{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"WILLIAM SHIFFLETT","gend":0,"add":"233 FELLOWSHIP ROAD","city":"HARRISONBURG","state":"VA","zip":"22802-9998","dob":"1972-09-22","age":"","mstatus":"","insh":"20053342*01","cliId":"","pno":"540\/271-3538","cno":"540\/271-3538","email":"","ename":"","eno":"","pphy":"MORGAN, ALAN J MD","ppno":"540\/564-7300","pcpadd":"1661 S MAIN ST","pcpcity":"HARRISONBURG","pcpstate":"VA","pcpzip":22801,"pcpcounty":"","pcpid":188285,"pcpname":"SRMHMG - Sentara South Main Health Center","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/431-7100","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I11.0","R50.9","I50.9","C18.9","E66.01","Z68.43","Z79.899","I10.","M25.561","M25.562","G89.29","C19.","E78.6"],"date":["2020-08-20","2020-08-20","2020-08-20","2020-08-20","2020-11-17","2020-11-17","2020-08-20","2021-01-11","2021-01-11","2021-01-11","2021-01-11","2020-11-17","2020-11-17"],"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":[["","68645051054","HYDROCHLOROT ","25MG","30","Select","Select",""],["","68645055454","LISINOPRIL ","30MG","30","Select","Select",""],["","68645051554","AMLODIPINE ","5MG","90","Select","Select",""],["","68382005005","MELOXICAM ","7.5MG","60","Select","Select",""],["","65162083366","DICLOFENAC ","1%","100","Select","Select",""],["","68645051054","HYDROCHLOROT","25MG","30","Select","Select",""],["","68645055454","LISINOPRIL","30MG","90","Select","Select",""],["","68382005005","MELOXICAM","7.5MG","60","Select","Select",""],["","68645051554","AMLODIPINE","5MG","30","Select","Select",""],["","65162083366","DICLOFENAC","1%","100","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":""}]}]}