{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DELOIS   E NELSON","gend":1,"add":"12490 SPICEWODD ROAD","city":"ORANGE","state":"VA","zip":"22960-9998","dob":"1968-03-20","age":"","mstatus":"","insh":"900039069*01","cliId":"","pno":"540\/522-6597","cno":"","email":"","ename":"","eno":"","pphy":"FIELD, LIISA K NP","ppno":"540\/825-6100","pcpadd":"1200 SUNSET LN SUITE 2210","pcpcity":"CULPEPER","pcpstate":"VA","pcpzip":22701,"pcpcounty":"","pcpid":"","pcpname":"UNIVERSITY OF VIRGINIA PHYSICIANS GROUP","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"540\/825-1829","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M33.12","T81.31XA","L89.219","L97.119","L94.2","G25.81","D50.9","M33.00","R13.10","M33.90","Q82.8","S81.802A","S71.001A","R31.29","W19.XXXD","E78.2","R53.83","R31.21","H92.01","M81.0","R31.9","Z12.11","T07.XXXA","Z23.","S71.101A","D89.89","T81.30XA","K21.9","M54.5","Z72.0","R82.89","M81.8","T14.8XXD","R05."],"date":["2020-03-18","2020-03-18","2020-03-18","2020-03-18","2021-12-02","2021-09-15","2021-04-19","2021-12-02","2021-07-19","2021-12-02","2021-11-15","2021-09-28","2021-09-28","2021-12-02","2021-08-24","2021-06-15","2021-06-15","2021-11-02","2021-07-19","2021-11-15","2021-12-02","2020-07-23","2021-09-15","2021-11-15","2020-03-04","2020-03-04","2020-03-04","2020-07-27","2021-09-15","2021-09-15","2021-11-02","2021-02-11","2021-06-15","2021-06-15"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}}]},{"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":[]},{"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":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","53489011905","DOXYCYCLINE HYCLATE                                                   ","100MG","20","Select","Select",""],["","00378064010","PREDNISONE                                                            ","5MG","90","Select","Select",""],["","55111015810","OMEPRAZOLE                                                            ","20MG","90","Select","Select",""],["","00168000615","TRIAMCINOLONE ACETONIDE                                               ","0.10%","30","Select","Select",""],["","00536100901","FERROUS SULFATE                                                       ","325MG","30","Select","Select",""],["","69097094312","GABAPENTIN                                                            ","300MG","180","Select","Select",""],["","68180071909","AMLODIPINE BESYLATE                                                   ","2.5MG","90","Select","Select",""],["","23155013525","DOXYCYCLINE MONOHYDRATE                                               ","100MG","20","Select","Select",""],["","67877012450","SILVER SULFADIAZINE                                                   ","1%","50","Select","Select",""],["","80995803361","MEDI-HONEY PASTE                                                      ","","44","Select","Select",""]]}},{"a":[]},{"a":[]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":[]}]},{"t":"Mini-Cog","q":[{"a":[]},{"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":"","a13":""}]}]}