{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TIFFANY   L WILLIAMS","gend":1,"add":"1010 CLAY STREET","city":"LYNCHBURG","state":"VA","zip":"24504-2543","dob":"1991-02-15","age":"","mstatus":"","insh":7335680,"cliId":"","pno":4344415529,"cno":4344415529,"email":"","ename":"","eno":"","pphy":"THOMAS, ANN C","ppno":4342005200,"pcpadd":"2323 Memorial Ave, ","pcpcity":"LYNCHBURG","pcpstate":"VA","pcpzip":245012661,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"APT 10-C","add3":"","madd1":"1010 CLAY STREET","madd2":"APT 10-C","madd3":"","mcity":"LYNCHBURG","mstate":"VA","mzip":"24504-2543","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z21","I10","R10.9","R11.2","D69.6","B20","D50.9","N92.0","E88.09","Z23","M79.602","A41.9","N17.9","D69.1","R23.8","Z20.828","N39.0","E86.0","F17.210","Z79.899","R50.9","K92.1","R93.6"],"date":["2020-10-28","2020-10-28","2021-05-02","2021-05-02","2020-10-28","2020-10-21","2020-10-21","2020-10-21","2020-10-21","2019-07-22","2020-08-25","2020-10-28","2020-10-28","2020-09-08","2020-09-08","2020-10-28","2020-10-28","2020-10-28","2020-10-28","2020-10-28","2020-10-27","2019-05-20","2020-08-25"],"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":[["","65862068730","RITONAVIR ","TAB 100MG","30","Select","Select",""],["","65862071330","ATAZANAVIR ","CAP 300MG","30","Select","Select",""],["","65862018730","ONDANSETRON ","TAB 4MG","30","Select","Select",""],["","67877019810","AMLODIPINE ","TAB 5MG","30","Select","Select",""],["","00904759180","FERROUS ","TAB 325MG","90","Select","Select",""],["","61958070101","TRUVADA ","TAB 200-300","30","Select","Select",""],["","00591086205","LISINOP\/HCTZ ","TAB 20-25MG","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":""}]}]}