{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KYLE   R PROPST","gend":0,"add":"16020 ELDERLY LANE                                          ","city":"TIMBERVILLE                   ","state":"VA","zip":"22853-2922","dob":"2004-09-29","age":"","mstatus":"","insh":4480179,"cliId":"","pno":5405641110,"cno":"","email":"","ename":"","eno":"","pphy":"DERBY, JENNIFER REBECCA                                     ","ppno":5409010800,"pcpadd":"13892 Timber Way                                            ,                                                            ","pcpcity":"Broadway                      ","pcpstate":"VA","pcpzip":228153332,"pcpcounty":"","pcpid":"","pcpname":"SRMH TIMBER WAY HEALTH CENTER","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"16020 ELDERLY LANE                                          ","add3":"","madd1":"16020 ELDERLY LANE                                          ","madd2":"                                                            ","madd3":"","mcity":"TIMBERVILLE                   ","mstate":"VA","mzip":"22853-2922","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R30.0","R35.0","R10.31","M41.84","Z00.129","M43.9","H54.7","G47.00","F32.0","Z23","F43.20","R03.1","L55.9","S90.01XA","M25.571","S99.911A","R20.0","F41.9","Z00.121","M41.124","M41.126","F51.01","L23.7","J10.1","Z20.822","R07.9","R11.0","R11.2","R19.7","R50.9"],"date":["2020-12-16","2020-11-18","2020-12-16","2021-06-10","2021-06-10","2021-06-10","2021-06-10","2021-11-23","2021-11-23","2021-08-04","2021-10-18","2021-08-13","2021-08-13","2021-08-29","2021-10-26","2021-10-01","2021-10-26","2021-11-23","2022-06-24","2022-06-24","2022-06-24","2022-06-24","2022-07-03","2022-10-20","2022-10-20","2022-10-20","2022-10-20","2022-10-20","2022-10-20","2022-10-20"],"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":[["","68382080510","TRAZODONE","TAB 50MG","30","Select","Select",""],["","70954005920","PREDNISONE","TAB 10MG","42","Select","Select",""],["","64380071206","BENZONATATE","CAP 100MG","30","Select","Select",""],["","50383070016","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","69367030951","SODIUM","CRE 5000 PLS","51","Select","Select",""],["","57237002801","AMOXICILLIN","TAB 500MG","15","Select","Select",""],["","59651036105","IBUPROFEN","TAB 600MG","24","Select","Select",""],["","00406012305","HYDROCO\/APAP","TAB 5-325MG","8","Select","Select",""],["","00054418425","DEXAMETHASON","TAB 4MG","6","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":""}]}]}