{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ELSIE   L WEST","gend":1,"add":"553 BRIDGE RD                                               ","city":"MINERAL                       ","state":"VA","zip":"23117-3912","dob":"1950-03-25","age":"","mstatus":"","insh":10053465,"cliId":"","pno":5408949458,"cno":"","email":"","ename":"","eno":"","pphy":"DOWDELL, KIMBERLY J                                         ","ppno":"","pcpadd":"415 Ray C Hunt Dr","pcpcity":"Charlottesville               ","pcpstate":"VA","pcpzip":229032980,"pcpcounty":"","pcpid":"P0060016","pcpname":"UNIVERSITY PHYSICIANS CHARLOTTESVILLE CLINC","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"553 BRIDGE RD                                               ","madd2":"                                                            ","madd3":"","mcity":"MINERAL                       ","mstate":"VA","mzip":"23117-3912","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N18.2","I10","E79.0","E11.9","R31.29","D63.1","E83.52","N18.3","M85.88","J20.9","K21.0","R09.89","Z12.31","Z80.3","E78.2","N18.9","H25.13","H52.03","H52.221","H52.4","Z86.010","N32.81","J31.0","D72.819","M79.644","M65.341","N95.0","N93.9","N84.1","D25.1","N39.0","R35.0","M50.322","M40.50","M47.812","M54.2","M62.838","E55.9","N84.0","Z23","M19.012","M25.512","G89.29","K62.89","M75.82","E21.3","K59.4","H10.9","G44.009","H40.053","H35.40","H35.033","K21.9","R10.84","Z13.31","M79.643","R31.0","R39.9","H40.013","H35.031","H35.032","R10.33","Z87.19","R31.9","R10.32","K57.10","R10.9","N34.2","Z83.49","L04.9","R22.1","K59.01","E87.5","R05","E87.6","E78.5","H61.22","H93.8X1","H61.21","N18.31","E21.0","R30.0","N18.30","Z11.59","S43.014A","S49.91XA","W06.XXXA","Y92.009","R20.0","M25.50","Z88.1","Z88.5","Z88.0","S49.90XA","S43.004A","M25.511","S43.004D","H52.223","M17.12","M11.262","M19.011","M25.562","G56.01"],"date":["2019-02-21","2021-10-28","2019-02-21","2021-08-30","2020-08-03","2021-08-30","2021-10-28","2020-09-01","2019-04-02","2020-09-09","2019-11-11","2019-06-25","2021-07-27","2021-07-27","2021-08-30","2021-08-30","2021-06-21","2021-06-21","2019-05-07","2021-06-21","2021-08-30","2019-11-11","2019-06-25","2019-05-28","2019-08-14","2020-05-27","2019-09-19","2019-09-19","2019-07-11","2019-07-16","2019-07-26","2020-08-12","2019-08-21","2019-08-21","2019-08-21","2019-08-21","2019-08-21","2021-08-30","2019-09-19","2021-10-04","2019-10-25","2019-10-25","2021-07-14","2019-10-21","2019-10-25","2021-10-11","2019-11-15","2019-12-31","2020-02-11","2020-02-18","2020-02-18","2020-06-15","2020-08-28","2020-03-23","2020-05-11","2020-05-27","2020-06-10","2020-06-10","2021-06-21","2020-06-15","2020-06-15","2020-06-24","2020-06-24","2020-08-03","2020-06-24","2020-07-06","2020-07-06","2020-08-12","2020-09-01","2020-09-01","2020-10-01","2020-09-03","2020-09-09","2020-09-11","2020-09-09","2020-09-09","2020-10-26","2021-01-05","2021-01-05","2021-10-28","2021-10-28","2021-02-15","2021-08-30","2021-03-03","2021-03-10","2021-03-10","2021-03-10","2021-03-10","2021-03-10","2021-03-10","2021-03-10","2021-03-10","2021-03-10","2021-03-10","2021-03-12","2021-07-14","2021-08-16","2021-06-21","2021-07-14","2021-07-14","2021-07-14","2021-07-14","2021-08-16"],"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":[["","00093727098","PRAVASTATIN","80MG","30","Select","Select",""],["","68180098201","LISINOPRIL","30MG","30","Select","Select",""],["","00054327099","FLUTICASONE","50MCG","16","Select","Select",""],["","00904582460","VITAMIN","1000UNIT","30","Select","Select",""],["","00193707025","CONTOUR","BLD GLUC","25","Select","Select",""],["","49884093547","DICLOFENAC","1%","100","Select","Select",""],["","50428031441","CVS","1000UNIT","90","Select","Select",""],["","62756052069","SUMATRIPTAN","25MG","9","Select","Select",""],["","33342009809","TOLTERODINE","2MG","60","Select","Select",""],["","65862085901","FAMOTIDINE","20MG","60","Select","Select",""],["","65862042005","SMZ\/TMP","800-160","14","Select","Select",""],["","00781808926","AZITHROMYCIN","250MG","6","Select","Select",""],["","57237000511","FLUCONAZOLE","150MG","1","Select","Select",""],["","51293081001","PHENAZOPYRID","100MG","16","Select","Select",""],["","62559043130","HYDROCORTISO","2.50%","30","Select","Select",""],["","58160081912","SHINGRIX","50\/0.5ML","1","Select","Select",""],["","29300012410","MELOXICAM","7.5MG","30","Select","Select",""],["","31604002677","D3","1000UNIT","90","Select","Select",""],["","65162062711","TRAMADOL","50MG","10","Select","Select",""],["","57237007730","ONDANSETRON","4MG ODT","20","Select","Select",""],["","55111012701","CIPROFLOXACN","500MG","20","Select","Select",""],["","59267100002","PFIZER","COVID-19","0.3","Select","Select",""],["","65862018601","CLINDAMYCIN","300MG","21","Select","Select",""],["","00093727098","PRAVASTATIN ","TAB 80MG","30","Select","Select",""],["","68180098201","LISINOPRIL ","TAB 30MG","30","Select","Select",""],["","00054327099","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","00904582460","VITAMIN ","TAB 1000UNIT","30","Select","Select",""],["","00193707025","CONTOUR ","TES BLD GLUC","25","Select","Select",""],["","49884093547","DICLOFENAC ","GEL 0.01","100","Select","Select",""],["","50428031441","CVS ","CAP 1000UNIT","90","Select","Select",""],["","62756052069","SUMATRIPTAN ","TAB 25MG","9","Select","Select",""],["","33342009809","TOLTERODINE ","TAB 2MG","60","Select","Select",""],["","65862085901","FAMOTIDINE ","TAB 20MG","60","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","14","Select","Select",""],["","00781808926","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","57237000511","FLUCONAZOLE ","TAB 150MG","1","Select","Select",""],["","51293081001","PHENAZOPYRID ","TAB 100MG","16","Select","Select",""],["","62559043130","HYDROCORTISO ","CRE 0.025","30","Select","Select",""],["","58160081912","SHINGRIX ","INJ 50\/0.5ML","1","Select","Select",""],["","29300012410","MELOXICAM ","TAB 7.5MG","30","Select","Select",""],["","31604002677","D3 ","CAP 1000UNIT","90","Select","Select",""],["","65162062711","TRAMADOL ","TAB 50MG","10","Select","Select",""],["","57237007730","ONDANSETRON ","TAB 4MG ODT","20","Select","Select",""],["","55111012701","CIPROFLOXACN ","TAB 500MG","20","Select","Select",""],["","59267100002","PFIZER ","INJ COVID-19","0.3","Select","Select",""],["","65862018601","CLINDAMYCIN ","CAP 300MG","21","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":""}]}]}