{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MICHELLE FIELD","gend":1,"add":"1539 MILTON ROAD","city":"CHARLOTTESVILLE","state":"VA","zip":"22902-7300","dob":"1975-03-09","age":"","mstatus":"","insh":7763380,"cliId":"","pno":4342347578,"cno":4342347578,"email":"","ename":"","eno":"","pphy":"JESTEADT, GREGORY C","ppno":5404339151,"pcpadd":"1831 Reservoir St, ","pcpcity":"Harrisonburg","pcpstate":"VA","pcpzip":228018743,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"1539 MILTON ROAD","madd2":"                                                            ","madd3":"","mcity":"CHARLOTTESVILLE","mstate":"VA","mzip":"22902-7300","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M16.0","M62.81","M24.152","M25.552","R94.131","Z13.31","F41.9","I10","M79.641","F32.9","R73.03","E78.2","E89.40","E66.1","Z79.890","Z68.32","Z23","M47.816","M47.817","G72.9","M25.541","M47.812","R29.6","M25.50","R26.1","M25.852","S73.192A","G72.49","S73.192D","R53.1","M48.02","Z12.31","E66.9","Z68.33","F51.04","M25.542","J06.9","J30.2","K58.2","B35.3","B97.89","M16.12","M51.27","M51.37","R29.898","M50.222"],"date":["2019-11-13","2020-01-06","2019-12-31","2020-07-14","2019-12-31","2020-08-20","2021-04-21","2021-04-22","2020-09-23","2021-04-21","2021-04-22","2021-04-22","2021-04-21","2021-04-21","2021-04-21","2021-04-21","2021-04-23","2019-11-13","2019-11-13","2020-07-14","2020-08-07","2020-08-08","2020-08-08","2019-11-19","2020-08-08","2020-01-06","2019-12-31","2020-01-06","2020-01-06","2020-07-14","2020-07-14","2020-08-20","2020-11-20","2020-11-20","2021-01-15","2020-08-07","2019-09-19","2019-09-19","2019-09-19","2019-09-19","2019-09-19","2019-11-13","2019-12-05","2019-12-05","2019-12-31","2020-08-08"],"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":[["","51672129803","KETOCONAZOLE ","CRE 0.02","60","Select","Select",""],["","50228043605","NAPROXEN ","TAB 500MG","30","Select","Select",""],["","00555088602","ESTRADIOL ","TAB 1MG","30","Select","Select",""],["","64380080807","IBUPROFEN ","TAB 600MG","20","Select","Select",""],["","51224000150","BENZONATATE ","CAP 200MG","24","Select","Select",""],["","65862037501","ESCITALOPRAM ","TAB 20MG","30","Select","Select",""],["","00591079401","DICYCLOMINE ","CAP 10MG","60","Select","Select",""],["","23155050105","HYDROXYZ ","TAB 25MG","60","Select","Select",""],["","00406012305","HYDROCO\/APAP ","TAB 5-325MG","6","Select","Select",""],["","00116200116","CHLORHEX ","SOL 0.0012","473","Select","Select",""],["","68180098003","LISINOPRIL ","TAB 10MG","14","Select","Select",""],["","68180037703","LOSARTAN ","TAB 50MG","30","Select","Select",""],["","13668033005","TRAZODONE ","TAB 50MG","60","Select","Select",""],["","61314062810","POLYMYXIN ","SOL TRIMETHP","10","Select","Select",""],["","68462026390","ROSUVASTATIN ","TAB 20MG","90","Select","Select",""],["","69238111701","BUSPIRONE ","TAB 10MG","180","Select","Select",""],["","00143993905","AMOXICILLIN ","CAP 500MG","21","Select","Select",""],["","67877056105","METFORMIN ","500MG","90","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":""}]}]}