{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SAMUEL DUPUIS","gend":0,"add":"2687 MILTON FARM ROAD","city":"CHARLOTTESVILLE","state":"VA","zip":"22902-9998","dob":"1992-08-07","age":"","mstatus":"","insh":"20043063*01","cliId":"","pno":"434\/293-5089","cno":"","email":"","ename":"","eno":"","pphy":"LEINER, JOHN G MD","ppno":"434\/924-1931","pcpadd":"LEE STREET PRIMARY CARE CTR 4TH FLR","pcpcity":"CHARLOTTESVILLE","pcpstate":"VA","pcpzip":22908,"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":["R19.7","G40.209","E03.9","E10.65","Z79.4","E10.649","E10.9","G40.109","G40.919","L72.0","D22.9","Z12.83","D22.5","Z80.8","Z20.828","L85.8","D22.4","D22.61","D22.62","D22.71","D22.72","H61.23","J01.00","H61.20","Z96.41","Z46.81","R94.5","J06.9","H25.13","H44.23","Z11.59","Z00.00","Z23.","H52.223"],"date":["2019-01-16","2019-01-16","2021-12-15","2021-12-15","2021-12-09","2021-12-15","2021-12-09","2021-04-15","2021-04-15","2020-09-02","2021-09-21","2021-09-21","2021-09-21","2021-09-21","2020-11-23","2021-09-21","2021-09-21","2021-09-21","2021-09-21","2021-09-21","2021-09-21","2021-10-19","2019-12-30","2020-10-20","2021-12-15","2020-12-16","2021-12-15","2020-01-10","2019-04-09","2021-08-31","2020-11-23","2021-10-19","2021-10-19","2021-08-31"],"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":{"indx":[false,false],"comment":["",""],"score":["",""]}},{"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":[["","","ATORVASTATIN"," ATORVASTATIN ","30","Select","Select",""],["","","GLUCAGEN"," GLUCAGEN ","1","Select","Select",""],["","","CONTOUR"," CONTOUR ","300","Select","Select",""],["","","LEVOTHYROXIN"," LEVOTHYROXIN ","30","Select","Select",""],["","","OXCARBAZEPIN"," OXCARBAZEPIN ","180","Select","Select",""],["","","DIPHEN\/ATROP"," DIPHEN\/ATROP ","30","Select","Select",""],["","","HUMALOG"," HUMALOG ","30","Select","Select",""],["","","ZONISAMIDE"," ZONISAMIDE ","210","Select","Select",""],["","","CLORAZ"," CLORAZ ","30","Select","Select",""],["","","GLUCAGON"," GLUCAGON ","1","Select","Select",""],["","","BAQSIMI"," BAQSIMI ","1","Select","Select",""],["","","LANTUS"," LANTUS ","10","Select","Select",""],["","","AZITHROMYCIN"," AZITHROMYCIN ","6","Select","Select",""],["","","BENZONATATE","CAP 100MG","","Select","Select",""],["","","CLOBAZAM","TAB 10MG","","Select","Select",""],["","","INSULIN","INJ 100\/ML","","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":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"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":""}]}]}