{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KELLY   G WILMER","gend":0,"add":"1423 CAMPBELL STREET","city":"LYNCHBURG","state":"VA","zip":"24501-2819","dob":"1967-08-30","age":"","mstatus":"","insh":10063986,"cliId":"","pno":4344776121,"cno":4344776121,"email":"","ename":"","eno":"","pphy":"WOLF, ANDREW MICHAEL","ppno":4349245321,"pcpadd":"100 Colonnades Hill Dr, ","pcpcity":"Charlottesville","pcpstate":"VA","pcpzip":229012204,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"APT B","add3":"","madd1":"1423 CAMPBELL STREET","madd2":"APT B","madd3":"","mcity":"LYNCHBURG","mstate":"VA","mzip":"24501-2819","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F25.0","J43.2","M25.512","R07.9","Z87.09","I82.402","G47.33","Z72.0","L97.322","L03.116","F17.200","B35.1","L60.3","F31.9","R60.0","S62.625A","M19.042","S89.91XA","R60.1","R19.7","E78.1","G47.10","F32.9","W19.XXXS","E11.622","L98.499","A41.9","R06.02","R65.20","J18.9","I48.91","R74.0","Z86.718","Z79.899","Z79.01","Z79.51","F17.210","Z20.828","H20.012","H25.13","H40.033","H18.232","H40.42X0","H20.9","Z01.810","I50.30","D50.9","I82.90","J43.9","I48.0","Z86.59","H40.42X3","K21.9","Z13.220","Z51.81","H61.23","M62.81","R25.2","S83.91XA","M25.561","W01.0XXA","S69.92XA","M25.642","M79.645","S62.625D","M25.442","H40.032","H40.42X4","E61.1","Z86.010","Z86.19","L30.9","I50.9","H40.9","Z01.818","Z48.810","Z13.1","I82.5Y2","Z23","S46.911A","M25.511","S43.101A","E87.1","E87.6","H57.9","R68.89","M62.838","G47.30","Z87.81","I82.502","J43.1","R03.0","M25.572","S62.653A","L50.9","T14.8XXA","W57.XXXA","R73.9","H20.12","H25.12","H40.2223","D12.3","Z12.11","I49.9","K08.89","Z71.3","D51.8","Z76.89","R53.83","Z13.228","Z11.4","Z11.59","M17.11","R91.8","R53.1","R41.82","R74.01","H53.8","H25.812","H57.03","J44.9","Z91.19","Z09","Z86.79","H01.00B","W57.XXXS","B88.8","H40.2220","H21.562","K64.8","K57.30","W57.XXXD","F17.218","R42","R50.9","Z71.6"],"date":["2021-05-26","2020-01-13","2019-09-16","2019-10-16","2019-10-16","2019-10-16","2021-02-22","2021-05-11","2021-02-22","2020-08-10","2021-05-11","2020-09-03","2019-12-23","2020-01-13","2021-05-11","2020-05-17","2020-05-17","2020-05-17","2020-05-19","2020-06-22","2021-05-11","2020-05-25","2020-05-25","2020-06-22","2020-09-08","2020-08-10","2020-09-03","2020-08-27","2020-08-27","2020-09-03","2020-08-27","2020-09-03","2020-08-27","2020-08-27","2021-02-22","2020-08-27","2021-02-22","2020-08-27","2020-11-17","2021-05-20","2021-03-12","2021-01-26","2021-01-11","2021-05-20","2021-02-22","2021-02-22","2021-02-22","2021-02-22","2021-02-22","2021-02-22","2021-02-22","2021-05-20","2021-03-15","2021-03-15","2021-03-15","2021-03-15","2021-03-15","2019-07-30","2020-09-09","2020-07-23","2020-05-17","2020-05-17","2020-08-19","2020-09-09","2020-09-09","2020-08-19","2021-01-26","2021-04-06","2020-12-23","2021-04-08","2020-12-23","2020-12-23","2021-01-22","2021-03-04","2021-03-04","2021-04-23","2019-01-10","2019-01-10","2020-10-07","2019-08-12","2019-08-12","2019-08-12","2020-09-03","2020-09-03","2020-11-27","2021-02-26","2019-08-10","2019-10-15","2019-11-04","2020-06-22","2019-11-04","2021-05-11","2019-11-04","2020-05-22","2020-08-10","2020-09-03","2020-06-22","2020-06-22","2021-02-16","2021-03-08","2021-03-12","2021-04-08","2021-04-08","2021-04-08","2021-05-11","2021-05-11","2021-05-11","2020-03-26","2020-03-26","2020-03-26","2020-03-26","2020-03-26","2020-09-09","2020-08-27","2020-08-27","2020-08-27","2020-10-07","2020-10-07","2021-02-26","2021-03-08","2019-10-15","2019-10-15","2020-09-03","2020-09-03","2020-09-03","2020-09-03","2020-12-23","2021-03-08","2021-03-08","2021-04-08","2021-04-08","2020-08-10","2020-08-10","2020-08-27","2020-08-27","2020-04-27"],"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":[["","00597007541","SPIRIVA ","CAP HANDIHLR","30","Select","Select",""],["","65162089703","ARIPIPRAZOLE ","TAB 5MG","30","Select","Select",""],["","76385010410","BENZTROPINE ","TAB 1MG","60","Select","Select",""],["","62756079713","DIVALPROEX ","TAB 250MG DR","30","Select","Select",""],["","00186037020","SYMBICORT ","AER 160-4.5","10.2","Select","Select",""],["","50458057930","XARELTO ","TAB 20MG","30","Select","Select",""],["","60258017101","MAG ","TAB 400MG","30","Select","Select",""],["","68462026390","ROSUVASTATIN ","TAB 20MG","30","Select","Select",""],["","68382041205","OMEPRAZOLE ","CAP 20MG","60","Select","Select",""],["","00143980350","DOXYCYCL ","CAP 100MG","20","Select","Select",""],["","43547039910","CYCLOBENZAPR ","TAB 5MG","30","Select","Select",""],["","57896048930","POLYETH ","POW 3350 NF","510","Select","Select",""],["","61314063705","PREDNISOLONE ","SUS 1% OP","10","Select","Select",""],["","70000053801","GENTLE ","TAB 5MG EC","2","Select","Select",""],["","23155028801","ACETAZOLAMID ","TAB 250MG","60","Select","Select",""],["","49884093547","DICLOFENAC ","GEL 0.01","200","Select","Select",""],["","00093317431","ALBUTEROL ","FAT E HFA INH","8.5","Select","Select",""],["","65862044990","VALACYCLOVIR ","TAB 1GM","42","Select","Select",""],["","24208046325","LATANOPROST ","SOL 0.00005","2.5","Select","Select",""],["","00023921105","COMBIGAN ","SOL 0.2\/0.5%","10","Select","Select",""],["","10006070020","NIACIN ","CAP 250MG TR","30","Select","Select",""],["","23155050101","HYDROXYZ ","TAB 25MG","90","Select","Select",""],["","61314001910","DORZOLAMIDE ","SOL 2% OP","10","Select","Select",""],["","00536100901","FERROUS ","TAB 325MG","30","Select","Select",""],["","00904671772","CETIRIZINE ","TAB 10MG","30","Select","Select",""],["","65162027210","SMZ\/TMP ","TAB 800-160","20","Select","Select",""],["","57896072301","IRON ","TAB 325MG","30","Select","Select",""],["","70436001102","BUPROPN ","TAB 300MG XL","30","Select","Select",""],["","74312001380","VITAMIN ","TAB 1000MCG","30","Select","Select",""],["","69315011610","FUROSEMIDE ","TAB 20MG","14","Select","Select",""],["","00009540001","NICOTROL ","INH ","168","Select","Select",""],["","67877021905","CEPHALEXIN ","CAP 500MG","20","Select","Select",""],["","45802011222","MUPIROCIN ","OIN 0.02","22","Select","Select",""],["","00713026831","TRIPLE ","OIN ","28.4","Select","Select",""],["","00143992801","CIPROFLOXACN ","TAB 500MG","20","Select","Select",""],["","50484001030","SANTYL ","OIN 250\/GM","30","Select","Select",""],["","55111028050","LEVOFLOXACIN ","TAB 500MG","10","Select","Select",""],["","00597008717","ATROVENT ","AER 17MCG","12.9","Select","Select",""],["","00536589653","NICOTINE ","DIS 21MG\/24H","28","Select","Select",""],["","00093227534","AMOX\/K ","875-125","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":[[["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":""}]}]}