{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BETTY   J OLIVER","gend":1,"add":"200 MAIN ST","city":"LOVINGSTON","state":"VA","zip":"22949-9998","dob":"1951-09-02","age":"","mstatus":"","insh":"900040913*01","cliId":"","pno":"434\/263-8734","cno":"434\/882-4508","email":"","ename":"","eno":"","pphy":"HEIM, STEVEN W MD","ppno":"434\/361-2555","pcpadd":"RT 151 AT VALLEY GREEN CENT","pcpcity":"NELLYSFORD","pcpstate":"VA","pcpzip":22958,"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\/361-2363","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z12.11","R30.0","R39.9","R06.83","R53.83","M24.50","E78.71","Z99.3","F72.","K21.9","I10.","E11.9","E78.5","G80.9","F39.","Z79.82","L81.9","T14.8XXA","R32.","K92.2","R60.0","Z12.31","H26.8","Z96.1","R09.81","E66.9","R53.81","F28.","Z00.00","F29.","N89.8","E66.09","Z63.6","J06.9"],"date":["2021-05-23","2021-08-31","2021-08-31","2021-09-23","2021-05-07","2021-07-25","2021-07-25","2021-09-23","2021-12-09","2021-09-23","2021-09-23","2021-10-18","2021-09-23","2021-07-13","2021-07-13","2021-09-23","2021-09-23","2021-09-23","2021-09-23","2021-09-23","2021-09-23","2021-09-28","2021-10-18","2021-10-18","2021-12-09","2021-12-09","2021-12-09","2021-12-09","2021-09-23","2021-09-27","2021-12-01","2021-09-23","2021-09-23","2021-12-13"],"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":[["","40985027139","D3-1000                                                               ","1000UNIT","31","Select","Select",""],["","65862000899","METFORMIN HYDROCHLORIDE                                               ","500MG","62","Select","Select",""],["","00904645780","DOK                                                                   ","100MG","28","Select","Select",""],["","59762200301","ZIPRASIDONE HCL                                                       ","60MG","31","Select","Select",""],["","60505017007","PRAVASTATIN SODIUM                                                    ","40MG","31","Select","Select",""],["","43547035211","LISINOPRIL                                                            ","5MG","31","Select","Select",""],["","57896050410","ONE-DAILY MULTI VITAMINS                                              ","MULT VIT","31","Select","Select",""],["","00781286810","OMEPRAZOLE                                                            ","20MG","62","Select","Select",""],["","60505265601","TRIAMTERENE\/HYDROCHLOROTHIAZIDE                                       ","37.5-25","31","Select","Select",""],["","24979002807","DILTIAZEM HYDROCHLORIDE ER                                            ","240MG ER","31","Select","Select",""],["","51645091901","VITAMIN D                                                             ","1000UNIT","31","Select","Select",""],["","43292055812","CRANBERRY JUICE POWDER                                                ","425MG","31","Select","Select",""],["","00904582493","VITAMIN D3                                                            ","1000UNIT","31","Select","Select",""],["","57896050110","ONE-DAILY MULTI-VITAMIN                                               ","MULT-VIT","31","Select","Select",""],["","16714083701","ZIPRASIDONE HYDROCHLORIDE                                             ","60MG","30","Select","Select",""],["","66424039910","STOOL SOFTENER                                                        ","100MG","30","Select","Select",""],["","51552069906","EMOLLIENT CREAM BASE                                                  ","BASE","454","Select","Select",""],["","00904699880","DOCUSATE SODIUM                                                       ","100MG","30","Select","Select",""],["","00093314705","CEPHALEXIN                                                            ","500MG","-10","Select","Select",""],["","65862042005","SULFAMETHOXAZOLE\/TRIMETHOPRIM DS                                      ","800-160","-14","Select","Select",""],["","00904772524","ANTI-DIARRHEAL                                                        ","2MG","20","Select","Select",""],["","57896010410","ACETAMINOPHEN                                                         ","325MG","60","Select","Select",""],["","49348027472","SM DOUBLE ANTIBIOTIC                                                  ","","28","Select","Select",""],["","00904505359","SUDOGEST                                                              ","30MG","60","Select","Select",""],["","49348014370","SM CLEARLAX                                                           ","","238","Select","Select",""],["","57896062912","GERI-LANTA                                                            ","","150","Select","Select",""],["","65862018730","ONDANSETRON HYDROCHLORIDE                                             ","4MG","20","Select","Select",""],["","49348001734","SM TUSSIN DM                                                          ","100-10\/5","118","Select","Select",""],["","00904001259","ALLERGY                                                               ","4MG","30","Select","Select",""],["","69618002201","CHLORPHENIRAMINE MALEATE                                              ","MAL 4MG","30","Select","Select",""],["","00904775127","MINERIN CREME                                                         ","","454","Select","Select",""],["","45802043803","HYDROCORTISONE                                                        ","1%","28","Select","Select",""],["","16714089803","LORATADINE                                                            ","10MG","30","Select","Select",""],["","68180037603","LOSARTAN POTASSIUM                                                    ","25MG","21","Select","Select",""],["","00316022130","NYSTATIN                                                              ","100000","30","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":""}]}]}