{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SILAS PROFFITT","gend":0,"add":"1622 HORSE SHOE ROAD","city":"ARRINGTON","state":"VA","zip":"22922-9998","dob":"1962-01-13","age":"","mstatus":"","insh":"20033647*01","cliId":"","pno":"434\/363-2621","cno":"434\/363-2621","email":"","ename":"","eno":"","pphy":"CALLENDER, DAVID M MD","ppno":"434\/924-1931","pcpadd":"1222 JEFFERSON PARK AVE FL 3","pcpcity":"CHARLOTTESVILLE","pcpstate":"VA","pcpzip":22903,"pcpcounty":"","pcpid":"","pcpname":"UNIVERSITY OF VIRGINIA PHYSICIANS GROUP","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/924-1138","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I70.211","I10.","E78.5","E11.9","F17.210","Z71.89","M79.602","R25.2","I25.110","I21.4","I25.2","R00.0","I25.799","Z95.1","K62.5","I74.3","Z79.01","I73.9","Z72.0","Z71.85","Z13.9","F17.218","K21.9","J40.","R10.84","R73.9","M54.9","R06.9","R07.2","R77.8","Z95.828","J44.9","N40.0","Z87.19","I25.10","I70.202","R09.02","I95.9","E87.8","J96.01","E87.79","D62.","E86.1","G89.18","Z48.812","Z48.298","E11.51","I47.1","R26.81","J45.909","M54.5","F17.200","Z51.81","M19.90","I49.1","I51.7","R94.31","D69.6","E11.65","I25.119","D72.829","K59.00","Z20.822","Z79.4","Z79.899","F17.211","U07.1","E78.00","E87.1","R10.9","Z01.810","K92.1","K92.2","R05.9","R05.","Z80.0","I70.212","I99.8","I49.3","I70.213","Z11.59","K59.01"],"date":["2021-03-17","2022-07-13","2022-07-13","2022-05-16","2022-07-13","2021-08-23","2020-09-24","2020-09-24","2021-01-26","2021-03-17","2021-01-28","2022-07-13","2022-05-16","2022-02-10","2021-02-14","2021-02-14","2021-03-17","2021-04-23","2021-04-23","2022-02-10","2022-05-16","2022-05-16","2022-05-16","2022-02-10","2022-07-12","2022-07-12","2022-07-12","2022-07-12","2021-01-25","2021-01-25","2021-01-25","2021-03-17","2021-01-25","2021-10-13","2021-03-17","2021-01-28","2021-01-30","2021-01-30","2021-01-30","2021-01-30","2021-01-30","2021-01-30","2021-01-30","2021-01-30","2021-03-17","2021-03-17","2021-03-17","2021-03-17","2021-03-17","2021-03-17","2021-03-17","2021-03-17","2021-03-17","2022-05-27","2022-07-13","2022-07-13","2022-07-13","2021-01-25","2021-02-04","2021-01-25","2021-01-25","2022-07-13","2021-01-25","2021-01-25","2022-07-13","2021-05-17","2022-07-13","2022-07-13","2022-07-13","2022-07-13","2021-01-26","2021-02-14","2021-02-14","2022-05-16","2021-08-23","2021-05-17","2021-01-28","2021-01-28","2021-02-04","2021-05-17","2021-05-17","2021-10-13"],"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":[]},{"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":[["","00363056317","ASPIRIN","TAB 81MG EC","90","Select","Select",""],["","65862056090","PANTOPRAZOLE","TAB 40MG","90","Select","Select",""],["","00378004710","METOPROL","TAB 100MG","270","Select","Select",""],["","27808006502","PROMETH\/COD","SOL 6.25-10","120","Select","Select",""],["","65162019050","NAPROXEN","TAB 500MG","180","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","00254100752","ALBUTEROL","AER HFA","7","Select","Select",""],["","53885004601","ONETOUCH","KIT ULTRA 2","1","Select","Select",""],["","00406324301","HYDROMORPHON","TAB 2MG","20","Select","Select",""],["","23155000810","HYDROCHLOROT","TAB 25MG","30","Select","Select",""],["","00003089421","ELIQUIS","TAB 5MG","60","Select","Select",""],["","00054429731","FUROSEMIDE","TAB 20MG","7","Select","Select",""],["","67877022210","GABAPENTIN","CAP 100MG","15","Select","Select",""],["","45802086801","POLYETH","POW 3350 NF","119","Select","Select",""],["","65702071110","ACCU-CHEK","TES GUIDE","300","Select","Select",""],["","08290320550","BD  PEN NEEDL","MIS 32GX5\/32","200","Select","Select",""],["","00193731150","CONTOUR","TES NEXT","300","Select","Select",""],["","99073012050","FREESTYLE    TES","TES ","300","Select","Select",""],["","56151146004","TRUE","TES GLUCOSE","300","Select","Select",""],["","00002879959","HUMALOG","INJ 100\/ML","3","Select","Select",""],["","57237001405","TAMSULOSIN","CAP 0.4MG","30","Select","Select",""],["","00088221905","LANTUS","INJ 100\/ML","3","Select","Select",""],["","99073070827","FREESTYLE    TES LITE","TES LITE","300","Select","Select",""],["","00378395305","ATORVASTATIN","TAB 80MG","30","Select","Select",""],["","00832532411","POT  CL MICRO","TAB 10MEQ ER","7","Select","Select",""],["","70010049105","METFORMIN","TAB 500MG ER","360","Select","Select",""],["","00169430313","RYBELSUS","TAB 3MG","30","Select","Select",""],["","00054001925","PREDNISONE","TAB 50MG","5","Select","Select",""],["","68180016013","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","00143992801","CIPROFLOXACN","TAB 500MG","14","Select","Select",""],["","00002143380","TRULICITY","INJ 0.75\/0.5","2","Select","Select",""],["","57237022030","PIOGLITAZONE","TAB 30MG","34","Select","Select",""],["","50458014130","INVOKANA","TAB 300MG","30","Select","Select",""],["","50111033402","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","00597015290","JARDIANCE","TAB 10MG","30","Select","Select",""],["","00085113204","PROVENTIL","AER HFA","7","Select","Select",""],["","00597007541","SPIRIVA","CAP HANDIHLR","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":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"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":""}]}]}