{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JABALI   I THOMAS","gend":0,"add":"272   WILKERSON ROAD                                        ","city":"DANVILLE                      ","state":"VA","zip":"24540-0659","dob":"1974-10-06","age":"","mstatus":"","insh":10053606,"cliId":"","pno":4344293644,"cno":4348572221,"email":"","ename":"","eno":"","pphy":"DESAI, BALAJI                                               ","ppno":"","pcpadd":"159 Executive Dr","pcpcity":"Danville                      ","pcpstate":"VA","pcpzip":245414160,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"APT G                                                       ","add3":"","madd1":"1215 WASHINGTON ST                                          ","madd2":"                                                            ","madd3":"","mcity":"DANVILLE                      ","mstate":"VA","mzip":"24540-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R68.83","J10.1","E78.5","E53.8","F41.9","R05","R63.4","I10","J30.2","D72.829","F17.200","R79.89","R51","L23.9","R10.9","Z53.20","R82.998"],"date":["2019-01-02","2019-01-02","2019-08-05","2019-03-26","2020-01-13","2019-03-26","2019-03-26","2020-01-13","2019-08-05","2020-01-13","2019-08-05","2019-08-05","2020-01-13","2020-08-17","2021-03-23","2021-03-23","2021-03-23"],"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":[["","57237002801","AMOXICILLIN","500MG","21","Select","Select",""],["","64380080707","IBUPROFEN","800MG","16","Select","Select",""],["","00378427593","VALACYCLOVIR","500MG","60","Select","Select",""],["","69452015120","VITAMIN","50000UNT","4","Select","Select",""],["","67877024910","QUETIAPINE","50MG","30","Select","Select",""],["","45802057178","FEXOFENADINE","180MG","30","Select","Select",""],["","59267100001","PFIZER","COVID-19","0.3","Select","Select",""],["","43547039711","HYDROCHLOROT","25MG","90","Select","Select",""],["","00406048401","APAP\/CODEINE","300-30MG","16","Select","Select",""],["","55111068401","IBU","800MG","16","Select","Select",""],["","00116200116","CHLORHEX","0.12%","473","Select","Select",""],["","59746017509","PREDNISONE","20MG","12","Select","Select",""],["","00904685272","LORATADINE","10MG","10","Select","Select",""],["","10135013201","THIAMINE","100MG","30","Select","Select",""],["","57237002801","AMOXICILLIN ","TAB 500MG","21","Select","Select",""],["","64380080707","IBUPROFEN ","TAB 800MG","16","Select","Select",""],["","00378427593","VALACYCLOVIR ","TAB 500MG","60","Select","Select",""],["","69452015120","VITAMIN ","CAP 50000UNT","4","Select","Select",""],["","67877024910","QUETIAPINE ","TAB 50MG","30","Select","Select",""],["","45802057178","FEXOFENADINE ","TAB 180MG","30","Select","Select",""],["","59267100001","PFIZER ","INJ COVID-19","0.3","Select","Select",""],["","43547039711","HYDROCHLOROT ","TAB 25MG","90","Select","Select",""],["","00406048401","APAP\/CODEINE ","TAB 300-30MG","16","Select","Select",""],["","55111068401","IBU ","TAB 800MG","16","Select","Select",""],["","00116200116","CHLORHEX ","SOL 0.0012","473","Select","Select",""],["","59746017509","PREDNISONE ","TAB 20MG","12","Select","Select",""],["","00904685272","LORATADINE ","TAB 10MG","10","Select","Select",""],["","10135013201","THIAMINE ","TAB 100MG","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":[[["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":""}]}]}