{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JEREMY SIZEMORE","gend":0,"add":"LARRY SIZEMORE                                              ","city":"FREDERICKSBURG                ","state":"VA","zip":"22407-5901","dob":"1996-04-19","age":"","mstatus":"","insh":10030862,"cliId":"","pno":5407857380,"cno":5407857380,"email":"","ename":"","eno":"","pphy":"BABAR, AHMAD                                                ","ppno":"","pcpadd":"4376 Germanna Hwy","pcpcity":"Locust Grove                  ","pcpstate":"VA","pcpzip":225082008,"pcpcounty":"","pcpid":"P0110933","pcpname":"UVA PRIMARY CARE LOCUST GROVE","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"CENTRAL","aligned":"","ano":"","add2":"8909 GENERAL AYRES CIRCLE                                   ","add3":"","madd1":"LARRY SIZEMORE                                              ","madd2":"8909 GENERAL AYRES CIRCLE                                   ","madd3":"","mcity":"FREDERICKSBURG                ","mstate":"VA","mzip":"22407-5901","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F33.1","F41.1","F84.0","F20.81","E11.9","F41.9","F32.9","G47.00","H61.23","J30.2","L60.3","R10.11","R10.31","R10.9","M79.671","M21.621","M20.61","M20.41","E08.65","R19.7","K62.5","Z00.00","M79.661","F64.9"],"date":["2019-01-10","2019-01-10","2020-01-30","2019-01-10","2021-04-30","2021-07-07","2021-07-07","2019-01-21","2019-03-18","2019-03-18","2019-05-22","2020-01-31","2020-01-30","2020-01-30","2021-04-30","2021-04-30","2021-04-30","2021-04-30","2021-07-07","2021-06-09","2021-06-09","2021-07-07","2021-07-07","2021-11-19"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","",null]}},{"a":[]}]},{"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":[]}]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","70436001102","BUPROPN","300MG XL","30","Select","Select",""],["","43547030303","ARIPIPRAZOLE","5MG","30","Select","Select",""],["","00002143480","TRULICITY","1.5\/0.5","6","Select","Select",""],["","00378623101","CITALOPRAM","10MG","30","Select","Select",""],["","13107000334","MIRTAZAPINE","30MG","30","Select","Select",""],["","00228285311","GUANFACINE","3MG ER","30","Select","Select",""],["","00093100301","BUSPIRONE","15MG","60","Select","Select",""],["","51224000760","METFORMIN","500MG ER","60","Select","Select",""],["","49281042050","FLUZONE","2020-21","0.5","Select","Select",""],["","70436001102","BUPROPN ","TAB 300MG XL","30","Select","Select",""],["","43547030303","ARIPIPRAZOLE ","TAB 5MG","30","Select","Select",""],["","70010049110","METFORMIN ","TAB 500MG ER","90","Select","Select",""],["","00002143480","TRULICITY ","INJ 1.5\/0.5","6","Select","Select",""],["","00378623101","CITALOPRAM ","TAB 10MG","30","Select","Select",""],["","13107000334","MIRTAZAPINE ","TAB 30MG","30","Select","Select",""],["","00228285311","GUANFACINE ","TAB 3MG ER","30","Select","Select",""],["","00093100301","BUSPIRONE ","TAB 15MG","60","Select","Select",""],["","49281042050","FLUZONE ","INJ 2020-21","0.5","Select","Select",""]]}},{"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":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[[["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""]]]},{"t":"Mini-Cog","q":[{"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":""}]}]}