{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   NNOVEDSNIKNAH S","gend":1,"add":"           DAOR NOSREDNEH 5803                              ","city":"ALTON                         ","state":"VA","zip":"24520-3545","dob":"1976-10-26","age":"","mstatus":"","insh":"21015115","cliId":"","pno":"7543485239","cno":4345793258,"email":"","ename":"","eno":"","pphy":"SETTLE, PAUL C                                              ","ppno":"","pcpadd":"404 Airport Dr","pcpcity":"Danville                      ","pcpstate":"VA","pcpzip":245405196,"pcpcounty":"","pcpid":"P9058529","pcpname":"CMG PRIMECARE","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"3085 HENDERSON ROAD                                         ","madd2":"                                                            ","madd3":"","mcity":"ALTON                         ","mstate":"VA","mzip":"24520-3545","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N91.1","Z32.01","J02.9","J06.9","J10.1","R05","R51","K21.9","Z79.899","O09.892","Z34.82","Z3A.20","O09.92","O36.8120","O09.522","Z3A.26","O09.893","R31.29","Z23","Z98.890","O13.3","O09.523","R10.9","M54.9","Z3A.36","O61.0","Z3A.37","O13.4","O32.4XX0","O69.81X0","O75.81","Z3A.38","Z37.0","Z30.2","O47.1","O13.5","Z39.2","T19.2XXA","X58.XXXA","L91.8","B07.8","L98.8","Z01.411","R10.2","Z12.4","Z01.419","Z12.39","F41.8","K02.9","K08.89","Z98.51","Z87.891","Z82.49"],"date":["2019-01-21","2019-01-21","2019-03-12","2019-03-12","2019-03-12","2019-03-12","2019-03-12","2019-03-12","2019-03-12","2019-06-13","2019-03-20","2019-04-22","2019-04-22","2019-06-08","2019-06-08","2019-06-08","2019-08-19","2019-07-11","2021-04-08","2019-08-13","2019-08-16","2019-08-18","2019-08-18","2019-08-18","2019-08-18","2019-08-21","2019-08-21","2019-08-29","2019-08-29","2019-08-29","2019-08-29","2019-08-29","2019-08-29","2019-08-29","2019-08-28","2019-09-09","2019-10-21","2019-10-27","2019-10-27","2020-02-03","2020-02-03","2020-02-03","2020-02-27","2020-02-27","2021-03-24","2021-03-24","2021-03-24","2021-03-24","2021-07-14","2021-07-14","2021-07-14","2021-07-14","2021-07-14"],"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":[["","68645052154","SERTRALINE","25MG","30","Select","Select",""],["","68645056259","IBUPROFEN","600MG","30","Select","Select",""],["","00093005805","TRAMADOL","50MG","18","Select","Select",""],["","00781261305","AMOXICILLIN","500MG","30","Select","Select",""],["","68645052154","SERTRALINE ","TAB 25MG","30","Select","Select",""],["","00093005805","TRAMADOL ","TAB 50MG","18","Select","Select",""],["","00781261305","AMOXICILLIN ","CAP 500MG","30","Select","Select",""],["","68645056259","IBUPROFEN ","TAB 600MG","30","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","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["No","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":""}]}]}