{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JOCELYN BECKLER","gend":1,"add":"2740   EVERSOLE ROAD                                        ","city":"ROCKINGHAM                    ","state":"VA","zip":"22802-0837","dob":"1989-07-13","age":"","mstatus":"","insh":10051787,"cliId":"","pno":5408207730,"cno":5408207730,"email":"","ename":"","eno":"","pphy":"WITMAN, JOHN A                                              ","ppno":"","pcpadd":"1751 Erickson Ave","pcpcity":"Harrisonburg                  ","pcpstate":"VA","pcpzip":228018555,"pcpcounty":"","pcpid":"P9307496","pcpname":"ROCKINGHAM FAMILY PHYSICIANS","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"2740   EVERSOLE ROAD                                        ","madd2":"                                                            ","madd3":"","mcity":"ROCKINGHAM                    ","mstate":"VA","mzip":"22802-0837","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F41.1","G81.14","M79.672","M25.572","G80.1","R60.9","R60.0","R79.89","M79.606","S82.852A","S82.422A","W10.8XXA","X50.1XXA","G80.9","Z79.899","S82.52XA","S82.452A","S82.852D","X58.XXXD","Z96.7","Z98.890"],"date":["2021-06-28","2019-05-16","2019-05-16","2019-08-28","2020-11-26","2020-08-13","2020-08-13","2020-08-13","2021-10-02","2021-10-02","2021-10-02","2021-10-02","2021-10-02","2021-10-02","2021-10-02","2021-10-02","2021-10-02","2021-11-18","2021-11-18","2021-10-28","2021-10-28"],"priorHcc":["","","","","","","","","","","","","","","","","",null,null,null,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":[["","68645057054","CITALOPRAM","20MG","30","Select","Select",""],["","68645057054","CITALOPRAM ","TAB 20MG","30","Select","Select",""],["","31722099601","HYDROCO\/APAP ","TAB 5-325MG","12","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":""}]}]}