{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"L   LORACLLENNACS ","gend":1,"add":"         EVIRD  EEFENEM   0101                              ","city":"GOODE                         ","state":"VA","zip":"24556-2646","dob":"1965-05-26","age":"","mstatus":"","insh":"50018643","cliId":"","pno":"4943497571","cno":4349417579,"email":"","ename":"","eno":"","pphy":"BOLUSA-SABUGO, AHGNES U                                     ","ppno":"","pcpadd":"320 Federal St","pcpcity":"Lynchburg                     ","pcpstate":"VA","pcpzip":245042306,"pcpcounty":"","pcpid":"P9058759","pcpname":"JOHNSON HEALTH CENTER","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"1010   MENEFEE  DRIVE                                       ","madd2":"                                                            ","madd3":"","mcity":"GOODE                         ","mstate":"VA","mzip":"24556-2646","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M65.341","G56.02","M65.312","G56.03","M18.0","Z53.9","M79.7","K21.9","D69.9","K22.11","F99","F17.210","Z85.828","M65.322","M19.042","M19.041","F31.9","F43.10","J18.9","J18.0","R30.0","U07.1","S61.211A"],"date":["2019-03-21","2019-03-21","2019-03-21","2019-03-07","2019-03-07","2019-03-07","2019-03-21","2019-03-21","2019-03-21","2019-03-21","2019-03-07","2019-03-07","2019-03-21","2019-03-21","2019-03-21","2019-03-21","2019-03-21","2019-03-21","2019-09-10","2019-11-26","2019-11-26","2020-12-27","2021-09-24"],"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":[["","00093005805","TRAMADOL","50MG","12","Select","Select",""],["","68180012202","CEPHALEXIN","500MG","15","Select","Select",""],["","00093005805","TRAMADOL ","TAB 50MG","12","Select","Select",""],["","68180012202","CEPHALEXIN ","CAP 500MG","15","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","",""],["Yes","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":""}]}]}