{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ALIXANDRA   M BATTAGLIA","gend":1,"add":"1510 SAVOY PLACE                                            ","city":"LYNCHBURG                     ","state":"VA","zip":"24503-3122","dob":"1985-12-03","age":"","mstatus":"","insh":10125249,"cliId":"","pno":2023209014,"cno":8569040172,"email":"","ename":"","eno":"","pphy":"JOHNSON, MATTHEW                                            ","ppno":"","pcpadd":"125 Nationwide Dr","pcpcity":"Lynchburg                     ","pcpstate":"VA","pcpzip":245024272,"pcpcounty":"","pcpid":"P0125628","pcpname":"COMMUNITY ACCESS NETWORK","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"1510 Savoy Pl                                               ","madd2":"                                                            ","madd3":"","mcity":"Lynchburg                     ","mstate":"VA","mzip":"24503-3122","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z36.3","M25.469","F32.9","F43.10","F33.1","Z34.02","O36.0930","Z34.03","Z23","Z36.89","Z36.5","Z13.29","Z39.1","Z34.82","Z34.83","O44.43","R19.00","D48.5","O20.0","R03.0","Z34.01","Z71.89","Z36.85","Z3A.36","O13.3","Z3A.37","O13.4","Z37.0","Z3A.38","O99.824","O36.63X0","O75.89","Z67.21","O80","D23.5","L30.9","Z13.32","Z39.2","R53.83","M25.562","X58.XXXA","Y93.B9","Y99.8","Z90.89","Z79.899","Z01.411","N64.4","Z03.818","R35.0","T23.061A","Z20.828","L72.3","F90.9","N64.52","Z32.01","Z68.29","N97.9","Z12.4","Z11.3","Z20.822","Z11.4","R11.0","R06.02","M25.551","L91.0","Z13.89"],"date":["2021-12-02","2019-02-12","2019-02-13","2021-11-12","2020-02-07","2019-02-06","2019-03-08","2019-05-08","2021-01-25","2021-10-04","2021-10-04","2019-03-08","2019-03-08","2021-12-02","2019-03-08","2019-03-28","2019-04-03","2019-04-03","2021-07-12","2019-05-22","2021-10-05","2019-04-19","2019-04-25","2019-05-02","2019-05-14","2019-05-10","2019-05-14","2019-05-15","2019-05-15","2019-05-14","2019-05-14","2019-05-14","2019-05-14","2019-05-15","2019-06-19","2019-06-19","2021-12-02","2019-06-21","2019-09-04","2019-10-23","2019-10-23","2019-10-23","2019-10-23","2019-10-23","2019-10-23","2020-09-17","2020-12-14","2020-12-17","2020-12-19","2020-12-19","2020-12-30","2021-03-05","2021-04-26","2021-04-20","2021-07-14","2021-07-14","2021-07-30","2021-10-05","2021-10-05","2021-10-06","2021-10-04","2021-10-06","2021-10-06","2021-11-12","2021-11-12","2021-12-02"],"priorHcc":[null,"","",null,"","","","","","","","","",null,"","","","","","","","","","","","","","","","","","","","","","",null,"","","","","","","","","","","","","","","","","","","","","","","","","","",null,null,null]}},{"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":[["","68382013814","TOPIRAMATE","25MG","30","Select","Select",""],["","00169452514","WEGOVY","0.25MG","2","Select","Select",""],["","29300012510","MELOXICAM","15MG","30","Select","Select",""],["","69315012710","FOLIC","1000MCG","30","Select","Select",""],["","67877041305","METFORMIN","500MG ER","30","Select","Select",""],["","47781017601","AMPHET\/DEXTR","10MG","30","Select","Select",""],["","68382013814","TOPIRAMATE ","TAB 25MG","30","Select","Select",""],["","00169452514","WEGOVY ","INJ 0.25MG","2","Select","Select",""],["","29300012510","MELOXICAM ","TAB 15MG","30","Select","Select",""],["","69315012710","FOLIC ","TAB 1000MCG","30","Select","Select",""],["","67877041305","METFORMIN ","TAB 500MG ER","30","Select","Select",""],["","47781017601","AMPHET\/DEXTR ","TAB 10MG","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","",""],["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":""}]}]}