{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BRANDON TILLMAN","gend":0,"add":"219 FOREST HILL ROAD                                        ","city":"GORDONSVILLE                  ","state":"VA","zip":"22942-7308","dob":"2001-11-21","age":"","mstatus":"","insh":6835543,"cliId":"","pno":5403959341,"cno":"","email":"","ename":"","eno":"","pphy":"SOUTHALL III, ALGER R                                       ","ppno":5409672202,"pcpadd":"210 Elm Ave                                                 ,                                                            ","pcpcity":"Louisa                        ","pcpstate":"VA","pcpzip":230936578,"pcpcounty":"","pcpid":"","pcpname":"LOUISA FAMILY PRACTICE PLC","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"219 FOREST HILL ROAD                                        ","add3":"","madd1":"219 FOREST HILL ROAD                                        ","madd2":"                                                            ","madd3":"","mcity":"GORDONSVILLE                  ","mstate":"VA","mzip":"22942-7308","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M51.36","R29.898","M54.41","R10.9","M25.551","R39.9","G89.29","M54.5","J45.30","F32.9","K21.9","F41.9","G47.00","F10.120","F10.10","T68.XXXA","R52","M25.572","F41.1","F51.01","R68.84","R63.8","S91.332A","F12.10","G47.9","R11.10","F32.A"],"date":["2020-09-15","2020-09-15","2020-09-21","2020-09-15","2020-12-29","2020-09-21","2020-09-21","2020-12-29","2020-11-18","2021-10-14","2021-03-11","2021-10-14","2021-03-11","2020-12-29","2020-12-29","2020-12-29","2020-12-29","2020-12-29","2021-10-14","2021-10-14","2021-05-27","2021-10-14","2021-08-24","2021-10-14","2021-10-14","2021-10-14","2021-10-14"],"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":[["","55111015810","OMEPRAZOLE","CAP 20MG","90","Select","Select",""],["","50111064801","FLUOXETINE","CAP 20MG","60","Select","Select",""],["","13107000334","MIRTAZAPINE","TAB 30MG","30","Select","Select",""],["","00406012401","HYDROCO\/APAP","TAB 7.5-325","15","Select","Select",""],["","64380080807","IBUPROFEN","TAB 600MG","20","Select","Select",""],["","00781261305","AMOXICILLIN","CAP 500MG","21","Select","Select",""],["","68180044601","QUETIAPINE","TAB 50MG","120","Select","Select",""],["","65162027210","SMZ\/TMP","TAB 800-160","20","Select","Select",""],["","50111043302","TRAZODONE","TAB 50MG","60","Select","Select",""],["","00093117401","PENICILLN","TAB 500MG","21","Select","Select",""],["","00054001925","PREDNISONE","TAB 50MG","5","Select","Select",""],["","10370010150","BUPROPN","TAB 150MG XL","60","Select","Select",""],["","00603188016","LIDOCAINE","PAD 0.05","30","Select","Select",""],["","00093317431","ALBUTEROL","FAT E","8.5","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":""}]}]}