{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BRANDON PETTIFORD","gend":0,"add":"280 MILTON HIGHWAY                                          ","city":"RINGGOLD                      ","state":"VA","zip":"24586-2573","dob":"1997-11-21","age":"","mstatus":"","insh":10053341,"cliId":"","pno":4342700032,"cno":4342700032,"email":"","ename":"","eno":"","pphy":"SETTLE, PAUL C                                              ","ppno":"","pcpadd":"404 Airport Dr","pcpcity":"Danville                      ","pcpstate":"VA","pcpzip":245405196,"pcpcounty":"","pcpid":"P9058529","pcpname":"CMG PRIMECARE","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"LOT 15                                                      ","add3":"","madd1":"280 MILTON HIGHWAY                                          ","madd2":"LOT 15                                                      ","madd3":"","mcity":"RINGGOLD                      ","mstate":"VA","mzip":"24586-2573","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R41.82","S01.81XA","V49.88XA","S02.0XXA","R51","V43.63XA","Y92.9","Y99.9","S06.6X9A","Z72.0","S02.91XA","S06.0X1A","S51.819A","S06.360A","S02.91XS","Z09","Z23","V89.2XXA","R07.89","F17.210"],"date":["2019-12-15","2019-12-15","2019-12-15","2019-12-16","2019-12-27","2019-12-15","2019-12-15","2019-12-15","2019-12-16","2019-12-15","2019-12-15","2019-12-15","2019-12-15","2019-12-15","2019-12-15","2019-12-27","2019-12-27","2019-12-27","2021-10-07","2021-10-07"],"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":[["","69584061150","METHOCARBAM ","TAB 500MG","10","Select","Select",""],["","00603188016","LIDOCAINE ","PAD 0.05","10","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":""}]}]}