{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"GLENN NOWLIN","gend":0,"add":"PO BOX 53","city":"GLADYS                        ","state":"VA","zip":"24554-0053","dob":"2004-06-18","age":"","mstatus":"","insh":4591578,"cliId":"","pno":4342210859,"cno":"","email":"","ename":"","eno":"","pphy":"ELLIOTT, ROBERT","ppno":4343528235,"pcpadd":"527 Pocket Rd,","pcpcity":"Hurt                          ","pcpstate":"VA","pcpzip":245632023,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"PO BOX 53","add3":"","madd1":"PO BOX 53","madd2":"","madd3":"","mcity":"GLADYS                        ","mstate":"VA","mzip":"24554-0053","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F41.1","J09.X2","F90.9","T23.202A","X08.8XXA","F84.5","F32.9","T22.212A","X10.2XXA","T23.009A","T30.0","T23.002A","T23.042A","T31.0","X12.XXXA","Y93.G3","Y92.000","T23.362A","T23.342A","R11.2","Z48.1","Z48.817","Z48.01","G89.18","M79.602","M79.642","Z73.6","L90.5","R20.8","R53.1","S80.01XA","V87.7XXA","S89.91XA"],"date":["2021-04-09","2020-01-31","2020-03-31","2020-03-30","2020-03-30","2020-03-30","2020-03-31","2020-03-30","2020-04-01","2020-03-30","2020-03-30","2020-03-31","2020-03-31","2020-04-01","2020-03-31","2020-03-31","2020-03-31","2020-04-01","2020-03-31","2020-03-31","2020-04-02","2020-04-04","2020-04-06","2020-04-06","2020-04-06","2020-04-05","2020-06-10","2020-06-10","2020-06-10","2020-06-10","2021-12-04","2021-12-04","2021-12-04"],"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":[["","45802065078","LORATADINE","TAB 10MG","30","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","00591044401","GUANFACINE","TAB 1MG","30","Select","Select",""],["","54838052340","FLUOXETINE","SOL 20MG\/5ML","150","Select","Select",""],["","50428027684","MELATONIN","TAB 5MG","30","Select","Select",""],["","10702001801","OXYCODONE","TAB 5MG","20","Select","Select",""],["","50428026496","CVS","TAB 8.6MG","14","Select","Select",""],["","45802048678","DOCUSATE","CAP 100MG","14","Select","Select",""],["","69238126601","OSELTAMIVIR","CAP 75MG","10","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":""}]}]}