{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ELIZABETH   I FOSTER","gend":1,"add":"3943   RAPIDAN HILL DRIVE                                   ","city":"LOCUST GROVE                  ","state":"VA","zip":"22508-2273","dob":"1999-08-06","age":"","mstatus":"","insh":6875098,"cliId":"","pno":4344226090,"cno":5402211204,"email":"","ename":"","eno":"","pphy":"KO, DAVID S                                                 ","ppno":"","pcpadd":"100 Health Center Dr","pcpcity":"Bridgewater                   ","pcpstate":"VA","pcpzip":228129511,"pcpcounty":"","pcpid":"P0137900","pcpname":"CARILION CLINC FAMILY MEDICINE BRIDGEWATER","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"P O BOX 809                                                 ","add3":"","madd1":"3943   RAPIDAN HILL DRIVE                                   ","madd2":"P O BOX 809                                                 ","madd3":"","mcity":"LOCUST GROVE                  ","mstate":"VA","mzip":"22508-2273","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R68.89","Z36.89","O47.03","O47.1","O26.893","Z3A.37","Z88.5","Z34.03","Z36.85","O70.0","Z34.83","O69.81X0","Z3A.38","Z37.0","O80","O72.1","R42","R55","R93.89","Z79.899","Z72.0","F41.1","F32.9","M79.89","S83.8X1A","M25.561","W22.8XXA","Z87.891","S83.91XA","X50.1XXA"],"date":["2019-09-04","2019-09-04","2019-09-12","2019-09-12","2019-09-12","2019-09-12","2021-05-31","2019-09-19","2019-09-13","2019-09-22","2019-09-22","2019-09-22","2019-09-22","2019-09-22","2019-09-22","2019-10-10","2019-10-10","2019-10-10","2019-10-10","2019-10-10","2019-10-10","2019-10-21","2019-10-21","2021-05-31","2021-05-31","2021-05-31","2021-05-31","2021-05-31","2021-05-31","2021-05-31"],"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":[["","65162019050","NAPROXEN","500MG","14","Select","Select",""],["","65162019050","NAPROXEN ","TAB 500MG","14","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":""}]}]}