{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SYLVIE   R SEBASTIAN","gend":1,"add":"4018 MONACAN TRAIL  ROAD                                    ","city":"NORTH GARDEN                  ","state":"VA","zip":"22959-1929","dob":"1983-04-25","age":"","mstatus":"","insh":10222614,"cliId":"","pno":4344654555,"cno":4344654555,"email":"","ename":"","eno":"","pphy":"LOCKMAN, ANDREW R                                           ","ppno":"","pcpadd":"4916 Plank Rd Unit 205,Ste 103","pcpcity":"North Garden                  ","pcpstate":"VA","pcpzip":229591613,"pcpcounty":"","pcpid":"P0060034","pcpname":"UVA CROSSROADS FAMILY PRACTICE","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"4018 MONACAN TRAIL  ROAD                                    ","madd2":"                                                            ","madd3":"","mcity":"NORTH GARDEN                  ","mstate":"VA","mzip":"22959-1929","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R10.32","R59.0","B19.20","B96.89","N76.0","F41.1","F32.9","Z12.4","Z11.3","N63.13","R58","Z23"],"date":["2020-02-28","2020-02-28","2020-02-25","2020-02-25","2020-02-25","2021-04-14","2020-12-01","2020-12-01","2020-12-01","2021-02-24","2021-02-24","2021-04-10"],"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":[["","13668013601","ESCITALOPRAM","10MG","30","Select","Select",""],["","68682045570","METRONIDAZOL","0.75%VAG","70","Select","Select",""],["","00074262528","MAVYRET","100-40MG","84","Select","Select",""],["","13668013601","ESCITALOPRAM ","TAB 10MG","30","Select","Select",""],["","68682045570","METRONIDAZOL ","GEL 0.75%VAG","70","Select","Select",""],["","00074262528","MAVYRET ","TAB 100-40MG","84","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":""}]}]}