{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"GORDON LETT","gend":0,"add":"103 VINCENNES ROAD                                          ","city":"CHARLOTTESVILLE               ","state":"VA","zip":"22911-8551","dob":"1963-03-20","age":"","mstatus":"","insh":10195193,"cliId":"","pno":8086350074,"cno":"","email":"","ename":"","eno":"","pphy":"STEWART, RICHARD A                                          ","ppno":"","pcpadd":"201 Lew Dewitt Blvd Ste B","pcpcity":"Waynesboro                    ","pcpstate":"VA","pcpzip":229801663,"pcpcounty":"","pcpid":"P0110997","pcpname":"AUGUSTA HEALTH INTERNAL MEDICINE WAYNESBORO","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"103 VINCENNES ROAD                                          ","madd2":"                                                            ","madd3":"","mcity":"CHARLOTTESVILLE               ","mstate":"VA","mzip":"22911-8551","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z00.00","R10.9","E29.1","D04.39","D48.5","L82.1","Z80.8","R73.09","R74.8","R00.2","I48.0","K62.5","K64.9","R19.4","K64.0","Z79.899","Z20.828","M75.41","Z23","I71.2"],"date":["2019-11-06","2019-11-06","2019-11-06","2020-02-20","2019-11-20","2019-11-20","2019-11-20","2020-01-06","2020-03-10","2020-04-03","2021-06-04","2020-10-28","2020-10-28","2020-10-28","2020-10-28","2020-10-28","2020-12-10","2021-06-03","2021-06-05","2021-06-08"],"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":[["","42858010301","OXYCOD\/APAP","7.5-325","20","Select","Select",""],["","69097015807","MELOXICAM","7.5MG","10","Select","Select",""],["","13668000805","ZOLPIDEM","10MG","30","Select","Select",""],["","42858010301","OXYCOD\/APAP ","TAB 7.5-325","20","Select","Select",""],["","69097015807","MELOXICAM ","TAB 7.5MG","10","Select","Select",""],["","13668000805","ZOLPIDEM ","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","",""],["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":""}]}]}