{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JAMES KENNEDY","gend":0,"add":"3167 GARLAND LN","city":"CHARLOTTESVILLE","state":"VA","zip":"22902-9998","dob":"1957-06-16","age":"","mstatus":"","insh":"2045660*01","cliId":"","pno":"434\/979-8832","cno":"434\/979-8832","email":"","ename":"","eno":"","pphy":"BISHOP, RAYMOND MD","ppno":"434\/591-5056","pcpadd":"138 HERITAGE DR STE A","pcpcity":"PALMYRA","pcpstate":"VA","pcpzip":22963,"pcpcounty":"","pcpid":210191,"pcpname":"","plan":"OHP","program":"ACA","lob":"Individual","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"434\/218-8355","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/591-5057","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F10.20","F41.9","I10.","F33.9","F17.200","K51.90","Z23.","D12.2","D12.3","Z00.00","E78.5"],"date":["2021-07-21","2021-07-21","2021-07-21","2021-07-21","2021-07-21","2021-07-21","2021-05-17","2021-06-08","2021-06-08","2021-05-17","2021-07-21"],"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":[["","00185041552","BUPROPION","150MG SR","30","Select","Select",""],["","49281063115","FLUZONE","2019-20","0","Select","Select",""],["","13107015730","PAROXETINE","40MG","30","Select","Select",""],["","62037083201","METOPROL","100MG ER","30","Select","Select",""],["","63304017513","MESALAMINE","1.2GM","60","Select","Select",""],["","68180032006","BUPROPN","300MG XL","30","Select","Select",""],["","67877019990","AMLODIPINE","10MG","30","Select","Select",""],["","60505257908","ATORVASTATIN","20MG","30","Select","Select",""],["","68180098003","LISINOPRIL","10MG","30","Select","Select",""],["","52268001201","SUPREP","PREP KIT","354","Select","Select",""],["","13107015730","PAROXETINE ","40MG","30","Select","Select",""],["","00185041552","BUPROPION ","150MG SR","30","Select","Select",""],["","49281063115","FLUZONE ","2019-20","0","Select","Select",""],["","62037083201","METOPROL ","100MG ER","30","Select","Select",""],["","68180032006","BUPROPN ","300MG XL","30","Select","Select",""],["","63304017513","MESALAMINE ","1.2GM","60","Select","Select",""],["","60505257908","ATORVASTATIN ","20MG","90","Select","Select",""],["","67877019990","AMLODIPINE ","10MG","30","Select","Select",""],["","68180098003","LISINOPRIL ","10MG","30","Select","Select",""],["","52268001201","SUPREP ","PREP KIT","354","Select","Select",""],["","59267100003","PFIZER ","INJ COVID-19","0","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","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","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":""}]}]}