{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KEVIN KNIGHT","gend":0,"add":"5211 WESLEY CHAPEL ROAD","city":"FREE UNION","state":"VA","zip":"22940-9998","dob":"1977-01-13","age":"","mstatus":"","insh":"20030743*01","cliId":"","pno":"434\/973-0754","cno":"434\/973-0754","email":"","ename":"","eno":"","pphy":"REYNOLDS, PAMELA PRESTON MD","ppno":"434\/924-1931","pcpadd":"1222 JEFFERSON PK AVE 3RD FLOOR","pcpcity":"CHARLOTTESVILLE","pcpstate":"VA","pcpzip":22908,"pcpcounty":"","pcpid":100619,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/924-9810","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z47.89","M24.574","M20.5X1","M62.81","R26.2","R26.81","M21.6X1","Z98.1","Z48.89","Q66.10","R19.7","M25.561","K86.0"],"date":["2020-04-01","2020-09-25","2020-09-25","2020-11-20","2020-11-20","2020-11-20","2020-11-20","2020-04-01","2020-06-26","2020-06-26","2020-11-09","2020-10-22","2020-03-02"],"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":[["","68180011302","LEVETIRACETA ","500MG","60","Select","Select",""],["","64380073706","VITAMIN ","50000UNT","6","Select","Select",""],["","68180051703","LISINOPRIL ","40MG","30","Select","Select",""],["","51525043101","FELBAMATE ","600MG","120","Select","Select",""],["","68180012202","CEPHALEXIN ","500MG","40","Select","Select",""],["","65162083366","DICLOFENAC ","1%","200","Select","Select",""],["","51525043101","FELBAMATE","600MG","120","Select","Select",""],["","68180051703","LISINOPRIL","40MG","30","Select","Select",""],["","68180011302","LEVETIRACETA","500MG","60","Select","Select",""],["","64380073706","VITAMIN","50000UNT","6","Select","Select",""],["","68180012202","CEPHALEXIN","500MG","40","Select","Select",""],["","65162083366","DICLOFENAC","1%","200","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","",""],["No","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":""}]}]}