{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ASHANTI POSEY","gend":1,"add":"3445 SEMINOLE TRAIL","city":"CHARLOTTESVILLE","state":"VA","zip":"22911-5637","dob":"1976-10-14","age":"","mstatus":"","insh":1536076,"cliId":"","pno":4342420243,"cno":4342420243,"email":"","ename":"","eno":"","pphy":"LOCKMAN, ANDREW R","ppno":4342434660,"pcpadd":"4916 Plank Rd Unit 205, ","pcpcity":"North Garden","pcpstate":"VA","pcpzip":229591613,"pcpcounty":"","pcpid":"","pcpname":"UVA PRIMARY CARE RIVERSIDE","ano":"","add2":"APT 202","add3":"","madd1":"3445 SEMINOLE TRAIL","madd2":"APT 202","madd3":"","mcity":"CHARLOTTESVILLE","mstate":"VA","mzip":"22911-5637","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"WESTERN\/ CHARLOTTESVILLE","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11.9","D84.1","R06.09","F41.9","I27.20","R20.2","M54.5","M25.372","M25.572","G89.29","Z79.84","M54.6","M54.2","G57.82","M21.072","M21.6X2","Z01.818","R00.0","D72.829","R10.13","Z13.6","R06.02","Q21.1","M77.52","M25.472","Z98.890","M24.272","R93.7","E66.9","M21.962","Z01.810","F33.9","E78.00","E66.3","R10.9","R11.2","E78.5","E66.01","F32.9","K76.0","Z79.4","Z88.6","Z88.5","Z88.0","Z45.2","D18.03","R10.84","R93.1","R06.00","T78.3XXA","M47.26","M51.36","M79.18","M79.2","S84.12XD","M25.772","G57.62","Z68.41","T38.0X5A","I36.1","M19.90","E11.65","Z90.711","I50.9","T78.40XA","M54.42","M25.562","M51.26","M51.16","M54.16","D36.13","M89.9","Z68.34","Z88.8","R60.0","R07.9","I28.0","S93.402D","M65.872","M25.371","M24.072","M21.42","M21.41","M76.72","M76.62","Z01.812","M17.12","M48.061","M25.78","M19.172","M24.872","S84.11XA","R26.2","I49.9","M67.02","R09.02","M19.072","R79.1","J30.89","K21.9","T78.49XA","Z00.00","M25.579","M25.569","M25.462","Z79.899","Z68.38","R19.7","R11.0","R42"],"date":["2021-03-05","2020-06-13","2019-02-28","2020-06-12","2020-06-12","2021-05-05","2020-03-11","2020-10-19","2020-10-19","2019-09-27","2019-07-30","2020-03-11","2020-03-11","2021-05-05","2019-12-12","2020-06-15","2020-06-10","2020-06-13","2019-03-13","2019-03-04","2019-04-16","2019-09-13","2019-05-09","2020-05-29","2019-04-29","2019-04-29","2020-10-22","2019-04-29","2020-09-04","2020-05-18","2020-05-18","2021-04-16","2021-03-05","2021-03-05","2019-07-30","2019-03-03","2019-03-03","2020-06-12","2020-06-12","2019-03-03","2019-03-03","2019-03-03","2020-06-12","2020-06-12","2019-03-03","2019-03-03","2019-03-03","2019-05-09","2019-05-16","2019-07-30","2019-09-13","2019-09-13","2019-09-27","2019-11-19","2020-06-12","2020-06-12","2020-06-12","2019-02-24","2019-02-24","2019-02-24","2019-07-30","2019-02-24","2019-02-24","2019-02-26","2019-07-30","2019-09-27","2019-09-17","2019-09-27","2019-09-27","2019-10-11","2020-06-12","2020-06-12","2020-06-12","2020-06-12","2020-09-14","2019-02-27","2019-02-28","2019-05-03","2019-05-03","2019-03-26","2019-05-03","2019-05-03","2019-05-03","2019-05-03","2019-05-03","2019-07-16","2019-09-17","2019-10-11","2019-09-27","2019-10-08","2020-10-22","2020-03-16","2020-04-24","2019-02-26","2019-05-03","2019-02-27","2019-06-14","2019-02-26","2019-05-07","2019-05-07","2019-05-07","2019-05-09","2019-06-14","2019-06-14","2019-06-14","2019-07-30","2019-07-30","2019-07-30","2019-07-30","2019-07-30"],"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":[["","00054327099","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","00193731221","CONTOUR ","TES NEXT","100","Select","Select",""],["","68382003416","VENLAFAXINE ","CAP 37.5 ER","30","Select","Select",""],["","00310654004","BYDUREON ","INJ 2\/0.85ML","3.4","Select","Select",""],["","00169406013","VICTOZA ","INJ 18MG\/3ML","9","Select","Select",""],["","08290320122","BD  PEN NEEDL","MIS 32GX4MM","100","Select","Select",""],["","76385012810","METFORMIN ","TAB 500MG ER","120","Select","Select",""],["","45802057178","FEXOFENADINE ","TAB 180MG","30","Select","Select",""],["","00193654621","BAYER ","MIS LANCETS","100","Select","Select",""],["","70377000612","ROSUVASTATIN ","TAB 5MG","90","Select","Select",""],["","00173068220","VENTOLIN ","AER ","18","Select","Select",""],["","54092070203","FIRAZYR ","INJ 30MG\/3ML","18","Select","Select",""],["","33332032001","AFLURIA ","INJ 2020-21","0.5","Select","Select",""],["","00406012301","HYDROCO\/APAP ","TAB 5-325MG","12","Select","Select",""],["","00093742698","MONTELUKAST ","TAB 10MG","30","Select","Select",""],["","00093770198","LEVOCETIRIZI ","TAB 5MG","30","Select","Select",""],["","64380080307","RANITIDINE ","TAB 150MG","60","Select","Select",""],["","49502050002","EPIPEN ","INJ 0.3MG","2","Select","Select",""],["","42806000501","OXYCODONE ","TAB 5MG","32","Select","Select",""],["","69097081312","GABAPENTIN ","CAP 100MG","90","Select","Select",""],["","00378064110","PREDNISONE ","TAB 10MG","56","Select","Select",""],["","45802048678","DOCUSATE ","CAP 100MG","30","Select","Select",""],["","69097014260","ALBUTEROL ","AER HFA","6.7","Select","Select",""],["","99073012050","FREESTYLE    TES","TES ","50","Select","Select",""],["","00002880559","HUMULIN ","INJ U-100KWP","15","Select","Select",""],["","63833082502","BERINERT ","INJ 500UNIT","8","Select","Select",""],["","68180012202","CEPHALEXIN ","CAP 500MG","15","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","",""],["N\/A","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":""}]}]}