{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JOAN   M DEVOE","gend":1,"add":"1584 VALLEY PIKE                                            ","city":"LEXINGTON                     ","state":"VA","zip":"24450-3324","dob":"1961-07-28","age":"","mstatus":"","insh":10055426,"cliId":"","pno":5404632886,"cno":5404632886,"email":"","ename":"","eno":"","pphy":"SCOTT, EVELYN                                               ","ppno":"","pcpadd":"1222 Jefferson Park Ave","pcpcity":"Charlottesville               ","pcpstate":"VA","pcpzip":229033410,"pcpcounty":"","pcpid":"P0060358","pcpname":"UNIVERSITY MEDICAL ASSOCIATES CLINIC","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"APT B7                                                      ","add3":"","madd1":"1584 VALLEY PIKE                                            ","madd2":"APT B7                                                      ","madd3":"","mcity":"LEXINGTON                     ","mstate":"VA","mzip":"24450-3324","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G43.709","G44.89","R51","R68.89","Z87.891","R91.8","J44.9","D69.9","R23.8","D50.0","R74.0","M54.12","M54.2","M96.1","F33.2","M41.9","M47.22","M51.16","M43.16","M54.5","Z98.1","Q76.49","M48.02","M50.11","Q30.9","R93.0","E03.9","M85.80","M81.0","E55.9","E66.9","M79.18","F41.8","G25.81","D68.0","F17.210","Z79.899","Z88.6","Z88.5","L85.9","I87.2","L30.8","M47.812","M47.816","M17.0","M25.461","M17.12","M17.11","M25.561","M25.562","G43.909","M85.89","R29.6","F33.41","G90.50","F32.9","F41.9","Z86.73","Z72.0","M95.4","M54.40","R20.2","R20.0","R41.3","G47.00","M48.07","M51.37","M51.26","R60.0","M54.9","M22.41","M22.42","G89.29","K80.20","S83.281A","M65.861","M23.251","F17.200","M94.261","M94.262","M51.36","M54.16","M23.41","Z47.89","M46.1","M53.3","Z88.8","E78.49","H93.13","Z12.31","I10","G89.4","Z12.2","K44.9","Z01.818","M23.42","H90.3","R26.89","R94.120","I87.1","I89.0","E66.09","Z68.30","E78.3","M25.462","M54.41","R53.83","R51.9","F42.9","Z68.31","F32.1","R41.89","G47.01","Z86.59","Z51.81","M16.0","M79.604","M17.10","G93.89","M19.071","M79.671","M79.89","M77.51","S93.601A"],"date":["2021-09-17","2019-01-23","2020-06-23","2021-07-19","2021-01-21","2020-01-21","2021-07-16","2021-01-22","2020-01-21","2019-01-22","2020-01-21","2021-07-16","2020-06-23","2021-07-23","2019-12-12","2019-03-20","2021-07-16","2020-11-09","2019-03-20","2020-10-29","2020-07-21","2019-03-29","2020-07-21","2020-07-21","2019-04-10","2019-04-10","2021-07-16","2019-10-30","2019-04-29","2021-06-07","2021-07-16","2021-06-17","2019-08-06","2021-07-16","2021-07-16","2021-01-21","2021-08-20","2020-12-21","2020-05-19","2021-08-27","2021-08-27","2020-09-08","2020-07-02","2019-09-16","2021-05-20","2021-05-20","2021-05-20","2021-09-09","2021-05-20","2021-05-20","2021-10-15","2021-06-07","2021-06-07","2021-08-20","2020-05-19","2020-12-21","2021-08-20","2020-05-19","2021-07-16","2020-06-23","2020-07-02","2020-07-02","2020-07-02","2021-07-19","2020-10-26","2020-07-21","2020-07-21","2020-07-21","2021-08-27","2020-09-28","2020-10-05","2021-02-17","2021-10-15","2020-10-23","2020-10-26","2020-10-23","2020-10-23","2020-10-26","2020-11-18","2021-02-17","2021-07-23","2020-11-09","2020-11-18","2021-03-08","2021-07-23","2020-12-21","2020-12-21","2021-01-08","2021-09-07","2021-01-08","2021-10-15","2021-07-23","2021-01-21","2021-01-21","2021-02-15","2021-02-17","2021-09-07","2021-02-25","2021-02-25","2021-04-13","2021-04-13","2021-04-13","2021-04-13","2021-07-14","2021-05-20","2021-10-15","2021-07-14","2021-07-16","2021-07-16","2021-07-16","2021-07-19","2021-07-19","2021-07-19","2021-07-19","2021-08-20","2021-09-09","2021-09-09","2021-09-09","2021-09-17","2021-11-03","2021-11-03","2021-11-03","2021-11-03","2021-11-03"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",null,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":[["","59746011506","PROCHLORPER","10MG","30","Select","Select",""],["","67877026218","RIZATRIPTAN","10MG","9","Select","Select",""],["","69238183407","LEVOTHYROXIN","100MCG","15","Select","Select",""],["","70377002711","ATORVASTATIN","10MG","30","Select","Select",""],["","62332003031","ROPINIROLE","0.25MG","90","Select","Select",""],["","65862069790","VENLAFAXINE","150MG