{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ROBERT   W GENTRY","gend":0,"add":"505 ELLIOT AVENUE                                           ","city":"CHARLOTTESVILLE               ","state":"VA","zip":"22902-6129","dob":"1973-11-30","age":"","mstatus":"","insh":10052398,"cliId":"","pno":4345310999,"cno":4345310999,"email":"","ename":"","eno":"","pphy":"DAVISON, JOHN S                                             ","ppno":"","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":"505 ELLIOT AVENUE                                           ","madd2":"                                                            ","madd3":"","mcity":"CHARLOTTESVILLE               ","mstate":"VA","mzip":"22902-6129","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M54.42","M51.36","M47.816","Z72.0","G89.29","Z23","S61.511A","S49.92XA","M62.838","M54.2","M54.41","M50.322","F17.210","M50.13","M47.22","M47.26","M54.5","F33.1","M47.27","M47.812","M51.17","M48.02","M51.27","M50.122","M47.892","M47.817","F32.9","R20.0","K21.9","F41.9","R20.2","R05","R06.00"],"date":["2021-06-01","2021-06-01","2021-06-01","2021-09-20","2021-06-01","2021-11-19","2019-04-29","2019-06-18","2019-06-18","2020-07-27","2019-12-26","2020-01-10","2020-01-10","2020-02-28","2020-01-10","2020-02-28","2020-07-27","2020-03-25","2020-02-07","2020-02-07","2020-02-07","2020-02-07","2020-02-07","2020-02-28","2020-02-28","2020-07-27","2021-06-01","2021-06-01","2021-06-01","2021-06-01","2021-06-14","2021-09-20","2021-09-20"],"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":[]},{"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":[["","70710123001","AMITRIPTYLIN","150MG","90","Select","Select",""],["","69097094312","GABAPENTIN","300MG","90","Select","Select",""],["","55111015810","OMEPRAZOLE","20MG","90","Select","Select",""],["","69097014260","ALBUTEROL","HFA","6.7","Select","Select",""],["","00069047103","CHANTIX","0.5& 1MG","53","Select","Select",""],["","69097015807","MELOXICAM","7.5MG","12","Select","Select",""],["","68382003616","VENLAFAXINE","150MG ER","30","Select","Select",""],["","49281042050","FLUZONE","2020-21","0.5","Select","Select",""],["","00378064205","PREDNISONE","20MG","8","Select","Select",""],["","67877057305","BENZONATATE","100MG","15","Select","Select",""],["","68180016006","AZITHROMYCIN","250MG","6","Select","Select",""],["","00603188016","LIDOCAINE","5%","60","Select","Select",""],["","70710123001","AMITRIPTYLIN ","TAB 150MG","90","Select","Select",""],["","69097094312","GABAPENTIN ","CAP 300MG","90","Select","Select",""],["","55111015810","OMEPRAZOLE ","CAP 20MG","90","Select","Select",""],["","69097014260","ALBUTEROL ","AER HFA","6.7","Select","Select",""],["","00069047103","CHANTIX ","PAK 0.5& 1MG","53","Select","Select",""],["","69097015807","MELOXICAM ","TAB 7.5MG","12","Select","Select",""],["","68382003616","VENLAFAXINE ","CAP 150MG ER","30","Select","Select",""],["","49281042050","FLUZONE ","INJ 2020-21","0.5","Select","Select",""],["","00378064205","PREDNISONE ","TAB 20MG","8","Select","Select",""],["","67877057305","BENZONATATE ","CAP 100MG","15","Select","Select",""],["","68180016006","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","00603188016","LIDOCAINE ","PAD 0.05","60","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","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["No","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":""}]}]}