{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LUIS   E GARCIA-MARTINEZ","gend":0,"add":"300 OLD SOUTH HIGH STREET","city":"HARRISONBURG","state":"VA","zip":"22801-1964","dob":"2001-06-22","age":"","mstatus":"","insh":4111597,"cliId":"","pno":5402087523,"cno":5402087523,"email":"","ename":"","eno":"","pphy":"GERBER, AMANDA L","ppno":5404374800,"pcpadd":"4059 Quarles Ct, ","pcpcity":"Rockingham","pcpstate":"VA","pcpzip":228018717,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"APARTMENT 1","add3":"","madd1":"300 OLD SOUTH HIGH STREET","madd2":"APARTMENT 1","madd3":"","mcity":"HARRISONBURG","mstate":"VA","mzip":"22801-1964","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["S43.431D","M25.311","Z98.890","M25.511","M25.611","R29.898","F23","F16.10","F12.10","F41.0","Z03.818","R07.89","G47.9","F32.9","F19.980","R45.851","R45.850","S43.491A","X58.XXXA","Y93.67","Y93.89","M25.811","F19.959","F41.8","Z11.3","Z20.828","Y90.9","F10.20","Z87.891","R10.9","R51.9","F41.9","L02.212","M53.3","R07.9","R50.9","F19.10","B17.9","R19.7","S39.93XA","R53.83","N50.811","N50.812","S43.431A","M54.5","L70.0","N50.3","G89.18","J06.9","Z00.00","F19.11","N48.9","N50.819","N48.89"],"date":["2019-06-06","2019-06-06","2019-05-13","2019-04-12","2019-04-12","2019-04-12","2020-10-24","2020-10-24","2020-10-24","2020-11-25","2021-05-22","2020-09-15","2020-09-15","2020-10-28","2020-09-15","2020-10-17","2020-10-16","2019-01-29","2019-01-29","2019-01-29","2019-01-29","2019-01-29","2020-11-03","2021-02-11","2021-04-14","2021-01-18","2020-10-17","2020-10-17","2021-04-16","2020-11-11","2021-02-11","2021-01-10","2019-12-11","2019-12-11","2020-09-15","2020-10-17","2020-10-17","2020-10-17","2021-01-18","2019-12-11","2020-11-02","2021-04-16","2021-04-16","2019-01-29","2019-12-11","2021-02-24","2021-04-16","2019-01-29","2020-12-16","2021-02-11","2021-02-11","2021-04-14","2021-04-16","2021-04-16"],"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":[["","43547034106","RISPERIDONE ","TAB 1MG","60","Select","Select",""],["","68462018135","CLOTRIMAZOLE ","CRE 0.01","60","Select","Select",""],["","00406012305","HYDROCO\/APAP ","TAB 5-325MG","60","Select","Select",""],["","42806016005","HYDROXYZ ","TAB 25MG","60","Select","Select",""],["","50111064701","FLUOXETINE ","CAP 10MG","30","Select","Select",""],["","68180012202","CEPHALEXIN ","CAP 500MG","28","Select","Select",""],["","50111043301","TRAZODONE ","TAB 50MG","30","Select","Select",""],["","51672128902","NYSTATIN ","100000","30","Select","Select",""],["","70710113908","FLUCONAZOLE ","150MG","2","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":""}]}]}