{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   WERDNAREKLAW B","gend":0,"add":"EMOHSSEL","city":"DANVILLE","state":"VA","zip":"24541-9998","dob":"1977-12-02","age":"","mstatus":"","insh":"60011953","cliId":"","pno":"0743402309","cno":"","email":"","ename":"","eno":"","pphy":"VASIREDDY, VENUGOPAL K","ppno":4347992055,"pcpadd":"142 S Main St, ","pcpcity":"Danville","pcpstate":"VA","pcpzip":245412922,"pcpcounty":"","pcpid":"","pcpname":"DANVILLE PATIENT CARE INC","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"APARTMENT 15","add3":"","madd1":"HOMELESS","madd2":"APARTMENT 15","madd3":"","mcity":"DANVILLE","mstate":"VA","mzip":"24541-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11.65","T50.904A","R55","T88.7XXA","I10","H66.009","R85.9","F17.210","Z59.0","R85.89","M25.562","M25.462","Z53.20","Z72.0","I96","L03.116","L08.9","M00.9","A42.9","E87.1","F17.200","E87.6","M71.162","L02.416","F11.10","F15.10","F90.9","F31.9","B19.20","Z53.29","M71.10","D72.829","R79.82","R70.0","F31.4","F19.90","S81.002A","B95.4","A42.89","F19.10","M79.605","Z98.890","M00.261","S81.801A","G89.18","F11.20","F32.9","B96.89","M70.42","F16.10","F31.30","R09.02","T40.1X1A","T40.2X1A","F31.81","F90.2"],"date":["2022-02-17","2022-02-17","2022-02-17","2022-02-17","2020-06-02","2020-06-02","2020-06-02","2020-06-02","2020-10-28","2020-06-02","2020-10-09","2020-10-03","2020-10-03","2020-10-11","2020-10-10","2020-10-10","2020-10-10","2020-10-10","2020-10-10","2020-10-10","2020-10-10","2020-10-10","2020-10-28","2020-10-10","2020-10-17","2020-10-10","2020-10-28","2020-10-14","2020-10-21","2020-10-10","2020-10-10","2020-10-14","2020-10-10","2020-10-10","2020-10-10","2020-10-21","2020-10-19","2020-10-19","2020-10-19","2022-02-17","2020-10-14","2020-10-14","2020-10-12","2020-10-12","2020-10-13","2020-10-14","2020-10-14","2020-10-19","2020-10-28","2020-10-17","2020-10-28","2022-02-17","2022-02-17","2022-02-17","2019-02-25","2019-02-25"],"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":[["","57237004705","DIVALPROEX","TAB 250MG DR","120","Select","Select",""],["","66685100100","AMOX\/K","TAB 875-125","60","Select","Select",""],["","70010075405","METHOCARBAM","TAB 500MG","120","Select","Select",""],["","42858000101","OXYCODONE","TAB 5MG","20","Select","Select",""],["","65862019401","FLUOXETINE","CAP 40MG","30","Select","Select",""],["","00093314705","CEPHALEXIN","CAP 500MG","21","Select","Select",""],["","00228203150","ALPRAZOLAM","TAB 1MG","90","Select","Select",""],["","54092038701","ADDERALL","CAP 20MG","60","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":""}]}]}