{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"REBECCA   N SCOTT","gend":1,"add":"895 MORNING STAR ROAD","city":"APPOMATTOX","state":"VA","zip":"24522-9026","dob":"1987-11-02","age":"","mstatus":"","insh":10121235,"cliId":"","pno":4349441889,"cno":4349441889,"email":"","ename":"","eno":"","pphy":"COMBS, KIMBERLY H","ppno":4348467374,"pcpadd":"2019 Tate Springs Rd Ste A, ","pcpcity":"Lynchburg","pcpstate":"VA","pcpzip":245011131,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"LOT 13","add3":"","madd1":"895 MORNING STAR ROAD","madd2":"LOT 13","madd3":"","mcity":"APPOMATTOX","mstate":"VA","mzip":"24522-9026","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E04.1","E05.90","F43.23","N94.89","R90.89","O20.0","E03.9","G35","H53.2","H53.123","R20.0","R53.83","R30.0","H43.393","R51","H52.223","H53.9","Z01.419","N92.1","N83.202","E06.0","R20.2","N39.498","E05.10","M79.10","Z30.40"],"date":["2021-02-05","2019-06-18","2019-08-28","2019-11-21","2020-10-16","2020-08-14","2019-06-05","2020-06-18","2020-06-18","2020-06-18","2020-10-16","2020-05-18","2019-10-29","2019-06-20","2020-09-29","2019-06-20","2019-06-20","2020-08-12","2020-08-12","2020-08-12","2021-02-08","2020-09-29","2020-05-07","2019-06-18","2020-03-16","2020-08-14"],"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":[["","43547028810","BUPROPION ","TAB 100MG SR","60","Select","Select",""],["","10702001150","HYDROXYZ ","TAB 25MG","30","Select","Select",""],["","00116200116","CHLORHEX ","SOL 0.0012","473","Select","Select",""],["","00115165903","PROPRANOLOL ","TAB 10MG","270","Select","Select",""],["","53489011905","DOXYCYCL ","CAP 100MG","20","Select","Select",""],["","69452015120","VITAMIN ","CAP 50000UNT","4","Select","Select",""],["","53746010901","HYDROCO\/APAP ","TAB 5-325MG","5","Select","Select",""],["","59417010410","VYVANSE ","40MG","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","",""],["N\/A","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":""}]}]}