{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"F LEINADKCIREDER","gend":0,"add":"RAP S 513TEERTS K","city":"MARION","state":"VA","zip":"24354-2915","dob":"1972-11-01","age":"","mstatus":"","insh":"50012949","cliId":"","pno":"5767295419","cno":2767591459,"email":"","ename":"","eno":"","pphy":"CLAMPITT, ROBERT V","ppno":2767837167,"pcpadd":"1020 Terrace Dr, Ste 100","pcpcity":"Marion","pcpstate":"VA","pcpzip":243544392,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"SOUTHWEST","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"315 S PARK STREET","madd2":"                                                            ","madd3":"","mcity":"MARION","mstate":"VA","mzip":"24354-2915","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F90.0","F43.10","J01.90","H65.193","M54.6","L50.1","R42","S49.91XA","R60.9","W19.XXXA","Y93.9","Y92.9","S43.401A","F90.9","I10","Z72.0","I21.3","R07.9","Z88.0","F17.210","Z79.899","Z99.81","I50.9","R10.84","R07.89","G47.34","G47.30","E66.01","Z71.6","R63.5","I25.2","F90.1","X58.XXXA","H92.01","F10.10","G89.29","M25.511","R19.7","R11.2","R35.1","S23.3XXA","S29.9XXA","X50.0XXA","I21.9","I25.10","J98.4","Z71.89","F32.9","F15.20","F41.9","X50.1XXA","R06.02","E78.5","E66.9","Z68.42","Z95.1","Z79.82","J02.9","R09.89","I21.19","R07.2","I11.0","I34.0","I21.4","F17.200","Z95.5","F15.11","R61","Z74.3"],"date":["2019-02-20","2020-07-16","2020-07-16","2019-02-20","2020-02-15","2020-01-17","2020-01-17","2020-01-17","2020-01-17","2020-01-17","2020-01-17","2020-01-17","2020-01-17","2020-06-21","2020-08-14","2020-06-07","2020-06-07","2020-08-14","2020-06-21","2020-08-14","2020-08-14","2020-06-07","2020-06-07","2020-06-07","2020-08-14","2019-05-27","2020-06-25","2020-06-25","2020-06-25","2020-06-25","2020-08-14","2020-07-16","2020-01-17","2020-01-15","2020-01-15","2020-07-16","2020-07-16","2020-01-15","2020-01-15","2020-01-15","2020-02-15","2020-02-15","2020-02-15","2020-06-08","2020-08-14","2020-06-21","2019-06-19","2019-08-29","2019-08-29","2019-08-29","2020-02-15","2020-08-14","2020-08-14","2020-06-21","2020-06-21","2020-06-21","2020-08-14","2019-01-17","2019-04-18","2020-06-07","2020-06-07","2020-06-07","2020-06-08","2020-06-07","2020-06-07","2020-06-08","2020-06-15","2020-08-14","2020-08-14"],"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":[["","00228259711","INDAPAMIDE ","TAB 1.25MG","30","Select","Select",""],["","57664016758","METOPROL ","TAB 100MG","60","Select","Select",""],["","68382013201","TAMSULOSIN ","CAP 0.4MG","30","Select","Select",""],["","42806031250","DOXYCYCL ","TAB 100MG","20","Select","Select",""],["","68180098003","LISINOPRIL ","TAB 10MG","30","Select","Select",""],["","00904679480","ASPIRIN ","CHW 81MG","30","Select","Select",""],["","00406012405","HYDROCO\/APAP ","TAB 7.5-325","12","Select","Select",""],["","16729021816","CLOPIDOGREL ","TAB 75MG","30","Select","Select",""],["","00363021807","ASPIRIN-81 ","CHW 81MG","30","Select","Select",""],["","59746000103","METHYLPRED ","TAB 4MG","21","Select","Select",""],["","55111012305","ATORVASTATIN ","TAB 40MG","30","Select","Select",""],["","64380080707","IBUPROFEN ","TAB 800MG","30","Select","Select",""],["","52817033200","CYCLOBENZAPR ","TAB 10MG","15","Select","Select",""],["","00781577626","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","00186077760","BRILINTA ","TAB 90MG","60","Select","Select",""],["","10702010101","METHYLPHENID ","TAB 10MG","90","Select","Select",""],["","00904681552","MUCUS ","TAB 400MG","14","Select","Select",""],["","29300012810","HYDROCHLOROT ","TAB 25MG","30","Select","Select",""],["","16571040250","CETIRIZINE ","TAB 10MG","30","Select","Select",""],["","00363042816","NICOTINE ","GUM 2MG MINT","320","Select","Select",""],["","33332031901","AFLURIA ","INJ 2019-20","0.5","Select","Select",""],["","60505036301","OFLOXACIN ","DRO 0.3%OTIC","5","Select","Select",""],["","60505082901","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","66993068530","OLANZAPINE ","TAB 20MG","30","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","",""],["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":""}]}]}