{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JESSICA MARSHALL","gend":1,"add":"101   SPROUSE'S CORNER ROAD                                 ","city":"DILLWYN                       ","state":"VA","zip":"23936-2866","dob":"1988-01-21","age":"","mstatus":"","insh":10125079,"cliId":"","pno":4349603107,"cno":4349603107,"email":"","ename":"","eno":"","pphy":"RICHARD A JOYCE                                             ","ppno":"","pcpadd":"295 E Main St","pcpcity":"Scottsville                   ","pcpstate":"VA","pcpzip":245904995,"pcpcounty":"","pcpid":"P0124285","pcpname":"RICHARD A JOYCE","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"APT 26                                                      ","add3":"","madd1":"101   SPROUSE'S CORNER ROAD                                 ","madd2":"APT 26                                                      ","madd3":"","mcity":"DILLWYN                       ","mstate":"VA","mzip":"23936-2866","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F41.1","R01.1","K80.20","K80.80","R15.9","N39.41","G89.18","R15.2","Z00.00","Z30.09","Z30.011","Z13.1","Z13.220","Z11.3","Z12.4","O23.12","Z00.8","Z3A.15","R44.1","O23.40","O99.342","O99.89","Z3A.16","R44.3","Z13.79","O44.02","Z3A.20","Z36.3","O44.00","Z34.82","O26.892","R10.30","Z3A.23","N94.89","M54.5","Z3A.26","Z03.72","Z3A.28","Z23","Z34.83","Z34.80","Z3A.29","O09.899","Z3A.33","Z28.3","Z34.93","Z3A.36","O70.1","O80","Z37.0","Z3A.38","Z87.891","Z88.2","Z3A.00","Z39.2","F43.23","F41.9","L02.429","Z71.89","Z71.3"],"date":["2020-09-28","2019-03-01","2019-03-15","2019-03-15","2019-04-01","2019-03-29","2019-04-16","2019-04-01","2019-04-16","2019-04-16","2019-04-16","2019-04-16","2019-04-16","2019-04-16","2019-04-16","2020-04-13","2020-04-13","2020-04-13","2020-04-16","2020-04-13","2020-04-16","2020-06-26","2020-04-16","2020-04-16","2020-04-16","2020-06-26","2020-05-18","2020-05-18","2020-07-07","2020-07-07","2020-06-26","2020-06-07","2020-06-07","2020-06-26","2020-06-26","2020-06-26","2020-07-07","2020-07-07","2020-09-28","2020-09-01","2020-07-20","2020-07-20","2020-08-11","2020-08-11","2020-08-11","2020-09-01","2020-09-01","2020-09-16","2020-09-16","2020-09-16","2020-09-16","2020-09-16","2020-09-16","2020-09-16","2020-09-17","2021-02-22","2021-06-29","2021-06-29","2021-06-29","2021-06-29"],"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":[["","68180035302","SERTRALINE","100MG","30","Select","Select",""],["","68180012202","CEPHALEXIN","500MG","12","Select","Select",""],["","59267100001","PFIZER","COVID-19","0.3","Select","Select",""],["","68645056354","IBUPROFEN","800MG","60","Select","Select",""],["","68180035302","SERTRALINE ","TAB 100MG","30","Select","Select",""],["","68180012202","CEPHALEXIN ","CAP 500MG","12","Select","Select",""],["","59267100001","PFIZER ","INJ COVID-19","0.3","Select","Select",""],["","68645056354","IBUPROFEN ","TAB 800MG","60","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","",""],["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":""}]}]}