{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SAMUEL   J RUBIN","gend":0,"add":"1832 WICKHAM PL","city":"CHARLOTTESVILLE","state":"VA","zip":"22901-9998","dob":"1979-12-18","age":"","mstatus":"","insh":"1831430*01","cliId":"","pno":"434\/249-5724","cno":"434\/249-5724","email":"","ename":"","eno":"","pphy":"CLEMONS, BRUCE D MD","ppno":"434\/975-1267","pcpadd":"2250 IVY RD. STE 200","pcpcity":"CHARLOTTESVILLE","pcpstate":"VA","pcpzip":22903,"pcpcounty":"","pcpid":145521,"pcpname":"SMJMG - Sentara Blue Ridge Internal Medicine","plan":"OHP","program":"ACA","lob":"Small Group","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"434\/205-4359","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"844\/307-8606","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M25.562","R94.31","K51.018","M25.462","Z01.818","M23.42","S83.006A","S83.095A","R53.1","R26.2","G89.18","I10.","K51.919","F32.9","I71.01","S89.82XA","M25.862","R93.7","Z98.890","S89.92XA","S83.282A","M93.20","I71.4","I71.03","S83.005A","Z20.828","K13.79","G47.33","M07.60","M1A.0790","I71.00","E78.5","S76.112A","R91.8","Z68.31","M19.90","Z79.899","Z20.822"],"date":["2020-12-17","2020-09-24","2020-01-23","2020-10-15","2020-10-12","2020-10-15","2020-10-15","2020-10-15","2020-12-17","2020-12-17","2020-12-17","2021-08-30","2021-08-24","2021-08-24","2021-08-24","2020-10-02","2020-10-02","2020-10-02","2021-08-30","2020-10-02","2020-10-02","2020-10-07","2021-03-05","2021-03-05","2020-10-15","2021-01-29","2021-03-11","2021-08-24","2021-09-10","2021-09-10","2021-08-30","2020-08-12","2020-09-24","2021-03-05","2021-08-24","2021-08-24","2021-09-10","2021-01-22"],"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":[["","55111046901","METOPROL","200MG ER","90","Select","Select",""],["","00254200801","COLCHICINE","0.6MG","-90","Select","Select",""],["","68180072003","AMLODIPINE","5MG","90","Select","Select",""],["","55111073005","ALLOPURINOL","300MG","90","Select","Select",""],["","68180031909","BUPROPN","150MG XL","90","Select","Select",""],["","59762010401","SULFASALAZIN","500MG DR","-540","Select","Select",""],["","00093317431","ALBUTEROL","HFA","8","Select","Select",""],["","00527293441","PREDNISONE","20MG","2","Select","Select",""],["","00574402235","BACITRACIN","OP","4","Select","Select",""],["","00406012301","HYDROCO\/APAP","5-325MG","20","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","80777027399","MODERNA","COVID-19","0","Select","Select",""],["","55111046901","METOPROL ","200MG ER","90","Select","Select",""],["","00254200801","COLCHICINE ","0.6MG","90","Select","Select",""],["","59762010401","SULFASALAZIN ","500MG DR","-540","Select","Select",""],["","55111073005","ALLOPURINOL ","300MG","90","Select","Select",""],["","68180031909","BUPROPN ","150MG XL","90","Select","Select",""],["","68180072003","AMLODIPINE ","5MG","90","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","00093317431","ALBUTEROL ","HFA","8","Select","Select",""],["","00406012301","HYDROCO\/APAP ","5-325MG","40","Select","Select",""],["","00527293441","PREDNISONE ","20MG","2","Select","Select",""],["","80777027399","MODERNA ","COVID-19","0","Select","Select",""],["","00574402235","BACITRACIN ","OP","4","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","",""],["N\/A","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","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":""}]}]}