{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"EVAN PRIOR","gend":0,"add":"38 CREEK ROAD                                               ","city":"LYNDHURST                     ","state":"VA","zip":"22952-2200","dob":"1985-02-20","age":"","mstatus":"","insh":10160385,"cliId":"","pno":5404713175,"cno":5404713175,"email":"","ename":"","eno":"","pphy":"FARLEY, BENJAMIN GATES                                      ","ppno":"","pcpadd":"42 Lambert St","pcpcity":"Staunton                      ","pcpstate":"VA","pcpzip":244012437,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"38 CREEK ROAD                                               ","madd2":"                                                            ","madd3":"","mcity":"LYNDHURST                     ","mstate":"VA","mzip":"22952-2200","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F11.20","F41.1","F33.0","R46.81","F17.200","R68.89","S61.249A","W45.8XXA","K04.7","Z23","F42.2","F33.1","F12.10","Z72.0","J34.89","R05","F51.5","F31.31","R11.2","B18.2","M48.54XS","M54.6","M85.88","M54.5","Z79.899","Z88.6","S22.080A","F43.12","K62.3","K64.9","Z20.822","K62.9","G89.29","M62.89"],"date":["2021-11-23","2021-11-23","2019-06-25","2019-08-20","2019-05-28","2019-03-05","2019-03-12","2019-03-12","2019-03-12","2019-03-12","2019-04-30","2021-11-23","2021-10-19","2021-11-23","2019-09-06","2019-09-06","2019-11-12","2019-12-10","2020-03-07","2021-03-09","2021-03-18","2021-03-18","2021-03-18","2021-03-18","2021-03-18","2021-03-18","2021-03-18","2021-06-01","2021-07-27","2021-07-27","2021-11-24","2021-07-26","2021-08-24","2021-08-30"],"priorHcc":[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":[["","12496120803","SUBOXONE","8-2MG","56","Select","Select",""],["","65862019405","FLUOXETINE","40MG","30","Select","Select",""],["","70954002010","PRAZOSIN","2MG","90","Select","Select",""],["","00093317431","ALBUTEROL","E","8.5","Select","Select",""],["","00074262528","MAVYRET","100-40MG","84","Select","Select",""],["","65162019011","NAPROXEN","500MG","10","Select","Select",""],["","55111017915","TIZANIDINE","2MG","20","Select","Select",""],["","10702001801","OXYCODONE","5MG","15","Select","Select",""],["","57237007710","ONDANSETRON","4MG ODT","20","Select","Select",""],["","12496120803","SUBOXONE ","MIS 8-2MG","56","Select","Select",""],["","65862019405","FLUOXETINE ","CAP 40MG","30","Select","Select",""],["","70954002010","PRAZOSIN ","CAP 2MG","90","Select","Select",""],["","00093317431","ALBUTEROL ","FAT E","8.5","Select","Select",""],["","59310057922","PROAIR ","AER ","8.5","Select","Select",""],["","00074262528","MAVYRET ","TAB 100-40MG","84","Select","Select",""],["","65162019011","NAPROXEN ","TAB 500MG","10","Select","Select",""],["","55111017915","TIZANIDINE ","TAB 2MG","20","Select","Select",""],["","10702001801","OXYCODONE ","TAB 5MG","15","Select","Select",""],["","57237007710","ONDANSETRON ","TAB 4MG ODT","20","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":""}]}]}