{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ALEXANDER WOOD","gend":0,"add":"112 WEST MARKET ST APT B","city":"CHARLOTTESVILLE","state":"VA","zip":"22902-9998","dob":"1963-12-08","age":"","mstatus":"","insh":"900039773*01","cliId":"2WD9RX1RC52","pno":"434\/872-3843","cno":"434\/872-3843","email":"","ename":"","eno":"","pphy":"CASEY, CATHERINE F MD","ppno":"434\/924-5348","pcpadd":"LEE STREET UVA PRIM C CTR 1ST FL","pcpcity":"CHARLOTTESVILLE","pcpstate":"VA","pcpzip":22908,"pcpcounty":"","pcpid":100582,"pcpname":"","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"Non-DSNP","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/243-4306","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M54.5","R06.00","R73.03","Z13.220","M25.551","Z13.6","G89.29","R10.84","K76.0","R91.8","Z87.891","J98.11","M54.9","R10.9","Z74.3","K29.00","K21.9","J18.9","Z20.822","F17.210","Z79.899","R10.13","Z87.11","Z72.0","N48.89","R45.4","M79.674","N52.9","S01.81XA","S01.111A","M25.561","F10.929","R51.9","Z48.02","S01.01XA","W19.XXXA","S09.90XA","G44.319","Z12.11","R10.11"],"date":["2020-09-20","2020-12-02","2020-11-30","2020-11-30","2021-05-17","2020-11-30","2021-05-17","2021-01-15","2021-01-15","2020-12-02","2020-12-02","2021-01-15","2020-09-20","2021-01-15","2021-06-15","2021-04-19","2021-01-15","2021-01-15","2021-08-21","2021-06-15","2021-01-15","2021-08-21","2021-04-19","2021-04-19","2021-05-26","2021-05-26","2021-05-17","2021-05-17","2021-06-15","2021-06-15","2021-06-15","2021-06-15","2021-06-15","2021-06-22","2021-06-15","2021-06-15","2021-06-15","2021-06-15","2021-05-23","2021-08-21"],"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":[["","173068220","VENTOLIN HFA","AER ","18","Select","Select",""],["","67877022310","GABAPENTIN","CAP 300MG","180","Select","Select",""],["","172572880","FAMOTIDINE","TAB 20MG","-180","Select","Select",""],["","603188016","LIDOCAINE","PAD 0.05","10","Select","Select",""],["","49483061850","NAPROXEN","TAB 500MG","-30","Select","Select",""],["","904672080","ACETAMIN","TAB 500MG","90","Select","Select",""],["","42571016201","AMOX\/K CLAV","TAB 875-125","14","Select","Select",""],["","904671980","ACETAMINOPHE","TAB 325MG","30","Select","Select",""],["","67877031905","IBUPROFEN","TAB 400MG","30","Select","Select",""],["","67877031905","IBUPROFEN ","","30","Select","Select",""],["","603188016","LIDOCAINE ","","10","Select","Select",""],["","904671980","ACETAMINOPHEN ","","30","Select","Select",""],["","904672080","ACETAMINOPHEN EXTRA STRENGTH","","90","Select","Select",""],["","42571016201","AMOXICILLIN\/CLAVULANATE POTASSIUM ","","14","Select","Select",""],["","66993001968","ALBUTEROL SULFATE HFA","","-18","Select","Select",""],["","65162062710","TRAMADOL HCL","","20","Select","Select",""],["","00904671980","ACETAMINOPHEN","","30","Select","Select",""],["","42571016201","AMOXICILLIN\/CLAVULANATE POTASSIUM","","14","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","",""],["No","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","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":""}]}]}