{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BRITTNEY   R SHELTON","gend":1,"add":"1406 E MARKET STREET","city":"CHARLOTTESVILLE","state":"VA","zip":"22902-5449","dob":"1992-06-28","age":"","mstatus":"","insh":4099750,"cliId":"","pno":4344653146,"cno":"","email":"","ename":"","eno":"","pphy":"OMBRES, RACHEL L","ppno":5406613004,"pcpadd":"661 UNIVERSITY LN, STE A","pcpcity":"ORANGE","pcpstate":"VA","pcpzip":229602243,"pcpcounty":"","pcpid":"","pcpname":"BLUE RIDGE PACE","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"APARTMENT B","add3":"","madd1":"1406 E MARKET STREET","madd2":"APARTMENT B","madd3":"","mcity":"CHARLOTTESVILLE","mstate":"VA","mzip":"22902-5449","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R10.2","Z36.3","Z3A.20","Z36.89","O99.212","O34.80","Z34.82","N83.209","O99.891","Z86.19","O98.519","Z34.92","Z3A.23","U07.1","O98.512","O98.513","Z3A.28","Z34.83","D64.9","Z3A.30","O99.353","G43.709","O99.013","Z86.16","O09.899","Z28.3","Z23","Z3A.32","O36.8130","Z3A.36","Z3A.37","Z3A.39","O48.0","Z3A.40","O99.02","Z37.0","O76","O69.81X0","O99.284","E28.2","Z20.822","Z87.891","O69.89X0","Z39.1","N61.0","B37.89","N64.4","R53.83"],"date":["2020-12-17","2020-12-28","2020-12-28","2020-12-28","2020-12-28","2020-12-28","2021-06-14","2020-12-28","2021-03-25","2020-12-28","2021-03-25","2021-01-22","2021-01-22","2021-03-25","2021-01-22","2021-02-25","2021-02-25","2021-06-14","2021-05-17","2021-03-11","2021-03-11","2021-03-11","2021-05-17","2021-03-25","2021-03-25","2021-03-25","2021-03-25","2021-03-25","2021-04-22","2021-04-22","2021-04-29","2021-05-11","2021-05-17","2021-05-18","2021-05-17","2021-05-18","2021-05-17","2021-05-18","2021-05-17","2021-05-17","2022-02-08","2021-05-17","2021-05-18","2021-06-14","2021-10-14","2021-10-14","2021-10-14","2022-02-08"],"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":[["","70710113908","FLUCONAZOLE","TAB 150MG","1","Select","Select",""],["","51672130406","TERCONAZOLE","CRE 0.004","45","Select","Select",""],["","00093312301","DICLOXACILL","CAP 250MG","40","Select","Select",""],["","49483060350","IBUPROFEN","TAB 600MG","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":""}]}]}