCN","2.5-2.5%","30","Select","Select",""],["","68180096301","ALBUTEROL","HFA","8.5","Select","Select",""],["","08290320122","BD PEN NEEDL","32GX4MM","100","Select","Select",""],["","68645055354","LISINOPRIL ","TAB 20MG","45","Select","Select",""],["","68001035703","METOPROL ","TAB 50MG ER","30","Select","Select",""],["","00193731221","CONTOUR ","TES NEXT","100","Select","Select",""],["","00006027754","JANUVIA ","TAB 100MG","30","Select","Select",""],["","65862056090","PANTOPRAZOLE ","TAB 40MG","180","Select","Select",""],["","99073070822","FREESTYLE    TES LITE","TES LITE","100","Select","Select",""],["","99073070805","FREESTYLE    KIT LITE","KIT LITE","1","Select","Select",""],["","99073013001","FREESTYLE    MIS LANCETS","MIS LANCETS","100","Select","Select",""],["","00088221905","LANTUS ","INJ 100\/ML","15","Select","Select",""],["","00193730850","BAYER ","NE XT 50CT","100","Select","Select",""],["","63304090090","FENOFIBRATE ","TAB 54MG","90","Select","Select",""],["","69097052444","DICLOFENAC ","GEL 0.01","100","Select","Select",""],["","50383066730","LIDO\/PRILOCN ","CRE 2.5-2.5%","30","Select","Select",""],["","68180096301","ALBUTEROL ","AER HFA","8.5","Select","Select",""],["","08290320122","BD  PEN NEEDL","MIS 32GX4MM","100","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":""}]}]}