{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ANGEL   G LETCHFORD","gend":1,"add":"536 CARWILE ROAD                                            ","city":"RUSTBURG                      ","state":"VA","zip":"24588-2936","dob":"2002-10-05","age":"","mstatus":"","insh":4231090,"cliId":"","pno":4344016328,"cno":4344013775,"email":"","ename":"","eno":"","pphy":"THOMAS E DOBYNS MD                                          ","ppno":4345284312,"pcpadd":"4579 S Amherst Hwy                                          ,                                                            ","pcpcity":"MADISON HEIGHTS               ","pcpstate":"VA","pcpzip":245725343,"pcpcounty":"","pcpid":"","pcpname":"THOMAS E DOBYNS FAMILY PRACTICE","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"536 CARWILE ROAD                                            ","add3":"","madd1":"1305 Garfield Ave                                           ","madd2":"                                                            ","madd3":"","mcity":"Lynchburg                     ","mstate":"VA","mzip":"24501-2837","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F32.3","F64.0","F43.10","Z00.129","Z23","R45.851","F32.9","Z20.828","F17.210","F90.9","Z91.5","Z79.899","F33.1","R45.850","Z30.013","Z30.42","J06.9","R05.9","O20.0","O26.891","R10.2","N93.9","O23.41","Z3A.01","O20.9","Z3A.00","N92.6","Z32.01","Z09","Z11.3","Z11.8","Z3A.08","Z72.0","O26.899","M54.50","O99.331","O23.591","N89.8","Z36.0","Z3A.12"],"date":["2021-09-02","2022-06-30","2020-11-07","2020-09-16","2020-09-16","2020-11-09","2021-04-05","2020-11-05","2022-11-22","2020-11-07","2020-11-07","2021-04-05","2020-11-09","2021-04-05","2021-04-21","2021-07-21","2022-09-19","2022-09-19","2022-10-09","2022-10-09","2022-10-09","2022-10-09","2022-10-09","2022-10-09","2022-10-09","2022-11-09","2022-10-24","2022-10-24","2022-10-24","2022-10-24","2022-10-24","2022-10-24","2022-10-24","2022-11-09","2022-11-09","2022-11-22","2022-11-22","2022-11-22","2022-11-22","2022-11-22"],"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":[["","00555032302","HYDROXYZ","CAP 25MG","15","Select","Select",""],["","13107003134","MIRTAZAPINE","TAB 15MG","30","Select","Select",""],["","29300013501","CLONIDINE","TAB 0.1MG","30","Select","Select",""],["","73473030370","METRONIDAZOL","GEL 0.75%VAG","70","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","28","Select","Select",""],["","","BUPROPION","TAB 150MG SR","30","Select","Select",""],["","50111043301","TRAZODONE","TAB 50MG","30","Select","Select",""],["","65862007701","CIPROFLOXACN","TAB 500MG","14","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":""}]}]}