{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BRAD   G BROWN","gend":0,"add":"384 COVERSTONE ROAD","city":"FORT VALLEY","state":"VA","zip":"22652-1949","dob":"1967-08-27","age":"","mstatus":"","insh":5283066,"cliId":"","pno":5403258573,"cno":5403258573,"email":"","ename":"","eno":"","pphy":"CARDWELL, ELIZABETH","ppno":5404591254,"pcpadd":"755 SOUTH MAIN STREET, B08","pcpcity":"WOODSTOCK","pcpstate":"VA","pcpzip":226641143,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"NORTHERN\/ WINCHESTER","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"384 COVERSTONE ROAD","madd2":"                                                            ","madd3":"","mcity":"FORT VALLEY","mstate":"VA","mzip":"22652-1949","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J44.9","R07.81","F11.20","F17.210","G89.4","G50.0","F32.4","F51.05","F99","G89.29","M25.562","G90.09","T14.8XXA","B02.29","J06.9","B35.4","Z71.6","R05","J20.9","L20.84","Z12.11","R51","R42"],"date":["2020-03-19","2019-11-13","2021-05-17","2020-03-29","2019-11-13","2020-03-19","2019-11-13","2019-11-13","2019-11-13","2019-12-04","2019-12-04","2019-12-04","2019-12-04","2019-12-04","2020-03-29","2020-02-18","2020-02-18","2020-03-29","2020-04-15","2020-03-19","2020-03-19","2020-03-05","2020-03-05"],"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":[["","69097083412","SERTRALINE ","TAB 50MG","30","Select","Select",""],["","00054457125","METHADONE ","TAB 10MG","50","Select","Select",""],["","49035019502","EQ ","DIS 14MG\/24H","14","Select","Select",""],["","51672129801","KETOCONAZOLE ","CRE 0.02","60","Select","Select",""],["","45802006435","TRIAMCINOLON ","CRE 0.001","60","Select","Select",""],["","69238110005","DOXYCYCL ","CAP 100MG","20","Select","Select",""],["","72205001290","PREGABALIN ","CAP 50MG","60","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":""}]}]}