{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BLAKE   M PARKER","gend":0,"add":"109   MEDICAL CENTER ROAD                                   ","city":"DANVILLE                      ","state":"VA","zip":"24540-6501","dob":"2003-11-18","age":"","mstatus":"","insh":4366273,"cliId":"","pno":4347133847,"cno":4347135947,"email":"","ename":"","eno":"","pphy":"WINFIELD II, ALBERT C","ppno":4347930700,"pcpadd":"441 Piney Forest Rd                                         ,Ste E                                                       ","pcpcity":"DANVILLE                      ","pcpstate":"VA","pcpzip":245404154,"pcpcounty":"","pcpid":"","pcpname":"CORNERSTONE COMPLETE CARE INC","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"109   MEDICAL CENTER ROAD                                   ","add3":"","madd1":"109   MEDICAL CENTER ROAD                                   ","madd2":"                                                            ","madd3":"","mcity":"DANVILLE                      ","mstate":"VA","mzip":"24540-6501","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H61.23","H93.291","J06.9","J02.9","Z20.828","F43.23","F90.2","L72.3","M79.604","Z68.52","M79.661","Z20.818","R22.41","R09.81","R45.7","T18.128A","T17.228A","R11.10","X58.XXXA","F17.290","M54.2","S13.9XXA","R05.9","R06.2","R06.02","F32.89","J45.909","R50.9"],"date":["2020-05-14","2020-05-14","2022-11-09","2022-11-09","2021-03-30","2022-11-20","2021-06-02","2021-08-03","2021-08-03","2021-08-03","2021-08-23","2021-08-30","2021-09-21","2022-01-12","2022-02-22","2022-02-22","2022-02-22","2022-02-22","2022-02-22","2022-02-22","2022-04-28","2022-04-28","2022-06-07","2022-06-07","2022-06-07","2022-06-13","2022-09-28","2022-11-09"],"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":[["","41167580005","NASACORT","SPR 55MCG\/AC","16.9","Select","Select",""],["","11523716202","CLARITIN-D","TAB 5-120MG","14","Select","Select",""],["","00093227434","AMOX\/K","TAB 500-125","14","Select","Select",""],["","00591544310","PREDNISONE","TAB 20MG","10","Select","Select",""],["","65862064163","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","60432060416","PROMETHAZINE","SYP DM","120","Select","Select",""],["","59310057922","PROAIR","AER ","8.5","Select","Select",""],["","16571020210","DICLOFENAC","TAB 50MG DR","60","Select","Select",""],["","57237009960","CEFDINIR","CAP 300MG","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":""}]}]}