{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"EDWARD   L LOGAN","gend":0,"add":"405 STARMONT DRIVE","city":"DANVILLE","state":"VA","zip":"24540-2801","dob":"1966-11-24","age":"","mstatus":"","insh":10219183,"cliId":"","pno":4344295539,"cno":4348575656,"email":"","ename":"","eno":"","pphy":"BRIDGES, STEVEN D","ppno":5406350700,"pcpadd":"1020 TERRACE DRIVE, ","pcpcity":"MARION","pcpstate":"VA","pcpzip":243544392,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":4348575656,"add2":"                                                            ","add3":"","madd1":"405 STARMONT DRIVE","madd2":"                                                            ","madd3":"","mcity":"DANVILLE","mstate":"VA","mzip":"24540-2801","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F25.0","E66.9","D72.819","R68.89","M62.82","N17.9","E87.5","I87.2","R60.0","R06.02","I10","E78.2","F29","Z12.5","R10.84","R10.9","Z88.0","Z88.1","Z87.891","R88.8","J18.9","E87.1","Z20.828","E78.00","F20.9","U07.1","J80","R06.2","Z79.899","Z76.89","F23","R74.0","E78.5","K21.9","F41.9","M19.90","F33.2"],"date":["2020-06-04","2020-01-09","2020-01-09","2020-03-25","2020-08-08","2020-06-06","2020-06-06","2020-10-23","2020-10-26","2020-11-08","2020-10-26","2020-10-26","2020-06-06","2020-01-09","2020-01-24","2020-01-24","2020-11-08","2020-11-08","2020-11-08","2020-08-06","2020-08-08","2020-11-08","2020-08-08","2020-11-08","2020-11-08","2020-11-08","2020-11-08","2020-11-08","2020-11-08","2020-01-09","2020-06-03","2020-06-03","2020-06-03","2020-06-03","2020-06-03","2020-06-03","2020-06-04"],"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":[["","00904530680","BANOPHEN ","CAP 25MG","60","Select","Select",""],["","33342008607","OLANZAPINE ","TAB 20MG ODT","28","Select","Select",""],["","68382041205","OMEPRAZOLE ","CAP 20MG","28","Select","Select",""],["","50383070016","FLUTICASONE ","50MCG","16","Select","Select",""],["","10135013210","THIAMINE ","100MG","14","Select","Select",""],["","00093317431","ALBUTEROL ","E","8.5","Select","Select",""],["","00904404360","FISH ","1000MG","14","Select","Select",""],["","00904216680","FERROUS ","325MG EC","42","Select","Select",""],["","37205008978","VITAMIN ","500MG","42","Select","Select",""],["","00536250676","SALINE ","0.65%","44","Select","Select",""],["","00536110945","UREA ","20%","85","Select","Select",""],["","00185064801","DIPHENHYDRAM ","25MG","56","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","",""],["Yes","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":""}]}]}