{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JUSTIN REGENSBURG","gend":0,"add":"10909 AUGUST COURTS                                         ","city":"CHESTERFIELD                  ","state":"VA","zip":"23832-7041","dob":"1990-05-29","age":"","mstatus":"","insh":10234117,"cliId":"","pno":8043858498,"cno":8043858498,"email":"","ename":"","eno":"","pphy":"STIRGWOLT, JENNIFER K                                       ","ppno":"","pcpadd":"4917 Richmond Tappahannock Hwy","pcpcity":"Aylett                        ","pcpstate":"VA","pcpzip":230093427,"pcpcounty":"","pcpid":"P0113816","pcpname":"PRIMARY HEALTH GROUP INC","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"CENTRAL","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"10909 AUGUST COURTS                                         ","madd2":"                                                            ","madd3":"","mcity":"CHESTERFIELD                  ","mstate":"VA","mzip":"23832-7041","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F11.20","R06.00","R07.9","R06.02","J45.909","R53.83","M79.10","R51","Z20.828","F11.120","I10","R42","R07.89"],"date":["2021-02-02","2020-05-06","2020-10-30","2020-10-28","2020-10-30","2020-06-15","2020-06-15","2020-06-15","2020-06-15","2020-09-03","2020-10-30","2020-10-27","2020-10-30"],"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":[["","68462010530","ONDANSETRON","4MG","9","Select","Select",""],["","00228212750","CLONIDINE","0.1MG","9","Select","Select",""],["","69097094312","GABAPENTIN","300MG","9","Select","Select",""],["","12496120803","SUBOXONE","8-2MG","7","Select","Select",""],["","68462010530","ONDANSETRON ","TAB 4MG","9","Select","Select",""],["","00228212750","CLONIDINE ","TAB 0.1MG","9","Select","Select",""],["","69097094312","GABAPENTIN ","CAP 300MG","9","Select","Select",""],["","12496120803","SUBOXONE ","MIS 8-2MG","7","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","",""],["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":""}]}]}