{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ASHLEY COLLINS","gend":1,"add":"937   RAILROAD LANE                                         ","city":"PAMPLIN                       ","state":"VA","zip":"23958-3769","dob":"1996-12-25","age":"","mstatus":"","insh":10222199,"cliId":"","pno":4695252664,"cno":4695252664,"email":"","ename":"","eno":"","pphy":"ASHBY, JEFFREY A                                            ","ppno":"","pcpadd":"1831 Reservoir St","pcpcity":"Harrisonburg                  ","pcpstate":"VA","pcpzip":228018743,"pcpcounty":"","pcpid":"P0124050","pcpname":"HARRISONBURG FAMILY PRACTICE ASSOC PC","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"937   RAILROAD LANE                                         ","madd2":"                                                            ","madd3":"","mcity":"PAMPLIN                       ","mstate":"VA","mzip":"23958-3769","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["O99.332","O99.512","J06.9","J45.909","R06.02","F17.210","Z3A.25","Z36.89","O47.1","O43.93","O76","Z34.03","O32.1XX0","O77.0","Z3A.39","Z37.0","O75.89","O77.8","O99.345","F53.0","J45.901","R05.9","Z72.0","Z88.2","Z20.822"],"date":["2020-01-22","2020-01-22","2020-01-22","2020-04-30","2021-11-02","2020-01-22","2020-01-22","2020-02-14","2020-04-24","2020-04-30","2020-04-30","2020-04-30","2020-04-30","2020-04-30","2020-04-30","2020-04-30","2020-04-30","2020-04-30","2020-08-20","2020-08-20","2021-11-02","2021-11-02","2021-11-02","2021-11-02","2021-11-02"],"priorHcc":["","","","",null,"","","","","","","","","","","","","","","",null,null,null,null,null]}},{"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":[["","00093767902","ETONOGESTREL","ETHY EST","1","Select","Select",""],["","00093767902","ETONOGESTREL ","MIS ETHY EST","1","Select","Select",""],["","65862050220","AMOX\/K ","TAB 500-125","30","Select","Select",""],["","00093317431","ALBUTEROL ","FAT E","8.5","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":""}]}]}