{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"PAUL   L PATTERSON JR","gend":0,"add":"269 HUNDRED ACRE ROAD                                       ","city":"RINGGOLD                      ","state":"VA","zip":"24586-4319","dob":"1995-05-23","age":"","mstatus":"","insh":10053125,"cliId":"","pno":4344295145,"cno":4344295145,"email":"","ename":"","eno":"","pphy":"STEPHENS, AMBER                                             ","ppno":"","pcpadd":"2767 Franklin Tpke","pcpcity":"Danville                      ","pcpstate":"VA","pcpzip":245405273,"pcpcounty":"","pcpid":"P0124039","pcpname":"FAMILY HEALTHCARE CENTER OF MOUNT HERMON","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"269 HUNDRED ACRE ROAD                                       ","madd2":"                                                            ","madd3":"","mcity":"RINGGOLD                      ","mstate":"VA","mzip":"24586-4319","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E03.9","E66.9","I10","R22.43","S91.001A","R03.0","R60.0","M79.89","E66.01","Z68.42","Z23","Q90.9","M79.671","J12.82","U07.1"],"date":["2020-06-29","2020-06-29","2020-06-29","2019-06-05","2019-06-05","2019-08-27","2019-06-10","2019-08-27","2019-12-17","2019-12-17","2019-12-17","2020-06-29","2020-10-19","2021-02-22","2021-02-22"],"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":[["","00378181510","LEVOTHYROXIN","150MCG","30","Select","Select",""],["","68180098103","LISINOPRIL","20MG","30","Select","Select",""],["","59267100001","PFIZER","COVID-19","0.3","Select","Select",""],["","68180016113","AZITHROMYCIN","500MG","3","Select","Select",""],["","00378181510","LEVOTHYROXIN ","TAB 150MCG","30","Select","Select",""],["","68180098103","LISINOPRIL ","TAB 20MG","30","Select","Select",""],["","59267100001","PFIZER ","INJ COVID-19","0.3","Select","Select",""],["","68180016113","AZITHROMYCIN ","TAB 500MG","3","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","",""],["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":""}]}]}