{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"NAJAHAD ALLEN","gend":0,"add":"4 S BEARWOOD DRIVE","city":"PALMYRA","state":"VA","zip":"22963-2834","dob":"2002-04-16","age":"","mstatus":"","insh":4327591,"cliId":"","pno":4343277249,"cno":4343277249,"email":"","ename":"","eno":"","pphy":"ENGEL, GINA D","ppno":5409421200,"pcpadd":"15 Pratts Run, Ste 103","pcpcity":"Waynesboro","pcpstate":"VA","pcpzip":229806606,"pcpcounty":"","pcpid":"","pcpname":"UVA PRIMARY CARE RIVERSIDE","ano":"","add2":"APARTMENT B","add3":"","madd1":"4 S Bearwood Dr","madd2":"                                                            ","madd3":"","mcity":"Palmyra","mstate":"VA","mzip":"22963-2834","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"WESTERN\/ CHARLOTTESVILLE","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F41.1","Z00.8","F90.0","F12.150","J45.20","R07.9","R45.86","F29","R45.851","I49.3","F22","F98.8","D57.3","J45.909","Z91.19","Z79.899","Z81.8","F12.250","F41.9","F32.9","R06.02","F32.2","I10","E03.9","E11.9","E78.5","Z00.00","Z13.220","J45.30","R10.13","L70.0","J30.2","F20.9","Z56.0","K21.9","F19.959","Z13.6","F19.980","R10.9","F12.259","Z23","Z11.3","Z00.129","F23","Z87.09"],"date":["2019-07-18","2020-01-02","2021-04-19","2020-01-06","2020-01-28","2020-09-30","2020-05-11","2020-05-26","2020-05-19","2020-09-30","2020-01-03","2020-01-03","2020-01-03","2020-05-19","2020-01-03","2020-01-03","2020-05-19","2020-01-03","2020-01-03","2020-01-03","2020-01-28","2020-05-23","2020-05-23","2020-05-23","2020-05-23","2020-05-23","2021-02-10","2021-02-10","2021-02-10","2021-02-10","2019-04-29","2019-04-29","2019-07-10","2020-05-19","2020-09-30","2019-07-17","2020-01-03","2019-07-17","2019-07-17","2020-02-03","2019-09-26","2021-02-10","2019-09-26","2019-10-23","2020-01-05"],"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":[["","65862070260","ZIPRASIDONE ","CAP 20MG","60","Select","Select",""],["","65862022701","LAMOTRIGINE ","TAB 25MG","42","Select","Select",""],["","00054327099","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","45802065078","LORATADINE ","TAB 10MG","30","Select","Select",""],["","00093630195","ADAPALENE ","GEL 0.001","45","Select","Select",""],["","43547030503","ARIPIPRAZOLE ","TAB 15MG","30","Select","Select",""],["","70954001910","PRAZOSIN ","CAP 1MG","30","Select","Select",""],["","13668013601","ESCITALOPRAM ","TAB 10MG","30","Select","Select",""],["","69097082607","BENZTROPINE ","TAB 0.5MG","30","Select","Select",""],["","10702001050","HYDROXYZ ","TAB 10MG","60","Select","Select",""],["","59651000305","OMEPRAZOLE ","CAP 40MG","90","Select","Select",""],["","69097014260","ALBUTEROL ","AER HFA","6.7","Select","Select",""],["","00456315467","AEROCHAMBER ","MIS PLUS","1","Select","Select",""],["","00093310905","AMOXICILLIN ","500MG","56","Select","Select",""],["","00527193206","CLARITHROMYC ","500MG","28","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":[[["Yes","Select","","","","","Select","",""],["Yes","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":""}]}]}