{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MARY   C SHELDON","gend":1,"add":"P.O. BOX 78                                                 ","city":"RUCKERSVILLE                  ","state":"VA","zip":"22968-0078","dob":"2003-05-28","age":"","mstatus":"","insh":10222412,"cliId":"","pno":4349813173,"cno":4349813173,"email":"","ename":"","eno":"","pphy":"TAYLOR, MARSHA L                                            ","ppno":"","pcpadd":"140 Stoneridge Dr S","pcpcity":"Ruckersville                  ","pcpstate":"VA","pcpzip":229683096,"pcpcounty":"","pcpid":"P9307359","pcpname":"GREENE FAMILY MEDICINE","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"P.O. BOX 78                                                 ","madd2":"                                                            ","madd3":"","mcity":"RUCKERSVILLE                  ","mstate":"VA","mzip":"22968-0078","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F43.10","F33.1","F13.10","F10.10","T42.4X1A","F32.9","F60.3","F41.9","F39","L91.0","L81.3","L72.8","Z12.83","D22.5","D22.62","D22.61","D22.72","D22.71","Z20.828","Z00.129","Z23","Z01.00","S70.311A","S70.312A","L70.0","R23.8","Z13.220","Z13.1","R04.0","G47.00","Z20.822","N93.9","N94.6","Z87.891","Z97.5","N76.0","B96.89","R10.9","N83.201","Z30.432","J18.9","A41.9","R10.32","R10.30","N89.8"],"date":["2021-07-01","2021-07-01","2020-01-26","2020-01-26","2020-01-26","2020-01-27","2020-05-21","2020-05-21","2020-05-21","2021-08-06","2020-08-12","2020-08-12","2020-08-12","2020-08-12","2020-08-12","2020-08-12","2020-08-12","2020-08-12","2021-02-10","2020-10-06","2020-10-06","2020-10-06","2021-04-14","2021-04-14","2021-04-14","2021-06-07","2021-07-01","2021-07-01","2021-06-07","2021-07-01","2021-08-23","2021-11-07","2021-11-07","2021-11-17","2021-11-08","2021-11-09","2021-11-09","2021-11-08","2021-11-09","2021-11-09","2021-11-17","2021-11-17","2021-11-17","2021-11-17","2021-11-17"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",null,null,null,null,null,null,null,null,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":[["","43547030303","ARIPIPRAZOLE","5MG","30","Select","Select",""],["","13668013601","ESCITALOPRAM","10MG","30","Select","Select",""],["","50111056001","TRAZODONE","50MG","30","Select","Select",""],["","69097014260","ALBUTEROL","HFA","6.7","Select","Select",""],["","68682045570","METRONIDAZOL","0.75%VAG","70","Select","Select",""],["","49483060350","IBUPROFEN","600MG","30","Select","Select",""],["","00116200116","CHLORHEX","0.12%","473","Select","Select",""],["","53746010901","HYDROCO\/APAP","5-325MG","10","Select","Select",""],["","69238153106","LARISSIA","","28","Select","Select",""],["","70700011885","VIENVA","0.1-20","28","Select","Select",""],["","43547030303","ARIPIPRAZOLE ","TAB 5MG","30","Select","Select",""],["","13668013601","ESCITALOPRAM ","TAB 10MG","30","Select","Select",""],["","50111056001","TRAZODONE ","TAB 50MG","30","Select","Select",""],["","50111033401","METRONIDAZOL ","TAB 500MG","14","Select","Select",""],["","68462030929","NORGEST\/ETHI ","TAB 0.25\/35","84","Select","Select",""],["","69097014260","ALBUTEROL ","AER HFA","6.7","Select","Select",""],["","49483060350","IBUPROFEN ","TAB 600MG","30","Select","Select",""],["","00116200116","CHLORHEX ","SOL 0.0012","473","Select","Select",""],["","53746010901","HYDROCO\/APAP ","TAB 5-325MG","10","Select","Select",""],["","69238153106","LARISSIA ","TAB ","28","Select","Select",""],["","70700011885","VIENVA ","TAB 0.1-20","28","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":""}]}]}