{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"GEORGE   E KESSLER","gend":0,"add":"207 PINERIDGE LN","city":"CHARLOTTESVILLE","state":"VA","zip":"22911-9125","dob":"1959-09-29","age":"","mstatus":"","insh":10052331,"cliId":"","pno":4349732031,"cno":4349732031,"email":"","ename":"","eno":"","pphy":"DAVISON, JOHN S","ppno":4349757700,"pcpadd":"1800 Timberwood Blvd Ste A, ","pcpcity":"Charlottesville","pcpstate":"VA","pcpzip":229117544,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"207 PINERIDGE LN","madd2":"                                                            ","madd3":"","mcity":"CHARLOTTESVILLE","mstate":"VA","mzip":"22911-9125","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I26.99","M79.89","F32.89","M51.35","M50.30","G89.29","M54.5","R19.7","S72.145A","S79.912A","S72.002A","Z86.711","R26.81","F11.20","M51.36","E66.01","K59.00","L30.9","Z79.02","M54.42","G89.21","L30.8","S72.142A","R45.851","D64.9","S72.002D","R68.89","M79.605","M54.40","S72.142D","I82.412","I82.402","M54.16","M54.2","M54.10","L90.5","R29.6","R26.89","Z79.891","F51.3","F33.1","R29.898","I82.432","I82.5Y2","Z96.641","F17.200","Z79.899","F32.9","R22.42","M25.551","M19.90","R22.2","M25.559","S72.009A","R27.9","Z74.3","M17.12","Z98.1","M62.81","R93.7","L53.9","F17.220","Z79.01","Z91.14","M79.609","I82.4Z2","M79.9","W01.0XXA","Z66","J98.11","I45.10","Z80.3","M25.552","Z23","M79.652","R35.0","Z12.5","M54.17","Z98.890","T45.516A","Z74.09","Z72.0","Z87.81","Z96.643"],"date":["2020-10-30","2020-03-06","2020-10-30","2021-03-29","2021-03-29","2021-02-10","2019-07-29","2019-07-29","2019-09-02","2019-09-02","2019-09-09","2020-06-22","2019-11-02","2020-02-16","2021-03-29","2019-11-02","2019-11-02","2020-02-16","2019-11-02","2021-02-10","2020-05-13","2019-09-09","2019-09-14","2019-09-09","2019-09-08","2019-09-23","2020-02-19","2020-03-06","2021-02-10","2019-12-02","2020-02-19","2020-05-11","2021-02-10","2021-02-10","2021-02-10","2019-03-28","2019-09-09","2019-09-09","2020-03-06","2019-09-09","2019-09-10","2019-09-09","2020-02-16","2020-03-06","2019-05-16","2019-07-29","2019-09-14","2019-09-02","2019-11-13","2019-11-13","2019-11-13","2019-01-02","2019-09-02","2019-09-14","2019-09-20","2019-09-20","2019-09-23","2019-09-23","2019-09-23","2019-12-02","2020-03-06","2020-03-06","2020-06-22","2020-03-06","2020-03-06","2020-06-22","2019-01-11","2019-09-02","2020-02-16","2019-09-02","2019-09-02","2019-09-02","2019-09-23","2021-01-15","2019-11-18","2021-01-15","2021-01-15","2019-05-16","2019-05-16","2020-02-16","2020-02-16","2020-02-16","2020-02-16","2020-02-16"],"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":[["","10702000801","OXYCODONE ","TAB 15MG","150","Select","Select",""],["","00832105410","BACLOFEN ","TAB 10MG","60","Select","Select",""],["","68462080001","METHADONE ","TAB 5MG","60","Select","Select",""],["","50458057930","XARELTO ","TAB 20MG","30","Select","Select",""],["","69097083412","SERTRALINE ","TAB 50MG","30","Select","Select",""],["","67877025130","TRIAMCINOLON ","CRE 0.001","30","Select","Select",""],["","68382003416","VENLAFAXINE ","CAP 37.5 ER","30","Select","Select",""],["","00603188016","LIDOCAINE ","PAD 0.05","30","Select","Select",""],["","76385012450","METHOCARBAM ","TAB 750MG","40","Select","Select",""],["","59779009902","CORTISONE ","CRE 0.01","28.4","Select","Select",""],["","57237001401","TAMSULOSIN ","CAP 0.4MG","30","Select","Select",""],["","65862001501","AMOXICILLIN ","TAB 875MG","20","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","",""],["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":""}]}]}