{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" AISANATTTIRREM","gend":1,"add":"         .DR TSEROF YENIP 1231                              ","city":"DANVILLE                      ","state":"VA","zip":"24540-1642","dob":"1999-09-28","age":"","mstatus":"","insh":"71013605","cliId":"","pno":"1743469953","cno":4347135996,"email":"","ename":"","eno":"","pphy":"ADDIS, DANIEL M                                             ","ppno":"","pcpadd":"219 Parker Rd","pcpcity":"Danville                      ","pcpstate":"VA","pcpzip":245404034,"pcpcounty":"","pcpid":"P0060036","pcpname":"PIEDMONT FAMILY AND OCCUPATIONAL MEDICINE","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"APT. N103                                                   ","add3":"","madd1":"1321 PINEY FOREST RD.                                       ","madd2":"APT. N103                                                   ","madd3":"","mcity":"DANVILLE                      ","mstate":"VA","mzip":"24540-1642","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["L73.2","R89.9","Z97.5","R68.89","N76.0","Z11.3","N94.10","N64.4","Z01.411","F32.9","R11.0","Z72.51","Z30.8","Z01.419","Z20.828","N73.9","B37.3","N89.8","R10.2","L29.9","S39.012A","J06.9"],"date":["2020-05-22","2019-05-21","2019-05-21","2019-06-11","2020-12-03","2019-09-04","2019-07-30","2019-09-04","2019-09-04","2019-09-04","2019-11-08","2019-11-08","2020-03-23","2020-07-23","2020-07-15","2020-11-10","2020-11-10","2020-11-10","2020-11-10","2020-11-10","2021-09-23","2021-10-19"],"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":[["","16714069211","FLUCONAZOLE","150MG","1","Select","Select",""],["","51862027906","MICROGESTIN","1.5\/30","21","Select","Select",""],["","42806031250","DOXYCYCL","100MG","28","Select","Select",""],["","68462018022","MUPIROCIN","2%","22","Select","Select",""],["","63304061650","DOXYCYC","100MG","20","Select","Select",""],["","00234057508","HIBICLENS","4%","236","Select","Select",""],["","68382005105","MELOXICAM","15MG","30","Select","Select",""],["","80777027399","MODERNA","COVID-19","0.5","Select","Select",""],["","16714069211","FLUCONAZOLE ","TAB 150MG","1","Select","Select",""],["","45802065078","LORATADINE ","TAB 10MG","30","Select","Select",""],["","51862027906","MICROGESTIN ","TAB 1.5\/30","21","Select","Select",""],["","42806031250","DOXYCYCL ","TAB 100MG","28","Select","Select",""],["","68462018022","MUPIROCIN ","OIN 0.02","22","Select","Select",""],["","63304061650","DOXYCYC ","CAP 100MG","20","Select","Select",""],["","00234057508","HIBICLENS ","LIQ 0.04","236","Select","Select",""],["","68382005105","MELOXICAM ","TAB 15MG","30","Select","Select",""],["","80777027399","MODERNA ","INJ COVID-19","0.5","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":""}]}]}