{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CORDELL C VALENTINE","gend":1,"add":"1530 TREESDALE PARK CT APT 25","city":"CHARLOTTESVILLE","state":"VA","zip":"22901-9998","dob":"1969-08-02","age":"","mstatus":"","insh":"900045728*01","cliId":"","pno":"434\/964-6061","cno":"434\/964-6061","email":"","ename":"","eno":"","pphy":"KENT, JEREMY B MD","ppno":"434\/924-5348","pcpadd":"LEE ST 1ST FLOOR","pcpcity":"CHARLOTTESVILLE","pcpstate":"VA","pcpzip":22908,"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\/924-8335","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I50.22","E78.5","I10.","Z72.0","F33.1","G47.33","I73.9","E11.65","E11.42","Z79.4","M54.5","M25.551","E11.40","R26.2","G47.61","Z12.11","D12.2","D12.0","D12.4","D12.5","D12.3","K64.1","E11.9","E66.9","Z68.41","M72.2","E78.00","E11.51","M54.16","M79.604","M79.671","I42.9","F33.2","Z96.1","Z98.41","M54.31","M25.561","G89.29","Z20.6","F43.10","F41.1","F60.3","F17.200","R63.5","I42.8","M25.562","L29.9","M25.541","M25.542","R19.8","R14.0","Z96.41","E78.2","R42.","R07.9","R53.1","Z53.21","E11.649","G47.00","G47.9","G47.19","K21.9","I11.0","E66.01","R53.81","Z74.3","Z20.2","R29.818","Z99.89"],"date":["2021-09-09","2021-07-30","2021-11-29","2021-09-09","2021-07-30","2021-08-12","2021-08-10","2021-12-09","2021-11-29","2021-12-09","2021-09-29","2021-05-24","2021-05-24","2021-12-05","2021-05-25","2021-07-15","2021-07-15","2021-07-15","2021-07-15","2021-07-15","2021-07-15","2021-07-15","2021-12-09","2021-07-15","2021-08-12","2021-08-10","2021-08-10","2021-08-10","2021-12-05","2021-12-05","2021-12-05","2021-02-23","2021-07-22","2021-12-06","2021-12-06","2021-03-02","2021-07-20","2021-07-20","2021-07-20","2021-07-22","2021-07-22","2021-07-22","2021-07-22","2021-07-22","2021-09-09","2021-02-02","2021-02-02","2021-02-02","2021-02-02","2021-02-23","2021-02-23","2021-11-29","2021-07-28","2021-08-20","2021-08-21","2021-08-20","2021-08-21","2021-05-20","2021-09-21","2021-06-04","2021-06-04","2021-07-30","2021-07-30","2021-08-12","2021-08-20","2021-08-21","2021-01-25","2021-08-12","2021-08-12"],"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":[["","00093506101","HYDROXYZINE HYDROCHLORIDE ","25MG","90","Select","Select",""],["","68462016401","CARVEDILOL ","12.5MG","180","Select","Select",""],["","16714008401","SPIRONOLACTONE ","25MG","90","Select","Select",""],["","65862055990","PANTOPRAZOLE SODIUM ","20MG","-90","Select","Select",""],["","00088221905","LANTUS SOLOSTAR ","100\/ML","60","Select","Select",""],["","72205001290","PREGABALIN ","50MG","60","Select","Select",""],["","08290320119","BD PEN NEEDLE\/MINI\/ULTRA-FINE\/31G X 5MM ","31GX5MM","300","Select","Select",""],["","73070010011","INSULIN ASPART ","100\/ML","-7000","Select","Select",""],["","45802006435","TRIAMCINOLONE ACETONIDE ","0.10%","45","Select","Select",""],["","10572010001","PEG-3350\/ELECTROLYTES ","ELECTROL","4000","Select","Select",""],["","00002143380","TRULICITY ","0.75\/0.5","6","Select","Select",""],["","00169633910","NOVOLOG FLEXPEN ","FLEXPEN","105","Select","Select",""],["","53885000810","ONETOUCH DELICA PLUS LANCETS EXTRA FINE 33G ","PLUS 33G","400","Select","Select",""],["","65162083366","DICLOFENAC SODIUM ","1%","100","Select","Select",""],["","31722077701","ACYCLOVIR ","400MG","60","Select","Select",""],["","80777027399","MODERNA COVID-19 VACCINE ","COVID-19","0","Select","Select",""],["","65702071210","ACCU-CHEK GUIDE ","GUIDE","400","Select","Select",""],["","16729044310","BUPROPION HYDROCHLORIDE ER (XL) ","150MG XL","90","Select","Select",""],["","65702028810","ACCU-CHEK FASTCLIX LANCETS ","LANCETS","408","Select","Select",""],["","60505258009","ATORVASTATIN CALCIUM ","40MG","90","Select","Select",""],["","57237000930","MIRTAZAPINE ","30MG","30","Select","Select",""],["","00116200116","CHLORHEXIDINE GLUCONATE ","0.12%","473","Select","Select",""],["","00781261305","AMOXICILLIN ","500MG","21","Select","Select",""],["","00597015290","JARDIANCE ","10MG","-90","Select","Select",""],["","00054327099","FLUTICASONE PROPIONATE ","50MCG","-16","Select","Select",""],["","68001048600","LISINOPRIL ","40MG","90","Select","Select",""],["","57237016190","OMEPRAZOLE ","20MG","90","Select","Select",""],["","00591024001","LORAZEPAM ","0.5MG","2","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":""}]}]}