{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"WILLIAM   N GADDY III","gend":0,"add":"381 FONTAINE ROAD","city":"CASCADE","state":"VA","zip":"24069-3341","dob":"1990-10-12","age":"","mstatus":"","insh":10204155,"cliId":"","pno":4346853800,"cno":4346853800,"email":"","ename":"","eno":"","pphy":"TRIVEDI, RAJENDRA S","ppno":4347923730,"pcpadd":"501 Rison St, Ste 120","pcpcity":"Danville","pcpstate":"VA","pcpzip":245412426,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"381 FONTAINE ROAD","madd2":"                                                            ","madd3":"","mcity":"CASCADE","mstate":"VA","mzip":"24069-3341","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K63.9","S90.02XA","M79.672","W55.12XA","F17.200","K52.89","K50.919","J20.9","R05","Z03.818","Z01.818","S99.912A","M79.89","M25.572","S99.922A","K51.90","Z90.49","K52.9","R10.9","R63.0","F17.210","J45.909","Z87.19","Z93.4","J01.90","J06.9","W55.19XA"],"date":["2020-07-31","2021-01-24","2021-01-24","2021-01-24","2021-01-24","2020-06-10","2020-07-31","2020-10-09","2020-10-09","2020-11-07","2020-07-28","2021-01-24","2021-01-24","2021-01-24","2021-01-24","2020-07-31","2020-07-31","2020-06-10","2020-07-31","2020-07-31","2020-07-31","2020-07-31","2020-07-31","2020-07-31","2020-11-07","2020-11-07","2021-01-24"],"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":[["","59746017509","PREDNISONE ","TAB 20MG","15","Select","Select",""],["","42192060716","BROM\/PSE\/DM ","SYP ","240","Select","Select",""],["","53746010901","HYDROCO\/APAP ","TAB 5-325MG","12","Select","Select",""],["","68180016013","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","65862050320","AMOX\/K ","TAB 875-125","20","Select","Select",""],["","27808008602","HYD ","SUS 10-8\/5ML","120","Select","Select",""],["","60505082901","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","31722055190","LEVOCETIRIZI ","TAB 5MG","30","Select","Select",""],["","68382041205","OMEPRAZOLE ","CAP 20MG","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":""}]}]}