{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ALLA LINKEVYCH","gend":1,"add":"9222   CAVALRY DRIVE                                        ","city":"HENRICO                       ","state":"VA","zip":"23229-4551","dob":"1985-05-20","age":"","mstatus":"","insh":10264652,"cliId":"","pno":8043167552,"cno":8043167552,"email":"","ename":"","eno":"","pphy":"PITZER, MICHAEL E                                           ","ppno":"","pcpadd":"2530 Gaskins Rd Ste A,Ste 100","pcpcity":"Richmond                      ","pcpstate":"VA","pcpzip":232381483,"pcpcounty":"","pcpid":"P0124600","pcpname":"MCV PHYSICIANS AT MAYLAND CLINIC","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"CENTRAL","aligned":"","ano":"","add2":"APT B                                                       ","add3":"","madd1":"9222   CAVALRY DRIVE                                        ","madd2":"APT B                                                       ","madd3":"","mcity":"HENRICO                       ","mstate":"VA","mzip":"23229-4551","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z00.00","J38.3","R09.81","Z01.419","Z12.4","Z13.29","K21.9","N93.9","R10.2","O20.0","O99.891","R30.0","Z3A.11","O03.4","O36.80X0","Z3A.01","O03.9","O23.591","Z3A.09","J30.2","I83.813","R10.84","I83.893","R53.83","R11.0","Z87.09","H10.13","J30.89","J30.81"],"date":["2020-11-12","2020-11-12","2020-11-12","2020-12-14","2020-12-14","2020-12-21","2020-12-18","2021-05-10","2021-05-10","2021-05-10","2021-05-10","2021-05-10","2021-05-10","2021-05-12","2021-05-12","2021-05-12","2021-06-14","2021-06-03","2021-06-03","2021-06-14","2021-06-14","2021-06-14","2021-07-20","2021-09-28","2021-09-28","2021-11-09","2021-11-16","2021-11-16","2021-11-16"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","",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":[["","50111033401","METRONIDAZOL","500MG","14","Select","Select",""],["","68645056259","IBUPROFEN","600MG","21","Select","Select",""],["","43598081112","CETIRIZINE","10MG","30","Select","Select",""],["","00781261305","AMOXICILLIN","500MG","21","Select","Select",""],["","50111033401","METRONIDAZOL ","TAB 500MG","14","Select","Select",""],["","68645056259","IBUPROFEN ","TAB 600MG","21","Select","Select",""],["","43598081112","CETIRIZINE ","TAB 10MG","30","Select","Select",""],["","00781261305","AMOXICILLIN ","CAP 500MG","21","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":""}]}]}