{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JOHANN HERSHBERGER","gend":0,"add":"3438 AMBERLY ROAD","city":"ROCKINGHAM                    ","state":"VA","zip":"22802-0927","dob":"2004-07-21","age":"","mstatus":"","insh":4211187,"cliId":"","pno":5403241179,"cno":"","email":"","ename":"","eno":"","pphy":"KATZ, MARTIN D","ppno":4348171818,"pcpadd":"190 James River Rd,","pcpcity":"Scottsville                   ","pcpstate":"VA","pcpzip":245903812,"pcpcounty":"","pcpid":"","pcpname":"DOWNTOWN FAMILY HEALTH CARE, PRIVIA MEDICAL GROUP","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"3438 AMBERLY ROAD","add3":"","madd1":"3438 AMBERLY ROAD","madd2":"","madd3":"","mcity":"ROCKINGHAM                    ","mstate":"VA","mzip":"22802-0927","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H90.3","U07.1","Z00.121","E55.9","R53.83","Z91.018","J30.1","R73.9","G47.9","K90.49","R10.13","I49.9","R52","R41.0","M89.8X1","M79.622","V47.0XXA","S42.025A","Z88.0","S42.022A","S49.92XA","Z45.321","Q10.3","H47.333","H52.01","H52.12"],"date":["2021-11-08","2020-12-15","2021-01-15","2021-05-06","2021-02-08","2021-02-23","2021-11-10","2021-05-06","2021-05-06","2021-11-10","2021-06-02","2021-07-02","2021-07-02","2021-07-02","2021-07-03","2021-07-03","2021-07-03","2021-07-03","2021-07-03","2021-07-07","2021-07-03","2021-07-07","2021-10-01","2021-10-01","2021-10-01","2021-10-01"],"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":[["","65862057490","MONTELUKAST","TAB 10MG","90","Select","Select",""],["","00406012305","HYDROCO\/APAP","TAB 5-325MG","6","Select","Select",""],["","67877032005","IBUPROFEN","TAB 600MG","20","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":""}]}]}