{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"AYANA   D BANKS","gend":1,"add":"123 RIVER BREEZE LANE                                       ","city":"LOUISA                        ","state":"VA","zip":"23093-3156","dob":"1992-04-06","age":"","mstatus":"","insh":10204328,"cliId":"","pno":4342499917,"cno":4342499917,"email":"","ename":"","eno":"","pphy":"HARKRADER, EDWARD R                                         ","ppno":"","pcpadd":"101 Woolfolk Ave","pcpcity":"Louisa                        ","pcpstate":"VA","pcpzip":230934264,"pcpcounty":"","pcpid":"P0124234","pcpname":"LOUISA FAMILY PRACTICE PLC","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"123 RIVER BREEZE LANE                                       ","madd2":"                                                            ","madd3":"","mcity":"LOUISA                        ","mstate":"VA","mzip":"23093-3156","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z30.432","Z31.69","R10.30","K80.20","R10.32","R10.9","S09.92XA","Z34.81","Z86.32","Z3A.08","Z98.891","Z36.82","Z3A.12","Z87.59","Z86.59","Z31.5","Z13.79","Z36.3","O26.891","R51","O09.291","O24.419","Z34.82","O34.219","Z3A.17","E66.9","O99.212","Z3A.20","Z68.36","Z34.80","O34.211","Z39.1","Z34.83","O24.414","O26.893","O26.813","R07.9","R00.2","Z3A.28","O24.112","O09.899","K21.9","Z3A.29","O24.113","E11.9","Z34.90","Z3A.32","K64.8","Z23","Z3A.33","O24.415","Z3A.34","O40.3XX0","Z3A.37","O99.891","Z98.890","O24.424","O69.82X0","Z3A.38","O43.193","Z37.0","N85.8","O99.62","Z20.822","O80","R10.2","N93.9","Z39.2","R93.89","O72.0","O72.2","O73.1","Z30.430","Z00.00","R73.9","N92.6"],"date":["2019-10-24","2019-10-24","2020-01-26","2020-01-26","2020-01-26","2020-01-26","2020-06-24","2020-07-24","2020-07-24","2020-06-25","2020-06-25","2020-07-24","2020-07-24","2020-12-09","2020-12-09","2020-07-24","2020-07-24","2020-07-24","2020-07-24","2020-07-24","2020-07-24","2021-07-07","2020-11-09","2021-01-13","2020-08-24","2020-09-14","2020-09-14","2020-09-14","2020-09-14","2020-09-14","2021-01-19","2020-11-09","2021-01-13","2021-01-19","2020-11-11","2020-11-11","2020-11-11","2020-11-11","2020-11-11","2020-11-16","2021-01-13","2021-01-19","2020-11-16","2020-11-16","2020-11-16","2020-12-03","2020-12-09","2020-12-09","2020-12-09","2020-12-16","2020-12-23","2020-12-23","2021-01-19","2021-01-13","2021-01-13","2021-01-13","2021-01-19","2021-01-19","2021-01-20","2021-01-19","2021-01-20","2021-03-29","2021-01-19","2021-01-19","2021-01-20","2021-03-29","2021-03-08","2021-03-08","2021-03-29","2021-04-13","2021-04-07","2021-04-13","2021-06-04","2021-07-07","2021-07-07","2021-07-07"],"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":[["","65162019050","NAPROXEN","500MG","180","Select","Select",""],["","00904671980","ACETAMINOPHEN","B 325","30","Select","Select",""],["","68462030529","NORETHINDRON","0.35MG","84","Select","Select",""],["","00193731221","CONTOUR","NEXT","100","Select","Select",""],["","08290328468","INSULIN","0.5\/31G","100","Select","Select",""],["","65862050320","AMOX\/K","875-125","1","Select","Select",""],["","43386043201","OXYCODONE","5MG","1","Select","Select",""],["","49483060450","IBUPROFEN","800MG","1","Select","Select",""],["","00172392670","DIAZEPAM","5MG","1","Select","Select",""],["","00193654621","BAYER","LANCETS","100","Select","Select",""],["","00002831501","HUMULIN","U-100","10","Select","Select",""],["","65862085901","FAMOTIDINE","20MG","180","Select","Select",""],["","62559043130","HYDROCORTISO","2.50%","30","Select","Select",""],["","65162019050","NAPROXEN ","TAB 500MG","180","Select","Select",""],["","00904671980","ACETAMINOPHEN ","TA B 325","30","Select","Select",""],["","68462030529","NORETHINDRON ","TAB 0.35MG","84","Select","Select",""],["","00193731221","CONTOUR ","TES NEXT","100","Select","Select",""],["","08290328468","INSULIN ","MIS 0.5\/31G","100","Select","Select",""],["","65862050320","AMOX\/K ","TAB 875-125","1","Select","Select",""],["","43386043201","OXYCODONE ","TAB 5MG","1","Select","Select",""],["","49483060450","IBUPROFEN ","TAB 800MG","1","Select","Select",""],["","00172392670","DIAZEPAM ","TAB 5MG","1","Select","Select",""],["","00193654621","BAYER ","MIS LANCETS","100","Select","Select",""],["","00002831501","HUMULIN ","INJ U-100","10","Select","Select",""],["","65862085901","FAMOTIDINE ","TAB 20MG","180","Select","Select",""],["","62559043130","HYDROCORTISO ","CRE 0.025","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":[[["Yes","Select","","","","","Select","",""],["Yes","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":""}]}]}