{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KIARA WASHINGTON","gend":1,"add":"1228 OLIVER CREEK ROAD                                      ","city":"TROY                          ","state":"VA","zip":"22974-4041","dob":"1993-05-14","age":"","mstatus":"","insh":10272742,"cliId":"","pno":4349625427,"cno":4349625427,"email":"","ename":"","eno":"","pphy":"CHANG, ANDREW S                                             ","ppno":"","pcpadd":"575 Industrial Dr","pcpcity":"Louisa                        ","pcpstate":"VA","pcpzip":230934146,"pcpcounty":"","pcpid":"P9476202","pcpname":"UVA PRIMARY CARE RIVERSIDE","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"1228 OLIVER CREEK ROAD                                      ","madd2":"                                                            ","madd3":"","mcity":"TROY                          ","mstate":"VA","mzip":"22974-4041","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G62.9","R20.0","R20.2","M79.674","M79.675","G62.89","F41.9","H54.3","H01.001","H01.002","H01.004","H01.005","R29.818","M79.671","M79.672","Z23","E53.8","E87.5"],"date":["2020-12-21","2021-11-12","2021-11-12","2020-12-07","2020-12-07","2020-12-21","2021-11-08","2020-12-29","2020-12-28","2020-12-28","2020-12-28","2020-12-28","2020-12-29","2021-01-08","2021-01-08","2021-11-08","2021-11-12","2021-11-12"],"priorHcc":["",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":[["","51991074790","DULOXETINE","30MG","60","Select","Select",""],["","00536252525","CAPSAICIN","0.03%","60","Select","Select",""],["","59762453701","MEDROXYPR","150MG\/ML","1","Select","Select",""],["","70710113908","FLUCONAZOLE","150MG","1","Select","Select",""],["","43598029190","PREGABALIN","25MG","120","Select","Select",""],["","51991074790","DULOXETINE ","CAP 30MG","60","Select","Select",""],["","00536252525","CAPSAICIN ","CRE 0.00025","60","Select","Select",""],["","59762453701","MEDROXYPR ","INJ 150MG\/ML","1","Select","Select",""],["","70710113908","FLUCONAZOLE ","TAB 150MG","1","Select","Select",""],["","43598029190","PREGABALIN ","CAP 25MG","120","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":""}]}]}