{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"AMINA   H KEJJEH","gend":1,"add":"401 GARRETT STREET                                          ","city":"CHARLOTTESVILLE               ","state":"VA","zip":"22902-5637","dob":"1970-10-19","age":"","mstatus":"","insh":10052868,"cliId":"","pno":4342827878,"cno":4342827878,"email":"","ename":"","eno":"","pphy":"CAUGHRON, SAMUEL D                                          ","ppno":"","pcpadd":"901 Preston Ave Ste 300","pcpcity":"Charlottesville               ","pcpstate":"VA","pcpzip":229034491,"pcpcounty":"","pcpid":"P9307292","pcpname":"CHARLOTTESVILLE WELLNESS CENTER","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"APARTMENT E                                                 ","add3":"","madd1":"401 GARRETT STREET                                          ","madd2":"APARTMENT E                                                 ","madd3":"","mcity":"CHARLOTTESVILLE               ","mstate":"VA","mzip":"22902-5637","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11.9","M54.5","R06.09","Z30.09","G89.29","M51.36","M47.816","R26.2","R29.3","M62.81","R68.89","R06.02","F33.2","F51.04","E11.8","F43.10","R07.89","H40.053","Z98.41","J98.4","H35.373","J44.9","E66.9","F33.42","I10","Z23","E66.01","Z68.41","Q60.0","M75.82","M25.512","F33.1","E11.65","E11.69","E78.5","Z13.5","Z12.11","Z12.31","E11.42","J43.9","F33.0","H35.371","N18.1","E87.2","E11.21"],"date":["2021-09-28","2021-09-10","2019-03-20","2019-03-20","2021-09-10","2019-03-20","2019-03-20","2019-06-07","2019-06-07","2019-06-07","2019-06-07","2019-10-30","2021-04-22","2019-06-17","2019-09-30","2021-09-02","2019-09-30","2021-09-28","2019-10-18","2019-10-30","2019-11-27","2020-06-16","2021-09-10","2020-01-06","2021-01-20","2020-11-05","2020-03-02","2021-09-10","2021-09-29","2020-11-05","2021-01-26","2021-09-02","2021-11-08","2021-09-10","2021-09-10","2021-09-10","2021-09-10","2021-09-10","2021-09-10","2021-09-10","2021-09-10","2021-09-28","2021-09-29","2021-09-29","2021-09-29"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",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":[["","62756014202","METFORMIN","500MG ER","30","Select","Select",""],["","60505257808","ATORVASTATIN","10MG","30","Select","Select",""],["","24208046325","LATANOPROST","0.01%","2.5","Select","Select",""],["","65862001305","SERTRALINE","100MG","60","Select","Select",""],["","00378104901","DOXEPIN","10MG","30","Select","Select",""],["","43547035211","LISINOPRIL","5MG","30","Select","Select",""],["","00173052100","SEREVENT","50MCG","60","Select","Select",""],["","00173068220","VENTOLIN","","18","Select","Select",""],["","00093738101","VENLAFAXINE","50MG","30","Select","Select",""],["","00054429731","FUROSEMIDE","20MG","60","Select","Select",""],["","50111043303","TRAZODONE","50MG","30","Select","Select",""],["","62756014202","METFORMIN ","TAB 500MG ER","30","Select","Select",""],["","60505257808","ATORVASTATIN ","TAB 10MG","30","Select","Select",""],["","24208046325","LATANOPROST ","SOL 0.00005","2.5","Select","Select",""],["","65862001305","SERTRALINE ","TAB 100MG","60","Select","Select",""],["","00378104901","DOXEPIN ","CAP 10MG","30","Select","Select",""],["","00193658621","MICROLET ","MIS LANCETS","100","Select","Select",""],["","00193725201","CONTOUR ","KIT NEXT EZ","1","Select","Select",""],["","43547035211","LISINOPRIL ","TAB 5MG","30","Select","Select",""],["","00173052100","SEREVENT ","AER 50MCG","60","Select","Select",""],["","00173068220","VENTOLIN ","AER ","18","Select","Select",""],["","00093738101","VENLAFAXINE ","TAB 50MG","30","Select","Select",""],["","00054429731","FUROSEMIDE ","TAB 20MG","60","Select","Select",""],["","50111043303","TRAZODONE ","TAB 50MG","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":[[["Yes","Select","","","","","Select","",""],["Yes","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":""}]}]}