{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"HUNTER   E EARHART","gend":0,"add":"93 NEFF DR                                                  ","city":"STUARTS DRAFT                 ","state":"VA","zip":"24477-2901","dob":"1967-11-09","age":"","mstatus":"","insh":10052568,"cliId":"","pno":5402940213,"cno":5402940213,"email":"","ename":"","eno":"","pphy":"HOSTETTER, SAMUEL A                                         ","ppno":"","pcpadd":"24 Gloucester Rd","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":"93 NEFF DR                                                  ","madd2":"                                                            ","madd3":"","mcity":"STUARTS DRAFT                 ","mstate":"VA","mzip":"24477-2901","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K80.20","Q44.1","Z94.0","Z01.810","Z79.899","Z48.298","N25.81","Z71.89","Z85.820","K21.9","K80.10","R23.8","S31.139D","T16.1XXA","Z90.49","Z51.81","K21.0","K22.10","K29.50","J06.9","N17.9","E86.0","R42","R55","R11.2","R53.1","I10","Z88.2","Z79.82","E78.5","N18.9","D63.1","L57.0","D49.2","L73.8","L21.8","H25.12","Z96.1","Z98.41","C80.1","D48.5","L90.5","R53.83","J01.40","R07.89","Z87.19","K43.2","H61.23","H60.501","R09.81","D50.9","Z12.11","K44.9","D12.8","D12.2","K52.9","K43.9","D84.9","Z83.71","D64.9","K29.40","D13.2","K63.5","K63.89","K62.1","K31.89","L82.1","D23.5","H60.503","Z71.85","Z23","E21.3","E55.9","Z20.89","E11.8","L91.8","M25.522","M70.22"],"date":["2019-03-01","2019-04-09","2021-10-06","2019-02-05","2021-10-05","2019-02-19","2021-10-05","2020-02-25","2020-02-25","2021-10-05","2019-03-01","2019-03-10","2019-04-22","2019-03-12","2019-06-19","2021-07-01","2019-07-12","2019-05-03","2020-11-11","2019-05-18","2019-06-19","2019-06-19","2019-06-19","2019-06-19","2019-06-19","2019-06-19","2019-07-12","2020-11-11","2019-06-19","2021-10-06","2020-11-02","2020-11-02","2020-11-12","2021-11-11","2019-11-05","2019-11-05","2021-04-13","2021-04-13","2021-04-13","2019-11-12","2019-12-11","2019-12-11","2021-10-06","2020-03-23","2020-03-23","2020-09-17","2020-09-30","2021-09-09","2020-10-27","2020-10-27","2020-11-11","2020-11-11","2020-11-11","2020-11-11","2020-11-11","2020-11-11","2020-11-11","2020-11-11","2020-11-11","2020-11-11","2020-11-11","2020-11-11","2020-11-11","2020-11-11","2020-11-11","2020-11-11","2020-11-12","2020-11-12","2021-09-09","2021-10-05","2021-10-05","2021-10-06","2021-10-06","2021-10-06","2021-10-06","2021-11-11","2021-11-19","2021-11-19"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",null,"","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",null,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":[["","60505296507","MYCOPHENOLIC","180MG DR","120","Select","Select",""],["","68992307503","ENVARSUS","0.75MG","60","Select","Select",""],["","68001038100","LABETALOL","100MG","60","Select","Select",""],["","00527293243","PREDNISONE","5MG","30","Select","Select",""],["","65862056090","PANTOPRAZOLE","40MG","60","Select","Select",""],["","00093077198","PRAVASTATIN","10MG","30","Select","Select",""],["","24208041010","OFLOXACIN","0.3%OTIC","10","Select","Select",""],["","10572030201","PEG-3350\/KCL","\/SODIUM","4,000.00","Select","Select",""],["","49281012065","FLUZONE","PF 20-21","0.7","Select","Select",""],["","42571016242","AMOX\/K","875-125","20","Select","Select",""],["","60505082901","FLUTICASONE","50MCG","16","Select","Select",""],["","00093317431","ALBUTEROL","E","8.5","Select","Select",""],["","60505296507","MYCOPHENOLIC ","TAB 180MG DR","120","Select","Select",""],["","68992307503","ENVARSUS ","TAB 0.75MG","60","Select","Select",""],["","68001038100","LABETALOL ","TAB 100MG","60","Select","Select",""],["","00527293243","PREDNISONE ","TAB 5MG","30","Select","Select",""],["","65862056090","PANTOPRAZOLE ","TAB 40MG","60","Select","Select",""],["","00093077198","PRAVASTATIN ","TAB 10MG","30","Select","Select",""],["","24208041010","OFLOXACIN ","DRO 0.3%OTIC","10","Select","Select",""],["","10572030201","PEG-3350\/KCL ","SOL \/SODIUM","4,000.00","Select","Select",""],["","49281012065","FLUZONE ","INJ PF 20-21","0.7","Select","Select",""],["","42571016242","AMOX\/K ","TAB 875-125","20","Select","Select",""],["","60505082901","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","00093317431","ALBUTEROL ","FAT E","8.5","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":""}]}]}