{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"NY'CHINA MANNING","gend":1,"add":"1111   14TH STREET                                          ","city":"LYNCHBURG                     ","state":"VA","zip":"24504-3411","dob":"2002-09-19","age":"","mstatus":"","insh":4468789,"cliId":"","pno":4342587723,"cno":"","email":"","ename":"","eno":"","pphy":"ALBERS, GREGG                                               ","ppno":4348468421,"pcpadd":"2811 Linkhorne Dr Ste A                                     ,                                                            ","pcpcity":"Lynchburg                     ","pcpstate":"VA","pcpzip":245033354,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"1111   14TH STREET                                          ","add3":"","madd1":"1111   14TH STREET                                          ","madd2":"                                                            ","madd3":"","mcity":"LYNCHBURG                     ","mstate":"VA","mzip":"24504-3411","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R19.7","F43.10","N76.0","N92.6","R21","J02.9","J02.0","E28.2","Z11.3","Z01.419","R10.9","N88.8","R01.1","R43.0","R43.2","Z20.822","G89.11","V87.7XXA","N83.01","N83.02","J06.9","B37.3","R10.2","N94.6","J30.2"],"date":["2020-03-15","2020-04-20","2021-04-30","2022-10-18","2021-03-01","2022-08-22","2021-04-13","2022-04-27","2022-10-18","2021-04-30","2021-05-06","2021-05-06","2021-07-09","2021-09-13","2021-09-13","2021-09-23","2022-02-19","2022-02-19","2022-03-08","2022-03-08","2022-08-22","2022-08-22","2022-10-18","2022-10-24","2022-10-24"],"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":[["","00555077902","MEDROXYPR","TAB 10MG","10","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","12","Select","Select",""],["","65862001501","AMOXICILLIN","TAB 875MG","14","Select","Select",""],["","67877032105","IBUPROFEN","TAB 800MG","30","Select","Select",""],["","00378727253","NORETHINDRON","TAB 0.35MG","84","Select","Select",""],["","71093014105","METHOCARBAM","TAB 750MG","30","Select","Select",""],["","69230031703","ALLERGY","TAB 10MG","30","Select","Select",""],["","50228043605","NAPROXEN","TAB 500MG","60","Select","Select",""],["","50383070016","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","00378334053","XULANE","DIS 150-35","3","Select","Select",""],["","67405060301","FLUCONAZOLE","TAB 150MG","1","Select","Select",""],["","42571016242","AMOX\/K","TAB 875-125","20","Select","Select",""],["","00555901858","TRI-SPRINTEC","TAB ","84","Select","Select",""],["","67877056105","METFORMIN","TAB 500MG","60","Select","Select",""],["","68462029817","CLOTRIM\/BETA","CRE DIPROP","15","Select","Select",""],["","68462073329","DROSPIR\/ETHI","TAB 3-0.03MG","28","Select","Select",""],["","43547030303","ARIPIPRAZOLE","TAB 5MG","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":""}]}]}