{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JENNIFER   M CARTER","gend":1,"add":"27 JEFFERSON STREET","city":"VERONA","state":"VA","zip":"24482-2526","dob":"1977-05-03","age":"","mstatus":"","insh":10051249,"cliId":"","pno":5402484910,"cno":5402484910,"email":"","ename":"","eno":"","pphy":"LAGRUA, JAMES C","ppno":5402483413,"pcpadd":"1371 LEE HIGHWAY, ","pcpcity":"VERONA","pcpstate":"VA","pcpzip":244820001,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"27 JEFFERSON STREET","madd2":"                                                            ","madd3":"","mcity":"VERONA","mstate":"VA","mzip":"24482-2526","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R56.9","Z98.2","G93.1","K05.6","K06.9","K02.9","F72","F50.89","Z68.33","E03.9","S06.890A","Z00.01","X58.XXXA","E23.0","E78.49","Z51.81","S06.2X9A","Z01.810","Z13.9","R00.0","R94.31","S06.9X0A","G40.909","S09.92XA","S00.31XA","S09.90XA","R50.9","N39.0","G40.209","G40.802","I10","F03.90","K21.9","G89.29","E78.5","K59.09","Z87.820","Z79.890","Z79.899","Z30.09","N92.1","G40.409","R41.82"],"date":["2019-02-08","2020-09-30","2020-09-30","2019-05-29","2019-05-29","2019-05-29","2019-05-29","2019-05-29","2019-05-29","2021-03-17","2020-12-30","2020-12-30","2020-09-24","2020-12-30","2020-12-30","2019-10-07","2019-10-07","2019-05-06","2019-05-06","2019-05-06","2019-05-06","2020-09-24","2021-03-17","2021-05-08","2021-05-08","2019-02-07","2019-04-02","2019-04-02","2020-05-20","2019-02-07","2019-02-07","2019-02-07","2019-02-07","2019-02-07","2020-03-02","2019-02-07","2019-02-07","2019-04-02","2019-04-01","2020-07-28","2020-07-28","2019-02-08","2019-02-12"],"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":[["","59762453701","MEDROXYPR ","INJ 150MG\/ML","1","Select","Select",""],["","69097082112","GEMFIBROZIL ","TAB 600MG","60","Select","Select",""],["","68180011302","LEVETIRACETA ","TAB 500MG","62","Select","Select",""],["","60505257908","ATORVASTATIN ","TAB 20MG","31","Select","Select",""],["","00904645780","DOK ","CAP 100MG","62","Select","Select",""],["","16729015016","QUETIAPINE ","TAB 400MG","62","Select","Select",""],["","00378180710","LEVOTHYROXIN ","TAB 88MCG","31","Select","Select",""],["","64380080308","RANITIDINE ","TAB 150MG","31","Select","Select",""],["","37864073406","CA ","TAB 315\/250","62","Select","Select",""],["","67877022405","GABAPENTIN ","CAP 400MG","62","Select","Select",""],["","00904527260","CALCITRATE ","TAB ","62","Select","Select",""],["","68180012202","CEPHALEXIN ","CAP 500MG","28","Select","Select",""],["","68682065220","DIAZEPAM ","GEL 10MG","1","Select","Select",""],["","40985027495","CALCIUM+D3 ","TAB 315-250","62","Select","Select",""],["","33332031901","AFLURIA ","INJ 2019-20","0.5","Select","Select",""],["","57896045401","GERI-KOT ","TAB 8.6MG","60","Select","Select",""],["","61442010201","DICLOFENAC ","TAB 50MG DR","30","Select","Select",""],["","40985021501","CALCIUM ","TAB ","60","Select","Select",""],["","69618004410","DOCUSATE ","CAP 100MG","56","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","6","Select","Select",""],["","00904673080","ACETAMIN ","TAB 500MG","30","Select","Select",""],["","00904672580","SENNA ","8.6MG","60","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","",""],["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":""}]}]}