{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CIERRA   R EPPARD","gend":1,"add":"112   LEWIS AVENUE                                          ","city":"ELKTON                        ","state":"VA","zip":"22827-1436","dob":"2003-04-24","age":"","mstatus":"","insh":10231508,"cliId":"","pno":5404350371,"cno":5404350371,"email":"","ename":"","eno":"","pphy":"DOMINGUS, JEFF LEWIS                                        ","ppno":"","pcpadd":"339 NEBO SCHOOL RD","pcpcity":"NEBO                          ","pcpstate":"NC","pcpzip":287616848,"pcpcounty":"","pcpid":"P9120125","pcpname":"HARRISONBURG COMMUNITY HEALTH CENTER","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"APARTMENT 8                                                 ","add3":"","madd1":"112   LEWIS AVENUE                                          ","madd2":"APARTMENT 8                                                 ","madd3":"","mcity":"ELKTON                        ","mstate":"VA","mzip":"22827-1436","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F32.9","A69.20","G43.D0","Z20.828","Z71.89","M54.9","R52","R00.0","S99.912A","R35.0","R11.0","V48.4XXA","N12"],"date":["2020-02-05","2020-06-01","2020-07-23","2021-02-23","2021-02-23","2021-10-28","2021-10-28","2021-10-28","2021-10-28","2021-10-28","2021-10-28","2021-10-28","2021-10-28"],"priorHcc":["","","","","",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":[["","29300011201","LAMOTRIGINE","100MG","30","Select","Select",""],["","13668000905","CITALOPRAM","10MG","30","Select","Select",""],["","62135098505","DOXYCYCL","100MG","42","Select","Select",""],["","29300011201","LAMOTRIGINE ","TAB 100MG","30","Select","Select",""],["","13668000905","CITALOPRAM ","TAB 10MG","30","Select","Select",""],["","00093314705","CEPHALEXIN ","CAP 500MG","14","Select","Select",""],["","68001024617","ONDANSETRON ","TAB 4MG ODT","12","Select","Select",""],["","68462019005","NAPROXEN ","TAB 500MG","10","Select","Select",""],["","62135098505","DOXYCYCL ","CAP 100MG","42","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":""}]}]}