{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"NORVEL   C HARRIS","gend":0,"add":"581 GREENDALE DRIVE                                         ","city":"RUSTBURG                      ","state":"VA","zip":"24588-3545","dob":"1962-09-28","age":"","mstatus":"","insh":10052954,"cliId":"","pno":4342213336,"cno":"","email":"","ename":"","eno":"","pphy":"RANK, HARB L                                                ","ppno":"","pcpadd":"113 Wiggington Rd Ste A","pcpcity":"Lynchburg                     ","pcpstate":"VA","pcpzip":245025189,"pcpcounty":"","pcpid":"P9059252","pcpname":"WIGGINGTON ROAD FAMILY PRATICE","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"581 GREENDALE DRIVE                                         ","madd2":"                                                            ","madd3":"","mcity":"RUSTBURG                      ","mstate":"VA","mzip":"24588-3545","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E78.5","E78.2","I25.10","I10","R07.2","E03.9","R73.03","Z87.891","F41.9","E78.1","Z91.14","R00.2","Z95.1","I25.810","Z95.5","I25.2","J44.9","Z72.0","Z79.899","Z79.82","E11.65","T15.80XA","R10.84","Z12.5","K64.8","Z82.49","M79.604","M79.605","I70.219","I71.4","M79.606","M25.512","F17.210","R94.31","K21.9"],"date":["2021-08-04","2021-10-26","2021-11-09","2021-11-09","2019-11-12","2019-08-07","2021-05-20","2021-03-25","2021-03-25","2021-03-25","2020-06-16","2019-08-14","2020-06-16","2021-03-25","2021-03-25","2019-08-14","2019-12-10","2019-08-14","2019-08-14","2021-03-25","2021-06-07","2019-09-18","2019-12-10","2021-05-20","2019-12-23","2020-06-16","2020-06-16","2020-06-16","2021-03-25","2021-03-25","2021-03-25","2021-01-27","2021-03-25","2021-03-25","2021-08-30"],"priorHcc":["",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":[["","72511076002","REPATHA","140MG\/ML","6","Select","Select",""],["","55111019630","CLOPIDOGREL","75MG","30","Select","Select",""],["","69238183601","LEVOTHYROXIN","125MCG","30","Select","Select",""],["","68382009501","CARVEDILOL","25MG","60","Select","Select",""],["","43598043611","NITROGLYCERN","0.4MG","25","Select","Select",""],["","65162055710","TEMAZEPAM","30MG","30","Select","Select",""],["","68180051802","LISINOP\/HCTZ","10-12.5","90","Select","Select",""],["","68180072103","AMLODIPINE","10MG","90","Select","Select",""],["","68382013516","LOSARTAN","25MG","90","Select","Select",""],["","55111064505","OMEPRAZOLE","40MG","30","Select","Select",""],["","42806066405","BUSPIRONE","15MG","60","Select","Select",""],["","72511076002","REPATHA ","INJ 140MG\/ML","6","Select","Select",""],["","55111019630","CLOPIDOGREL ","TAB 75MG","30","Select","Select",""],["","69238183601","LEVOTHYROXIN ","TAB 125MCG","30","Select","Select",""],["","68382009501","CARVEDILOL ","TAB 25MG","60","Select","Select",""],["","43598043611","NITROGLYCERN ","SUB 0.4MG","25","Select","Select",""],["","65162055710","TEMAZEPAM ","CAP 30MG","30","Select","Select",""],["","68180051802","LISINOP\/HCTZ ","TAB 10-12.5","90","Select","Select",""],["","68180072103","AMLODIPINE ","TAB 10MG","90","Select","Select",""],["","68382013516","LOSARTAN ","TAB 25MG","90","Select","Select",""],["","55111064505","OMEPRAZOLE ","CAP 40MG","30","Select","Select",""],["","42806066405","BUSPIRONE ","TAB 15MG","60","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":""}]}]}