{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"  YNAFFITSENOJ A ","gend":1,"add":"SMAR 6821EVIRD YE","city":"MONETA","state":"VA","zip":"24121-5896","dob":"1998-06-20","age":"","mstatus":"","insh":"50011886","cliId":"","pno":"9804528270","cno":5408907282,"email":"","ename":"","eno":"","pphy":"GLENNEY, ROBERT","ppno":5402541239,"pcpadd":"18080 Main St, ","pcpcity":"Buchanan","pcpstate":"VA","pcpzip":240665482,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":5402387828,"add2":"                                                            ","add3":"","madd1":"1286 RAMSEY DRIVE","madd2":"                                                            ","madd3":"","mcity":"MONETA","mstate":"VA","mzip":"24121-5896","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R73.03","R76.8","R56.9","Z87.898","I10","N39.0","R53.83","E66.9","R00.2","R55","Z30.09","F32.9","E03.9","K21.9","R79.89","A41.9","R50.9","R10.33","R11.0","E11.9"],"date":["2020-05-08","2020-05-08","2019-08-26","2019-09-05","2020-05-08","2020-05-08","2020-05-08","2019-04-30","2019-05-13","2019-05-13","2019-09-05","2019-09-05","2020-05-08","2019-09-05","2019-05-10","2020-04-29","2020-04-29","2020-04-29","2020-04-29","2020-04-29"],"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":[["","65862019399","FLUOXETINE ","CAP 20MG","30","Select","Select",""],["","00193654621","BAYER ","MIS LANCETS","100","Select","Select",""],["","68180051303","LISINOPRIL ","TAB 5MG","30","Select","Select",""],["","00193731025","CONTOUR ","TES NEXT","25","Select","Select",""],["","55111015810","OMEPRAZOLE ","CAP 20MG","30","Select","Select",""],["","00186091706","PULMICORT ","INH 90MCG","1","Select","Select",""],["","68180011316","LEVETIRACETA ","TAB 500MG","60","Select","Select",""],["","69238183007","LEVOTHYROXIN ","TAB 25MCG","30","Select","Select",""],["","00555901658","SPRINTEC ","TAB 28 DAY","28","Select","Select",""],["","00093317431","ALBUTEROL ","FAT E HFA INH","8.5","Select","Select",""],["","16729020016","BUSPIRONE ","TAB 5MG","60","Select","Select",""],["","70710113908","FLUCONAZOLE ","TAB 150MG","1","Select","Select",""],["","68180071160","CEFDINIR ","CAP 300MG","20","Select","Select",""],["","00093221001","SUCRALFATE ","1GM","180","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":[[["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["No","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":""}]}]}