{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SUMMER CRAWFORD","gend":1,"add":"2250 BULLPEN DRIVE","city":"HARRISONBURG","state":"VA","zip":"22801-8827","dob":"1996-12-07","age":"","mstatus":"","insh":4109730,"cliId":"","pno":5402693174,"cno":5402693174,"email":"","ename":"","eno":"","pphy":"WEIRICH, GORDAN D","ppno":5402349241,"pcpadd":"1151 Keezletown Rd Ste 101, ","pcpcity":"Weyers Cave","pcpstate":"VA","pcpzip":244862337,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":5405781082,"add2":"APARTMENT 104","add3":"","madd1":"2250 BULLPEN DRIVE","madd2":"APARTMENT 104","madd3":"","mcity":"HARRISONBURG","mstate":"VA","mzip":"22801-8827","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J06.9","F15.10","Z34.92","Z36.3","Z3A.21","O99.89","R45.851","O99.323","F19.10","O99.283","E87.6","O09.293","O09.33","Z3A.33","O36.8990","Z3A.38","Z37.0","O69.89X0","F15.20","O80","N39.0","R79.89","E61.1","D50.9","B37.0","N12","A41.9","B96.20","R65.20","M79.642","F17.210","Z88.6","Z88.5","O99.343","F19.14","O26.893","O99.013","D64.9","O99.333","L03.012","S69.92XA","X58.XXXA","Z88.1","A08.4","R07.9","R50.9","R51","R16.2","R10.84","N19","R94.5","R10.2","O09.292","Z3A.20","F32.9","K06.9","Z3A.34","F15.94","A41.51","R11.2","N17.9","I95.9","Z20.828","R74.0","N92.0","M54.2","M43.6","R09.89","J02.9","R05","O26.892","O99.322","O99.332","O99.012","O99.820","Z86.59","O99.280","F15.90","Z88.8","Z79.899","Z87.59","Z72.0","Z56.0","Z63.79","F15.14","Z23","K21.9","Z34.82","F19.11","Z51.81","Z3A.36","N89.8","O13.4","O99.324","F11.10","F13.10","O99.824","O99.334","O99.62","K02.9"],"date":["2019-02-01","2020-02-13","2019-10-01","2019-10-16","2019-10-16","2020-02-02","2020-01-10","2020-02-02","2020-07-24","2020-01-10","2020-01-13","2020-01-10","2020-02-02","2020-01-10","2020-02-13","2020-02-13","2020-02-13","2020-02-13","2021-01-06","2020-02-13","2020-07-28","2020-07-28","2020-07-28","2020-07-28","2020-07-28","2020-07-28","2020-07-28","2020-07-28","2020-07-28","2019-06-27","2021-03-23","2019-06-27","2021-03-23","2020-01-13","2020-01-10","2020-01-10","2020-01-10","2020-01-10","2020-01-10","2021-03-23","2021-03-23","2021-03-23","2021-03-23","2019-09-19","2020-07-24","2020-07-28","2020-07-24","2020-07-28","2020-07-28","2020-07-28","2020-07-28","2020-02-02","2019-10-14","2019-10-11","2020-01-10","2019-10-07","2020-01-09","2020-01-13","2020-07-24","2020-07-24","2020-07-24","2020-07-24","2020-07-24","2020-07-24","2020-07-24","2020-07-24","2020-07-24","2019-02-01","2019-02-01","2019-02-01","2019-10-11","2019-10-11","2019-10-11","2019-10-14","2019-10-14","2020-02-13","2020-01-09","2020-01-09","2020-02-02","2020-02-02","2020-02-13","2020-01-10","2020-01-10","2020-01-10","2020-01-10","2020-02-13","2019-10-01","2019-10-14","2019-10-14","2020-01-10","2020-02-02","2020-02-02","2020-02-13","2020-02-13","2020-02-13","2020-02-13","2020-02-13","2020-02-13","2020-02-13","2020-02-13"],"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":[["","57896091136","ASPIRIN ","CHW 81MG","30","Select","Select",""],["","68645052254","SERTRALINE ","TAB 50MG","30","Select","Select",""],["","00781261305","AMOXICILLIN ","CAP 500MG","30","Select","Select",""],["","59746011506","PROCHLORPER ","TAB 10MG","10","Select","Select",""],["","67877032005","IBUPROFEN ","TAB 600MG","30","Select","Select",""],["","42858020101","HYDROCO\/APAP ","TAB 5-325MG","8","Select","Select",""],["","00904530680","BANOPHEN ","CAP 25MG","30","Select","Select",""],["","00116200116","CHLORHEX ","SOL 0.0012","473","Select","Select",""],["","31722072250","LEVOFLOXACIN ","TAB 500MG","7","Select","Select",""],["","42806031205","DOXYCYCL ","TAB 100MG","20","Select","Select",""],["","00904671980","ACETAMINOPHEN ","TA B 325","30","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":""}]}]}