ER","60","Select","Select",""],["","13107003234","MIRTAZAPINE","45MG","30","Select","Select",""],["","00172392670","DIAZEPAM","5MG","75","Select","Select",""],["","59310057922","PROAIR","","8.5","Select","Select",""],["","51293080401","SALSALATE","750MG","270","Select","Select",""],["","68180044601","QUETIAPINE","50MG","30","Select","Select",""],["","31722053401","METHOCARBAM","750MG","120","Select","Select",""],["","80681000900","VITAMIN","50MCG","90","Select","Select",""],["","00093317431","ALBUTEROL","E","8.5","Select","Select",""],["","00002449108","REYVOW","100MG","8","Select","Select",""],["","72618300002","NURTEC","75MG ODT","8","Select","Select",""],["","69918030130","TRANEX","650MG","9","Select","Select",""],["","00002143611","EMGALITY","120MG\/ML","1","Select","Select",""],["","31604002674","D3","2000UNIT","90","Select","Select",""],["","69097081312","GABAPENTIN","100MG","90","Select","Select",""],["","10702001801","OXYCODONE","5MG","12","Select","Select",""],["","55111018015","TIZANIDINE","4MG","90","Select","Select",""],["","00168016215","CLOBETASOL","0.05%","30","Select","Select",""],["","55513084101","AIMOVIG","70MG\/ML","1","Select","Select",""],["","00406012301","HYDROCO\/APAP","5-325MG","20","Select","Select",""],["","00536100836","ASPIRIN","81MG","28","Select","Select",""],["","00378104901","DOXEPIN","10MG","30","Select","Select",""],["","69238183407","LEVOTHYROXIN ","TAB 100MCG","15","Select","Select",""],["","59746011506","PROCHLORPER ","TAB 10MG","30","Select","Select",""],["","67877026218","RIZATRIPTAN ","TAB 10MG","9","Select","Select",""],["","70377002711","ATORVASTATIN ","TAB 10MG","30","Select","Select",""],["","62332003031","ROPINIROLE ","TAB 0.25MG","90","Select","Select",""],["","65862069790","VENLAFAXINE ","CAP 150MG ER","60","Select","Select",""],["","13107003234","MIRTAZAPINE ","TAB 45MG","30","Select","Select",""],["","00172392670","DIAZEPAM ","TAB 5MG","75","Select","Select",""],["","59310057922","PROAIR ","AER ","8.5","Select","Select",""],["","51293080401","SALSALATE ","TAB 750MG","270","Select","Select",""],["","68180044601","QUETIAPINE ","TAB 50MG","30","Select","Select",""],["","00093317431","ALBUTEROL ","FAT E","8.5","Select","Select",""],["","70010077001","METHOCARBAM ","TAB 750MG","120","Select","Select",""],["","80681000900","VITAMIN ","CAP 50MCG","90","Select","Select",""],["","00002449108","REYVOW ","TAB 100MG","8","Select","Select",""],["","72618300002","NURTEC ","TAB 75MG ODT","8","Select","Select",""],["","69918030130","TRANEX ","TAB 650MG","9","Select","Select",""],["","55513084301","AIMOVIG ","INJ 140MG\/ML","1","Select","Select",""],["","00002143611","EMGALITY ","INJ 120MG\/ML","1","Select","Select",""],["","31604002674","D3 ","TAB 2000UNIT","90","Select","Select",""],["","69097081312","GABAPENTIN ","CAP 100MG","90","Select","Select",""],["","10702001801","OXYCODONE ","TAB 5MG","12","Select","Select",""],["","55111018015","TIZANIDINE ","TAB 4MG","90","Select","Select",""],["","00168016215","CLOBETASOL ","OIN 0.0005","30","Select","Select",""],["","00406012301","HYDROCO\/APAP ","TAB 5-325MG","20","Select","Select",""],["","00536100836","ASPIRIN ","CHW 81MG","28","Select","Select",""],["","00378104901","DOXEPIN ","CAP 10MG","30","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":""}]}]}