{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SUMMER   N DUCKWORTH","gend":1,"add":"436 CHESTNUT RIDGE LANE                                     ","city":"KEELING                       ","state":"VA","zip":"24566-3960","dob":"2002-12-13","age":"","mstatus":"","insh":1351995,"cliId":"","pno":4348575353,"cno":"","email":"","ename":"","eno":"","pphy":"HUNDLEY, SUSAN D                                            ","ppno":4347386420,"pcpadd":"705 Main St                                                 ,                                                            ","pcpcity":"Danville                      ","pcpstate":"VA","pcpzip":245411803,"pcpcounty":"","pcpid":"","pcpname":"HEALTH CENTER OF THE PIEDMONT CHATHAM","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"436 CHESTNUT RIDGE LANE                                     ","add3":"","madd1":"436 CHESTNUT RIDGE LANE                                     ","madd2":"LOT 42                                                      ","madd3":"","mcity":"KEELING                       ","mstate":"VA","mzip":"24566-3960","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F33.1","F41.1","M25.572","M25.571","M77.50","M54.5","S39.012A","X50.0XXA","Y92.89","J03.90","R07.0","S93.491A","W01.0XXA","Y92.009","Y99.9","Z87.891","X50.9XXA","N94.6","N92.0","Z11.3","Z78.9","S90.112A","H10.13","R03.0","F41.9","L25.9","Z20.822","J06.9","R42","S93.601A","R09.81"],"date":["2021-03-22","2021-03-22","2021-03-26","2021-08-14","2021-03-26","2021-04-17","2021-04-17","2021-04-17","2021-04-17","2021-04-20","2021-04-20","2021-08-14","2021-08-14","2021-08-14","2021-08-14","2021-08-14","2021-08-14","2021-11-23","2021-11-23","2021-11-24","2021-11-23","2021-12-01","2022-04-08","2022-04-08","2022-09-21","2022-06-08","2022-09-21","2022-12-02","2022-09-21","2022-11-03","2022-12-02"],"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":[]},{"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":[["","00378334053","XULANE","DIS 150-35","3","Select","Select",""],["","66993037083","MEDROXYPR","INJ 150MG\/ML","1","Select","Select",""],["","50383004224","PREDNISOLONE","SOL 15MG\/5ML","60","Select","Select",""],["","67877025130","TRIAMCINOLON","CRE 0.001","30","Select","Select",""],["","00054001925","PREDNISONE","TAB 50MG","6","Select","Select",""],["","16571020106","DICLOFENAC","TAB 75MG DR","60","Select","Select",""],["","80777027399","MODERNA","INJ COVID-19","0.5","Select","Select",""],["","59267100002","PFIZER","INJ COVID-19","0.3","Select","Select",""],["","49483060450","IBUPROFEN","TAB 800MG","30","Select","Select",""],["","00603459321","METHYLPRED","TAB 4MG","21","Select","Select",""],["","00555902658","JUNEL","TAB 43831","28","Select","Select",""],["","13668013601","ESCITALOPRAM","TAB 10MG","30","Select","Select",""],["","57664049983","MIRTAZAPINE","TAB 15MG","30","Select","Select",""],["","69584061150","METHOCARBAM","TAB 500MG","56","Select","Select",""],["","42806016005","HYDROXYZ","TAB 25MG","60","Select","Select",""],["","50111045001","TRAZODONE","TAB 150MG","30","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":""}]}]}