{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"  ACISSEJNAMWOB D ","gend":1,"add":"           LAIDAR SMLEH E  532                              ","city":"STANLEY                       ","state":"VA","zip":"22851-9998","dob":"1985-04-16","age":"","mstatus":"","insh":"21019606","cliId":"","pno":"6604519169","cno":5406696191,"email":"","ename":"","eno":"","pphy":"LEE, ROLAND DAVID                                           ","ppno":"","pcpadd":"200 Memorial Dr","pcpcity":"Luray                         ","pcpstate":"VA","pcpzip":228351000,"pcpcounty":"","pcpid":"P9058925","pcpname":"PAGE MEMORIAL HOSPITAL","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"NORTHERN\/ WINCHESTER","aligned":"","ano":"","add2":"APT 4                                                       ","add3":"","madd1":"235  E HELMS RADIAL                                         ","madd2":"APT 4                                                       ","madd3":"","mcity":"STANLEY                       ","mstate":"VA","mzip":"22851-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F11.20","Z23","J02.0","J02.9","J10.1","R50.81","M79.621","W18.30XA","S42.301A","S49.91XA","W01.0XXA","Y92.009","S42.341A","M25.511","X58.XXXA","Z79.1","Z87.891","Z98.890","Z87.81","S42.301D","M25.521","W19.XXXA","S42.331A","Z01.812","Z96.7","R51.9","J34.89","Z01.84","Z20.828","R29.6","S59.901A","W01.198A","M79.5","R05","Z20.822","Z11.52"],"date":["2021-11-27","2019-10-28","2021-11-11","2020-01-10","2020-02-01","2020-02-01","2021-06-30","2020-02-14","2020-10-30","2021-06-30","2020-10-30","2020-02-14","2020-02-24","2020-02-24","2020-02-24","2020-02-24","2020-02-24","2020-11-12","2020-11-12","2020-06-18","2021-06-30","2020-10-26","2020-10-26","2020-10-29","2020-10-30","2021-02-02","2021-01-22","2021-01-22","2021-01-22","2021-06-30","2021-06-30","2021-06-30","2021-06-30","2021-09-10","2021-11-11","2021-11-11"],"priorHcc":[null,"",null,"","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",null,null]}},{"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":[["","65862050320","AMOX\/K","875-125","20","Select","Select",""],["","00093031401","KETOROLAC","10MG","15","Select","Select",""],["","68180012202","CEPHALEXIN","500MG","15","Select","Select",""],["","42858010201","OXYCOD\/APAP","5-325MG","20","Select","Select",""],["","69547035302","NARCAN","","2","Select","Select",""],["","53746010901","HYDROCO\/APAP","5-325MG","30","Select","Select",""],["","69097085207","NAPROXEN","500MG","60","Select","Select",""],["","69238126601","OSELTAMIVIR","75MG","10","Select","Select",""],["","00093310905","AMOXICILLIN","500MG","20","Select","Select",""],["","00591565810","CYCLOBENZAPR","10MG","15","Select","Select",""],["","00603188016","LIDOCAINE","5%","30","Select","Select",""],["","49483060450","IBUPROFEN","800MG","20","Select","Select",""],["","65862050320","AMOX\/K ","TAB 875-125","20","Select","Select",""],["","00093031401","KETOROLAC ","TAB 10MG","15","Select","Select",""],["","68180012202","CEPHALEXIN ","CAP 500MG","15","Select","Select",""],["","42858010201","OXYCOD\/APAP ","TAB 5-325MG","20","Select","Select",""],["","69547035302","NARCAN ","SPR ","2","Select","Select",""],["","00093310905","AMOXICILLIN ","CAP 500MG","20","Select","Select",""],["","53746010901","HYDROCO\/APAP ","TAB 5-325MG","30","Select","Select",""],["","69097085207","NAPROXEN ","TAB 500MG","60","Select","Select",""],["","69238126601","OSELTAMIVIR ","CAP 75MG","10","Select","Select",""],["","00591565810","CYCLOBENZAPR ","TAB 10MG","15","Select","Select",""],["","00603188016","LIDOCAINE ","PAD 0.05","30","Select","Select",""],["","49483060450","IBUPROFEN ","TAB 800MG","20","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","",""],["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":""}]}]}