{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"AUTUMN   D FOY","gend":1,"add":"2723 PROFFITT RD                                            ","city":"CHARLOTTESVILLE               ","state":"VA","zip":"22911-5703","dob":"1999-04-30","age":"","mstatus":"","insh":10035367,"cliId":"","pno":4349752722,"cno":4349752722,"email":"","ename":"","eno":"","pphy":"CHANG, ANDREW S                                             ","ppno":"","pcpadd":"575 Industrial Dr","pcpcity":"Louisa                        ","pcpstate":"VA","pcpzip":230934146,"pcpcounty":"","pcpid":"P9476202","pcpname":"UVA PRIMARY CARE RIVERSIDE","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"2723 PROFFITT RD                                            ","madd2":"                                                            ","madd3":"","mcity":"CHARLOTTESVILLE               ","mstate":"VA","mzip":"22911-5703","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Q14.1","H57.89","Z00.00","Z13.31","Z23"],"date":["2019-06-10","2019-06-15","2021-09-29","2021-09-29","2021-09-29"],"priorHcc":["","","","",""]}},{"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":[["","33332032001","AFLURIA","2020-21","0.5","Select","Select",""],["","00781709459","ERY\/BENZOYL","5-3%","46.6","Select","Select",""],["","00555901658","SPRINTEC","28 DAY","28","Select","Select",""],["","19515081852","FLULAVAL","2021-22","0.5","Select","Select",""],["","68462030929","NORGEST\/ETHI","0.25\/35","84","Select","Select",""],["","33332032001","AFLURIA ","INJ 2020-21","0.5","Select","Select",""],["","00781709459","ERY\/BENZOYL ","GEL 5-3%","46.6","Select","Select",""],["","00555901658","SPRINTEC ","TAB 28 DAY","28","Select","Select",""],["","19515081852","FLULAVAL ","INJ 2021-22","0.5","Select","Select",""],["","59267100002","PFIZER ","INJ COVID-19","0.3","Select","Select",""],["","68462030929","NORGEST\/ETHI ","TAB 0.25\/35","84","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":[[["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["No","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":""}]}]}