{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"R ADNOHRWORDLUM ","gend":1,"add":"          TS SNEHPETS 301                         ","city":"MARTINSVILLE             ","state":"VA","zip":"24112-9998","dob":"1990-11-13","age":"","mstatus":"","insh":"10118536","cliId":"","pno":"6975712886","cno":2762521959,"email":"","ename":"","eno":"","pphy":"HAYES, JANE SPERA","ppno":2766385437,"pcpadd":"314 FAIRY STREET EXT STE A,","pcpcity":"Martinsville","pcpstate":"VA","pcpzip":241121913,"pcpcounty":"","pcpid":"","pcpname":"CHILDREN FIRST PEDIATRICS OF VIRGINIA PC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"ROANOKE ALLEGHANY","aligned":"N","ano":"","add2":"                                                  ","add3":"","madd1":"103 STEPHENS ST                                   ","madd2":"                                                  ","madd3":"","mcity":"MARTINSVILLE             ","mstate":"VA","mzip":"24112-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z34.81","O26.91","Z79.899","Z36.9","R87.610","Z01.411","R79.9","O09.32","Z34.82","Z13.79","O14.94","Z3A.18","Z72.51","Z11.3","Z67.91","Z36.0","O35.8XX0","O34.219","O10.02","O76","Z37.0","Z3A.38","R82.90","Z13.1","N89.8","O10.919","Z32.01","Z34.90","Z31.430","O10.911","O09.893","O35.9XX1","O09.90","O28.8","Z82.79","O09.42","O10.912","Z3A.16","Z3A.32","Z36.2","Z3A.36","N83.8","O34.83","Z20.822","R03.0","O16.2","R10.11","Z3A.20","Z12.4","Z32.00","O26.893","R10.9","R10.30","Z3A.33","O98.93","093.0","O09.30","O26.859","Z3A.00","Z23","O98.813","R10.2","B37.3","Z87.59","Z3A.34","Z33.1","O09.92","93","Z01.31","O36.8331","O09.299","O35.2XX0","Z34.83","O36.8930","O10.913","O98.513","U07.1","Z31.5","Z81.8","Z81.0","F79","O09.293","Z00.110","O36.8390","Z86.16","O99.213","E66.9","Z3A.37","O80","Z37.9","O10.92","O24.429","O34.211","O99.02","D64.9","Z79.82","Z63.8","R06.9","P83.81","O24.420","Z00.111","Z38.00","Z3A.35"," "],"date":["2021-01-11","2021-01-08","2021-01-08","2021-01-20","2021-01-20","2021-02-02","2021-02-16","2021-02-09","2021-04-06","2021-02-16","2021-02-20","2021-02-09","2021-02-09","2021-04-06","2021-03-23","2021-02-09","2021-06-25","2022-06-07","2022-06-14","2022-06-13","2022-06-14","2021-06-25","2021-05-19","2021-03-23","2021-12-30","2021-12-30","2021-12-30","2021-12-30","2021-01-07","2021-01-07","2021-06-17","2021-04-27","2021-04-27","2022-06-13","2022-06-20","2021-01-20","2021-01-20","2021-01-20","2022-05-12","2022-05-12","2022-06-07","2021-06-24","2021-06-24","2022-01-14","2020-12-28","2021-01-21","2021-01-21","2021-01-21","2021-02-02","2021-02-02","2021-05-19","2021-04-24","2021-04-24","2022-05-19","2021-05-13","2021-05-13","2021-05-13","2021-05-16","2021-05-16","2022-04-25","2021-05-19","2021-05-19","2021-05-19","2021-05-19","2022-05-23","2020-12-28","2022-06-02","2021-05-13","2020-12-28","2022-05-19","2022-05-18","2022-05-18","2022-05-19","2022-05-23","2022-06-13","2022-06-07","2022-06-07","2022-05-09","2022-05-09","2022-05-09","2022-05-09","2022-05-09","2022-06-16","2022-06-13","2022-06-13","2022-06-13","2022-06-13","2022-06-14","2022-06-14","2022-06-14","2022-06-13","2022-06-13","2022-06-14","2022-06-13","2022-06-13","2022-06-13","2022-06-20","2022-06-20","2022-06-20","2022-06-14","2022-06-30","2022-06-15","2022-06-02","2022-06-30"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}}]},{"t":"Covid Screening","q":[{"a":[]}]},{"t":"Self-Assessment and Social History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":{"indx":[false,false],"comment":["",""],"score":["",""]}},{"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":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","16729018201","HYDROCHLOROT","TAB 12.5MG","90","Select","Select",""],["","00713067831","NYSTATIN","CRE 100000","30","Select","Select",""],["","00000000000","CLOPIDOGREL","TAB 75MG","3","Select","Select",""],["","00591060501","LABETALOL","TAB 100MG","60","Select","Select",""],["","00054372763","PROPRANOLOL","SOL 20MG\/5ML","24","Select","Select",""],["","00193731221","CONTOUR","TES NEXT","100","Select","Select",""],["","00193658621","MICROLET","MIS LANCETS","100","Select","Select",""],["","11917014296","ALCOHOL","PAD ","200","Select","Select",""],["","31722072320","LEVOFLOXACIN","TAB 750MG","7","Select","Select",""],["","59762305102","AZITHROMYCIN","POW 1GM PAK","1","Select","Select",""],["","67877032005","IBUPROFEN","TAB 600MG","30","Select","Select",""],["","51672130200","TERCONAZOLE","CRE 0.008","20","Select","Select",""],["","68180018001","CEFADROXIL","CAP 500MG","14","Select","Select",""],["","50111033402","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","50742026201","NIFEDIPINE","TAB 90MG ER","90","Select","Select",""],["","10702001850","OXYCODONE","TAB 5MG","10","Select","Select",""]]}},{"a":[]},{"a":[]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":[]}]},{"t":"Mini-Cog","q":[{"a":[]},{"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":"","a13":""}]}]}