{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DESIRAE HARRIS","gend":1,"add":"219 YORK DRIVE","city":"WAYNESBORO","state":"VA","zip":"22980-5318","dob":"2001-04-25","age":"","mstatus":"","insh":4118612,"cliId":"","pno":5404879977,"cno":5404879977,"email":"","ename":"","eno":"","pphy":"FISHER, JOSEPH D","ppno":5409320980,"pcpadd":"22 N Medical Park Dr, ","pcpcity":"Fishersville","pcpstate":"VA","pcpzip":229392344,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":5404879777,"add2":"                                                            ","add3":"","madd1":"219 YORK DRIVE","madd2":"                                                            ","madd3":"","mcity":"WAYNESBORO","mstate":"VA","mzip":"22980-5318","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M54.6","R51","E78.5","F32.9","G89.29","Y92.512","T59.811A","J70.5","Z88.1","Z88.8","L23.7","R21","J45.901","R06.02","J18.9","J96.01","B34.9","J01.90","O26.891","R10.30","Z3A.01","Z88.0","M79.10","R50.9","Z01.419","J45.909","R06.2","R09.02","R06.00","Z32.01","R11.0","R12","L03.115","M79.604","K13.0","R22.0","Z79.899","Z11.3","Z11.8","Z30.42","N91.0","T78.40XA","N93.9","Z30.09","O03.9","O99.341","L28.2","R10.84","Z36.9","R45.851","Z91.5","Z91.14","R10.2","Z29.13","S32.010D","K21.9","R41.82","Z3A.00","O20.9","R05","L50.0","J02.9","R09.81","Z20.828"],"date":["2019-01-08","2019-03-22","2019-01-08","2020-02-12","2019-01-08","2019-03-22","2019-03-22","2019-03-22","2020-03-12","2020-03-12","2019-06-07","2019-06-07","2019-11-03","2019-11-01","2019-11-03","2019-11-03","2019-12-08","2019-12-08","2020-02-13","2020-02-08","2020-02-12","2020-06-29","2020-06-29","2020-06-29","2019-02-28","2020-06-29","2019-08-27","2019-11-01","2019-11-01","2020-02-08","2020-02-08","2020-02-08","2020-03-12","2020-03-12","2019-02-04","2019-02-04","2019-02-04","2019-02-28","2019-02-28","2019-03-07","2019-11-07","2019-11-03","2020-02-13","2019-11-07","2020-02-15","2020-02-12","2021-02-21","2020-02-08","2020-02-13","2020-02-12","2020-02-12","2020-02-12","2020-02-13","2020-02-15","2019-01-01","2020-02-08","2020-02-12","2020-02-13","2020-02-13","2020-06-29","2021-02-05","2020-06-29","2020-06-29","2020-06-29"],"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":[["","00591544305","PREDNISONE ","TAB 20MG","30","Select","Select",""],["","59762453701","MEDROXYPR ","INJ 150MG\/ML","1","Select","Select",""],["","64679096101","AZITHROMYCIN ","TAB 250MG","4","Select","Select",""],["","00093314705","CEPHALEXIN ","CAP 500MG","28","Select","Select",""],["","00093317431","ALBUTEROL ","FAT E","8.5","Select","Select",""],["","00186037220","SYMBICORT ","AER 80-4.5","10.2","Select","Select",""],["","00173068220","VENTOLIN ","AER ","18","Select","Select",""],["","59746011306","PROCHLORPER ","TAB 5MG","30","Select","Select",""],["","00591372030","TRANEX ","TAB 650MG","30","Select","Select",""],["","00186091612","PULMICORT ","INH 180MCG","2","Select","Select",""],["","59779045839","CVS ","TAB 10MG","30","Select","Select",""],["","00054327099","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","57237005920","CEFUROXIME ","TAB 500MG","10","Select","Select",""],["","21922002107","PERMETHRIN ","CRE 0.05","60","Select","Select",""],["","00904530680","BANOPHEN ","CAP 25MG","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","",""],["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":""}]}]}