{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BRITTANY CAMPBELL","gend":1,"add":"517   MADISON ROAD                                          ","city":"STANARDSVILLE                 ","state":"VA","zip":"22973-2930","dob":"1988-04-26","age":"","mstatus":"","insh":10180648,"cliId":"","pno":4349397286,"cno":4349397286,"email":"","ename":"","eno":"","pphy":"TAYLOR, MARSHA L                                            ","ppno":"","pcpadd":"140 Stoneridge Dr S","pcpcity":"Ruckersville                  ","pcpstate":"VA","pcpzip":229683096,"pcpcounty":"","pcpid":"P9307359","pcpname":"GREENE FAMILY MEDICINE","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"APT 106                                                     ","add3":"","madd1":"517   MADISON ROAD                                          ","madd2":"APT 106                                                     ","madd3":"","mcity":"STANARDSVILLE                 ","mstate":"VA","mzip":"22973-2930","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M54.2","S16.1XXA","M79.18","M40.202","N76.0","R10.84","R11.0","F17.210","R14.0","R10.9","Z53.21","M50.322","Z11.3","Z01.411","R10.2","M50.30","R19.7","G89.29","E04.1","F07.81","G44.329","S39.012A","F43.10","F32.9","G44.85","R82.90","R20.0","R41.3","V89.2XXS","R41.89","F34.1","R20.2","J35.2","N89.8","Z86.718","Z87.891","N92.6","Z3A.01","O26.891","O99.89","R51","R10.30","Z34.81","Z36.0","Z3A.11","Z34.90","Z36.82","Z3A.13","Z34.80","K08.89","Z82.49","Z83.49","Z82.5","Z83.438","K04.7","Z36.3","Z3A.22","Z39.1","Z34.82","Z34.83","O36.5921","Z36.2","Z3A.27","R68.89","N36.8","R82.71","Z3A.28","O26.893","N34.0","O36.5931","Z3A.31","Z3A.32","Z11.4","Z13.1","O99.013","D64.9","Z3A.33","Z36.4","Z3A.35","Z03.74","Z3A.36","Z87.59","Z3A.37","Z3A.39","O99.343","F41.9","Z83.41","O48.0","Z3A.41","O36.8330","O80","O36.8130","Z3A.40","Z37.0","O90.81","O99.214","E66.9","O76","O09.293","O82","Z3A.00","Z39.2","R39.9","Z72.51","F23","Z04.6","F39","Z20.822","F29","Z72.0"],"date":["2019-12-12","2019-11-01","2019-10-09","2019-10-09","2019-08-29","2019-08-15","2020-03-22","2019-08-15","2019-08-15","2020-03-22","2021-10-30","2019-08-20","2019-08-29","2019-08-29","2020-03-22","2019-10-09","2019-10-26","2019-10-26","2019-10-29","2019-10-29","2019-11-01","2019-11-01","2019-11-14","2021-10-30","2019-12-18","2019-12-12","2019-12-18","2019-12-18","2019-12-12","2019-12-18","2019-12-12","2019-12-18","2019-12-18","2020-01-20","2020-01-20","2020-11-12","2021-05-21","2020-03-22","2020-03-22","2020-08-29","2020-03-22","2020-03-22","2020-04-23","2020-05-08","2020-04-23","2020-09-21","2020-05-08","2020-05-08","2020-07-20","2020-06-13","2020-11-12","2020-06-11","2020-06-11","2020-06-11","2020-06-12","2020-07-08","2020-07-08","2020-08-10","2020-08-10","2020-11-20","2020-08-12","2020-09-09","2020-08-12","2020-11-05","2020-08-29","2020-08-29","2020-08-29","2020-08-29","2020-08-29","2020-09-09","2020-09-09","2020-09-21","2020-09-21","2020-09-21","2020-11-20","2020-11-24","2020-09-29","2020-11-09","2020-10-13","2020-11-09","2020-10-21","2020-11-20","2020-10-28","2020-11-12","2020-11-12","2021-10-30","2020-11-12","2020-11-20","2020-11-24","2020-11-24","2020-11-24","2020-11-24","2020-11-24","2020-11-24","2020-11-24","2020-11-24","2020-11-24","2020-11-24","2020-11-24","2020-11-24","2020-11-24","2021-01-05","2021-05-21","2021-05-21","2021-10-29","2021-10-29","2021-10-29","2021-10-30","2021-11-23","2021-10-30"],"priorHcc":["","","","","","","","","","",null,"","","","","","","","","","","","",null,"","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",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":[["","00536100901","FERROUS","325MG","90","Select","Select",""],["","65162074510","PROMETHAZINE","12.5MG","30","Select","Select",""],["","49483060450","IBUPROFEN","800MG","30","Select","Select",""],["","10702001801","OXYCODONE","5MG","20","Select","Select",""],["","00093310905","AMOXICILLIN","500MG","30","Select","Select",""],["","00603233832","APAP\/CODEINE","300-30MG","16","Select","Select",""],["","50111033401","METRONIDAZOL","500MG","14","Select","Select",""],["","53746010901","HYDROCO\/APAP","5-325MG","20","Select","Select",""],["","68180012202","CEPHALEXIN","500MG","28","Select","Select",""],["","00536100901","FERROUS ","TAB 325MG","90","Select","Select",""],["","65162074510","PROMETHAZINE ","TAB 12.5MG","30","Select","Select",""],["","49483060450","IBUPROFEN ","TAB 800MG","30","Select","Select",""],["","10702001801","OXYCODONE ","TAB 5MG","20","Select","Select",""],["","00093310905","AMOXICILLIN ","CAP 500MG","30","Select","Select",""],["","00603233832","APAP\/CODEINE ","TAB 300-30MG","16","Select","Select",""],["","50111033401","METRONIDAZOL ","TAB 500MG","14","Select","Select",""],["","53746010901","HYDROCO\/APAP ","TAB 5-325MG","20","Select","Select",""],["","68180012202","CEPHALEXIN ","CAP 500MG","28","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":""}]}]}