{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   YLLOHYBGAB M","gend":1,"add":"AHC W 2971EVIRD LEP","city":"BUMPASS","state":"VA","zip":"23024-2425","dob":"1987-01-21","age":"","mstatus":"","insh":"2187739","cliId":"","pno":"2940871119","cno":5405051372,"email":"","ename":"","eno":"","pphy":"BOWLES JR, JAMES H","ppno":8045563172,"pcpadd":"2884 Sandy Hook Rd, ","pcpcity":"Sandy Hook","pcpstate":"VA","pcpzip":231532226,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":5405051372,"add2":"                                                            ","add3":"","madd1":"1792 W CHAPEL DRIVE","madd2":"                                                            ","madd3":"","mcity":"BUMPASS","mstate":"VA","mzip":"23024-2425","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G35","G62.9","N13.2","N10","K92.2","G93.2","R25.1","G43.709","R20.2","E55.9","G25.0","M54.5","Z68.41","Z79.899","R79.89","H47.093","Z01.419","N20.1","E66.01","N23","R31.29","N20.0","N13.30","L50.9","R06.02","N39.0","R20.0","R53.1","Z87.448","Z90.49","Z32.02","Z88.8","Z91.040","Z80.41","Z83.79","J45.21","N20.2","Z23","N12","R10.9","N83.202","R11.2","R10.2","M47.812","R21","K22.6","F41.9","M72.2","J34.2","J35.1","R06.83","G47.33","A41.9","N13.6","R73.03","E87.6","K42.9","G43.909","Z98.51","R50.9"],"date":["2021-04-03","2020-05-04","2019-11-23","2019-11-23","2019-11-23","2020-05-04","2020-05-04","2020-09-01","2021-03-05","2020-09-01","2020-09-01","2020-09-01","2020-09-01","2021-03-05","2021-03-04","2019-04-16","2019-05-06","2019-12-20","2019-12-06","2019-12-20","2019-12-20","2019-12-16","2019-12-20","2019-03-22","2019-11-22","2019-12-16","2021-03-05","2021-03-05","2021-03-05","2021-03-05","2021-03-05","2021-03-05","2021-03-05","2021-03-05","2021-03-05","2019-09-11","2019-12-06","2019-05-06","2019-11-22","2019-12-02","2019-11-23","2019-11-23","2019-12-02","2021-04-03","2019-03-22","2019-11-23","2019-11-22","2019-02-28","2019-05-20","2019-05-20","2019-05-20","2019-05-20","2019-11-22","2019-11-22","2019-11-22","2019-11-22","2019-11-22","2019-11-22","2019-11-22","2019-11-22"],"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":[["","69452015120","VITAMIN ","CAP 50000UNT","4","Select","Select",""],["","69097084615","CYCLOBENZAPR ","TAB 10MG","30","Select","Select",""],["","51991074790","DULOXETINE ","CAP 30MG","60","Select","Select",""],["","51991081701","PROPRANOLOL ","CAP 60MG ER","30","Select","Select",""],["","00093083205","CLONAZEPAM ","TAB 0.5MG","30","Select","Select",""],["","53489011905","DOXYCYCL ","CAP 100MG","14","Select","Select",""],["","69097094312","GABAPENTIN ","CAP 300MG","90","Select","Select",""],["","69097012403","TOPIRAMATE ","TAB 100MG","60","Select","Select",""],["","00172392670","DIAZEPAM ","TAB 5MG","2","Select","Select",""],["","68382003516","VENLAFAXINE ","CAP 75MG ER","60","Select","Select",""],["","50111033401","METRONIDAZOL ","TAB 500MG","4","Select","Select",""],["","68180012202","CEPHALEXIN ","CAP 500MG","40","Select","Select",""],["","00245531911","KLOR-CON ","TAB 20MEQ ER","3","Select","Select",""],["","75826011510","PHENAZOPYRID ","TAB 200MG","6","Select","Select",""],["","10702001150","HYDROXYZ ","TAB 25MG","20","Select","Select",""],["","57237001401","TAMSULOSIN ","CAP 0.4MG","30","Select","Select",""],["","00093317431","ALBUTEROL ","FAT E HFA INH","8.5","Select","Select",""],["","00378064010","PREDNISONE ","TAB 5MG","60","Select","Select",""],["","68180016013","AZITHROMYCIN ","TAB 250MG","6","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","",""],["Yes","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":""}]}]}