{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TONY   L WHITE","gend":0,"add":"20008 OLD RICHMOND ROAD","city":"KEELING","state":"VA","zip":"24566-4326","dob":"1965-11-16","age":"","mstatus":"","insh":10053778,"cliId":"","pno":4349416916,"cno":4344837156,"email":"","ename":"","eno":"","pphy":"TURNER, WESLEY CHAD","ppno":4347914122,"pcpadd":"705 Main St, ","pcpcity":"Danville","pcpstate":"VA","pcpzip":245411803,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":4347131457,"add2":"                                                            ","add3":"","madd1":"20008 OLD RICHMOND ROAD","madd2":"                                                            ","madd3":"","mcity":"KEELING","mstate":"VA","mzip":"24566-4326","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["A41.9","R56.9","G93.41","J69.0","J96.01","E43","M62.82","Z68.1","R47.01","E86.0","Z91.14","F14.10","F10.20","G40.909","F17.200","I16.0","R06.00","I10","F19.10","G40.919","R65.10","E87.2","R50.9","G40.509","Z91.19","R07.81","Z72.0","F10.131","F19.121","F17.210","G40.89","R41.0","F19.20","S22.32XA","R05","W19.XXXA","R41.82","Z79.899","F12.10","F10.10","F19.129","S22.42XA","F12.90","F14.90","R74.8","G40.409","Y90.0","F10.188","N17.9","J44.9","Z71.6","R53.1","F44.89","E88.81","G40.901","E78.5","T79.6XXS","R40.4","G40.219","F10.239","G40.319","Z91.128","R68.89","F10.231"],"date":["2019-09-05","2020-07-07","2021-02-18","2019-09-02","2021-02-17","2019-09-02","2021-02-17","2019-09-02","2019-10-24","2019-09-02","2021-02-18","2019-10-22","2019-09-02","2021-03-17","2021-03-17","2019-09-02","2019-09-03","2021-03-17","2021-03-17","2019-10-22","2019-10-22","2021-02-17","2021-02-17","2020-01-14","2021-03-17","2020-07-08","2020-07-07","2021-02-17","2021-02-17","2021-02-17","2021-02-24","2021-02-18","2021-03-17","2020-07-08","2020-07-08","2020-07-08","2020-01-14","2021-02-17","2019-10-22","2021-03-17","2019-09-02","2020-07-08","2021-02-17","2021-02-17","2021-02-17","2019-10-24","2019-10-22","2019-10-24","2019-10-24","2019-10-24","2019-10-22","2019-04-18","2019-04-18","2019-10-22","2020-01-21","2020-01-21","2021-03-17","2021-02-17","2021-03-17","2019-07-21","2019-07-21","2019-07-21","2019-11-11","2021-02-17"],"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":[["","59779044574","CVS ","DIS 14MG\/24H","14","Select","Select",""],["","65862024608","LEVETIRACETA ","TAB 500MG","20","Select","Select",""],["","53746010901","HYDROCO\/APAP ","TAB 5-325MG","18","Select","Select",""],["","69097086107","ZONISAMIDE ","CAP 100MG","60","Select","Select",""],["","68180072003","AMLODIPINE ","TAB 5MG","30","Select","Select",""],["","70377002811","ATORVASTATIN ","TAB 20MG","30","Select","Select",""],["","00378064110","PREDNISONE ","TAB 10MG","14","Select","Select",""],["","69452015020","VALPROIC ","CAP 250MG","90","Select","Select",""],["","29300013901","DIVALPROEX ","TAB 250MG DR","180","Select","Select",""],["","65862050320","AMOX\/K ","TAB 875-125","10","Select","Select",""],["","00069047103","CHANTIX ","PAK 0.5& 1MG","53","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","",""],["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":""}]}]}