{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KAYLA MORRIS","gend":1,"add":"PO BOX 32                                                   ","city":"DYKE                          ","state":"VA","zip":"22935-0032","dob":"1990-05-30","age":"","mstatus":"","insh":10052925,"cliId":"","pno":4345669770,"cno":4345669770,"email":"","ename":"","eno":"","pphy":"GILL, MARGO L                                               ","ppno":"","pcpadd":"500 Martha Jefferson Dr # Mbg254","pcpcity":"Charlottesville               ","pcpstate":"VA","pcpzip":229114668,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"PO BOX 32                                                   ","madd2":"                                                            ","madd3":"","mcity":"DYKE                          ","mstate":"VA","mzip":"22935-0032","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["S71.112A","W26.0XXA","Y93.89","F17.210","Z88.0","Z88.1","F32.9","G43.709","L65.9","Z11.3","L70.0","R19.7","B37.0","N76.0","B96.89","L03.116","S70.362A","L53.9","R22.42","R21","T36.8X5A","T78.40XA","X58.XXXA","N30.00","R30.0","Z30.431"],"date":["2019-04-06","2019-04-06","2019-04-06","2020-08-08","2020-08-08","2020-08-08","2019-04-08","2021-07-06","2019-09-26","2019-09-26","2019-09-26","2019-09-26","2019-11-13","2019-11-13","2019-11-13","2020-07-31","2020-07-31","2020-07-31","2020-07-31","2020-08-08","2020-08-08","2020-08-08","2020-08-08","2021-06-17","2021-06-17","2021-06-17"],"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":[["","16729017117","AMITRIPTYLIN","10MG","90","Select","Select",""],["","68462046699","RIZATRIPTAN","10MG","10","Select","Select",""],["","00002143611","EMGALITY","120MG\/ML","1","Select","Select",""],["","00378064205","PREDNISONE","20MG","6","Select","Select",""],["","65162019011","NAPROXEN","500MG","30","Select","Select",""],["","58657067601","CIPROFLOXACN","500MG","10","Select","Select",""],["","68180012202","CEPHALEXIN","500MG","28","Select","Select",""],["","65862042005","SMZ\/TMP","800-160","14","Select","Select",""],["","16729017117","AMITRIPTYLIN ","TAB 10MG","90","Select","Select",""],["","68462046699","RIZATRIPTAN ","TAB 10MG","10","Select","Select",""],["","00002143611","EMGALITY ","INJ 120MG\/ML","1","Select","Select",""],["","00378064205","PREDNISONE ","TAB 20MG","6","Select","Select",""],["","65162019011","NAPROXEN ","TAB 500MG","30","Select","Select",""],["","58657067601","CIPROFLOXACN ","TAB 500MG","10","Select","Select",""],["","68180012202","CEPHALEXIN ","CAP 500MG","28","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","14","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":""}]}]}