{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BOYD   A WHITE","gend":0,"add":"500 1ST ST APT 701","city":"CHARLOTTESVILLE","state":"VA","zip":"22902-9998","dob":"1958-08-03","age":"","mstatus":"","insh":"900039216*01","cliId":"","pno":"434\/960-9857","cno":"","email":"","ename":"","eno":"","pphy":"KON, RACHEL MD","ppno":"434\/924-1931","pcpadd":"1222 JEFFERSON PARK AVE 3RD FL","pcpcity":"CHARLOTTESVILLE","pcpstate":"VA","pcpzip":22903,"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":"434\/243-9282","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G89.4","M54.40","I10.","R21.","G89.29","Z12.11","Z02.89","Z23.","R97.20","Z79.899","L03.113","R26.89","S06.9X9A","M25.512","W10.9XXA","M25.511","F10.129","Z20.822","R26.9","K44.9","S50.312A","Z20.828","R35.8","M21.611","L30.9","R07.89","G89.21","M54.42","M54.41","L02.511","S61.411A","F14.90","Z72.0","Z86.19","Z96.659","B95.8","R51.9","M79.10","M51.36","M51.37","M47.816","M54.9","S69.91XA","M79.89","M79.641","T14.90XA","Z74.3","Z12.5","H61.21","L02.519","M54.5","M20.12","B35.1","L84.","B95.61","B95.0","F17.210","Z79.2","Z79.891","R40.20","T07.XXXA","S09.90XA","M47.812","J98.11","R91.8","R93.5","N40.0","I89.8","M47.814"],"date":["2021-11-16","2020-06-18","2021-11-12","2020-10-20","2021-02-12","2021-05-23","2020-10-20","2021-11-12","2021-11-12","2021-07-06","2020-12-26","2021-01-03","2021-01-01","2021-01-03","2021-01-03","2021-01-03","2021-01-02","2021-01-02","2021-01-02","2021-01-02","2021-01-02","2021-01-02","2021-07-06","2021-07-28","2020-10-20","2021-01-05","2021-01-13","2021-02-12","2021-02-12","2020-12-26","2020-12-21","2020-12-21","2020-12-21","2020-12-23","2020-12-21","2020-12-21","2021-01-05","2021-01-05","2021-11-16","2021-11-16","2021-11-16","2021-11-16","2020-12-21","2020-12-21","2020-12-21","2021-01-05","2021-01-05","2021-07-06","2021-07-27","2020-12-23","2020-12-23","2021-07-28","2021-07-28","2021-07-28","2020-12-26","2020-12-26","2020-12-26","2020-12-26","2020-12-26","2021-01-01","2021-01-01","2021-01-01","2021-01-01","2021-01-01","2021-01-01","2021-01-01","2021-01-01","2021-01-01","2021-01-01"],"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":[["","00093005805","TRAMADOL HCL                                                          ","50MG","120","Select","Select",""],["","65862020299","LOSARTAN POTASSIUM                                                    ","50MG","90","Select","Select",""],["","45802006335","TRIAMCINOLONE ACETONIDE                                               ","0.03%","30","Select","Select",""],["","10702001050","HYDROXYZINE HYDROCHLORIDE                                             ","10MG","30","Select","Select",""],["","42571016201","AMOXICILLIN\/CLAVULANATE POTASSIUM                                     ","875-125","5","Select","Select",""],["","00093081001","NORTRIPTYLINE HYDROCHLORIDE                                           ","10MG","30","Select","Select",""],["","69097015807","MELOXICAM                                                             ","7.5MG","14","Select","Select",""],["","68180072003","AMLODIPINE BESYLATE                                                   ","5MG","90","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":""}]}]}