{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LLOYD   C CATLETT JR","gend":0,"add":"8902 RIDGE RD                                               ","city":"ARVONIA                       ","state":"VA","zip":"23004-2145","dob":"1962-11-27","age":"","mstatus":"","insh":10051999,"cliId":"","pno":4345811525,"cno":4345811525,"email":"","ename":"","eno":"","pphy":"LANFORD, RANDOLPH E                                         ","ppno":"","pcpadd":"4064 JAMES MADISON HWY","pcpcity":"FORK UNION                    ","pcpstate":"VA","pcpzip":230550001,"pcpcounty":"","pcpid":"P9307347","pcpname":"FORK UNION MEDICAL ASSOCIATES INC","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"8902 RIDGE RD                                               ","madd2":"                                                            ","madd3":"","mcity":"ARVONIA                       ","mstate":"VA","mzip":"23004-2145","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I10","E03.9","E55.9","E78.41","E78.2","E03.8","J43.9","M19.90","H00.011","J44.1","E78.49","I73.9","C44.629","Z95.828","Z12.83","L57.0","L90.5","L94.2","Z85.828","B07.8","D48.5","L82.1","L57.8","E05.90","R79.89","E05.80","E04.2"],"date":["2021-08-30","2019-07-15","2019-02-25","2019-02-25","2021-04-26","2021-04-26","2021-08-30","2019-06-03","2019-07-15","2019-07-15","2021-08-30","2021-04-26","2020-01-23","2020-09-23","2021-03-29","2020-09-28","2021-03-29","2020-09-28","2021-03-29","2021-03-29","2021-03-29","2021-03-29","2021-03-29","2021-10-12","2021-10-25","2021-10-12","2021-10-25"],"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":[["","67877019810","AMLODIPINE","5MG","30","Select","Select",""],["","49884064001","METHIMAZOLE","5MG","60","Select","Select",""],["","70377000315","SIMVASTATIN","20MG","30","Select","Select",""],["","66993058597","FLUTIC\/SALME","250\/50","60","Select","Select",""],["","80777027399","MODERNA","COVID-19","0.5","Select","Select",""],["","00093317431","ALBUTEROL","E","8.5","Select","Select",""],["","59310057922","PROAIR","","8.5","Select","Select",""],["","67877019810","AMLODIPINE ","TAB 5MG","30","Select","Select",""],["","49884064001","METHIMAZOLE ","TAB 5MG","60","Select","Select",""],["","70377000315","SIMVASTATIN ","TAB 20MG","30","Select","Select",""],["","66993058597","FLUTIC\/SALME ","AER 250\/50","60","Select","Select",""],["","80777027399","MODERNA ","INJ COVID-19","0.5","Select","Select",""],["","00093317431","ALBUTEROL ","FAT E","8.5","Select","Select",""],["","59310057922","PROAIR ","AER ","8.5","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":[[["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","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":""}]}]}