{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JAMES   R LADD","gend":0,"add":"PO BOX 915                                                  ","city":"MINERAL                       ","state":"VA","zip":"23117-0915","dob":"1961-05-16","age":"","mstatus":"","insh":10052190,"cliId":"","pno":5407183023,"cno":5407183023,"email":"","ename":"","eno":"","pphy":"SOUTHALL III, ALGER R                                       ","ppno":"","pcpadd":"210 Elm Ave,Ste 511","pcpcity":"Louisa                        ","pcpstate":"VA","pcpzip":230936578,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"PO BOX 915                                                  ","madd2":"                                                            ","madd3":"","mcity":"MINERAL                       ","mstate":"VA","mzip":"23117-0915","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J20.9","R51","I10","Z23","M54.5","R68.89","G89.4","J02.0","M51.36","R05","S69.92XA","M79.642","M25.532","R20.0","R20.2","W18.30XA","M79.89","Z88.8","Z88.4","M47.817","M25.421","J01.90","H60.91","M15.8"],"date":["2021-02-15","2019-01-08","2019-06-21","2019-01-08","2021-09-20","2021-01-13","2021-10-18","2019-06-21","2021-06-30","2019-06-21","2020-01-15","2020-01-15","2020-01-15","2020-01-15","2020-01-15","2020-01-15","2020-01-15","2020-01-15","2020-01-15","2020-07-15","2020-07-16","2021-02-15","2021-02-15","2021-03-10"],"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":[["","10702001850","OXYCODONE","5MG","56","Select","Select",""],["","00591544305","PREDNISONE","20MG","13","Select","Select",""],["","69547035302","NARCAN","","2","Select","Select",""],["","57237002801","AMOXICILLIN","500MG","30","Select","Select",""],["","64380071306","BENZONATATE","200MG","30","Select","Select",""],["","10702001850","OXYCODONE ","TAB 5MG","56","Select","Select",""],["","00591544305","PREDNISONE ","TAB 20MG","13","Select","Select",""],["","69547035302","NARCAN ","SPR ","2","Select","Select",""],["","57237002801","AMOXICILLIN ","TAB 500MG","30","Select","Select",""],["","64380071306","BENZONATATE ","CAP 200MG","30","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":""}]}]}