{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"RIAN DAVIS","gend":0,"add":"2258 S RIVER ROAD                                           ","city":"BUENA VISTA                   ","state":"VA","zip":"24416-4123","dob":"2002-06-20","age":"","mstatus":"","insh":10195484,"cliId":"","pno":5403332724,"cno":5403332724,"email":"","ename":"","eno":"","pphy":"ARNOLD, COLLEEN M                                           ","ppno":"","pcpadd":"55 COMFORT WAY","pcpcity":"LEXINGTON                     ","pcpstate":"VA","pcpzip":244503788,"pcpcounty":"","pcpid":"P0110996","pcpname":"AUGUSTA HEALTH PRIMARY CARE LEXINGTON","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"2258 S RIVER ROAD                                           ","madd2":"                                                            ","madd3":"","mcity":"BUENA VISTA                   ","mstate":"VA","mzip":"24416-4123","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["S82.832A","R93.6","S93.05XA","S82.402A","S82.892A","S82.892D","S82.62XA","F17.290","J02.9","R63.4","S40.021A","F41.8","F17.200","Z28.21"],"date":["2020-03-02","2020-02-22","2020-02-22","2020-02-22","2020-02-24","2020-04-14","2020-03-02","2020-03-02","2021-04-06","2021-04-06","2021-04-06","2021-05-14","2021-05-14","2021-05-14"],"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":[["","00781261305","AMOXICILLIN","500MG","30","Select","Select",""],["","62332002231","FLUOXETINE","10MG","30","Select","Select",""],["","00116200116","CHLORHEX","0.12%","473","Select","Select",""],["","57237004101","PENICILLN","500MG","28","Select","Select",""],["","42858010201","OXYCOD\/APAP","5-325MG","12","Select","Select",""],["","00781261305","AMOXICILLIN ","CAP 500MG","30","Select","Select",""],["","62332002231","FLUOXETINE ","CAP 10MG","30","Select","Select",""],["","00116200116","CHLORHEX ","SOL 0.0012","473","Select","Select",""],["","57237004101","PENICILLN ","TAB 500MG","28","Select","Select",""],["","42858010201","OXYCOD\/APAP ","TAB 5-325MG","12","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":""}]}]}