{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"OM SEMAJREKAMYEN","gend":0,"add":"           ENAL YAWOLLAC   652                              ","city":"FARMVILLE                     ","state":"VA","zip":"23901-5300","dob":"1981-09-03","age":"","mstatus":"","insh":"50019813","cliId":"","pno":"6243411743","cno":"","email":"","ename":"","eno":"","pphy":"BROWN, BENJAMIN T                                           ","ppno":"","pcpadd":"4038 Thomas Nelson Hwy","pcpcity":"Arrington                     ","pcpstate":"VA","pcpzip":229222302,"pcpcounty":"","pcpid":"P0124427","pcpname":"LOVINGSTON HEALTH & REHAB CENTER","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"CENTRAL","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"256   CALLOWAY LANE                                         ","madd2":"                                                            ","madd3":"","mcity":"FARMVILLE                     ","mstate":"VA","mzip":"23901-5300","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z93.3","S31.105A","K46.0","R10.31","K56.699","K80.20","N20.0","D44.12","K43.3","K55.9","Z68.42","M54.5","F17.210","E66.01","I10","Z93.2","Z91.040","K66.0","K55.029","K56.609","Z46.59","G89.18","T81.30XA","D35.02","R10.9","R11.0","Y83.8","E66.9","Z68.41","E27.8","N13.2","R18.8","Z72.0","Z98.890","N13.4","N13.30","R10.30","H57.10","T15.01XA","T15.90XA","B37.2","K43.5","L03.311","B96.89","B36.9","Z87.891","Z28.21","R21","Z45.2","B96.5","B96.4","G89.29","Z87.442","Z90.49","Z79.899","Z88.8","L03.314","L03.90","K94.00","K61.0","M72.6","L03.317","R10.2","L30.4","L03.315","K61.1","K61.2","L02.215","R59.0","M54.9","I89.0","E11.9","R03.0"],"date":["2021-06-30","2021-09-16","2019-03-11","2019-03-11","2019-03-11","2020-09-26","2020-10-27","2019-03-11","2019-03-12","2019-03-12","2019-03-12","2020-09-26","2020-10-27","2020-10-30","2020-09-26","2020-09-26","2020-10-30","2019-03-12","2019-03-12","2019-08-11","2019-03-12","2019-03-24","2019-03-24","2020-09-26","2019-04-02","2019-03-24","2019-03-24","2020-09-26","2021-04-26","2019-04-02","2019-08-11","2019-04-02","2021-04-26","2019-08-11","2019-08-11","2019-08-11","2019-08-11","2020-02-18","2020-02-18","2020-02-18","2020-10-05","2020-10-30","2021-01-19","2020-09-08","2020-10-02","2020-09-26","2020-09-08","2020-09-08","2020-09-14","2020-09-26","2020-09-26","2021-04-26","2020-09-26","2020-09-26","2020-10-30","2020-09-26","2020-09-26","2020-10-02","2020-10-02","2020-10-27","2020-10-27","2020-10-27","2020-10-27","2020-10-27","2020-10-29","2020-10-30","2020-10-30","2020-11-02","2020-10-30","2021-04-26","2021-04-26","2021-04-26","2021-04-26"],"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":[["","68308015260","NYSTATIN","100000","60","Select","Select",""],["","42858010201","OXYCOD\/APAP","5-325MG","25","Select","Select",""],["","65862042005","SMZ\/TMP","800-160","14","Select","Select",""],["","68180012202","CEPHALEXIN","500MG","28","Select","Select",""],["","53746010901","HYDROCO\/APAP","5-325MG","7","Select","Select",""],["","70710114003","FLUCONAZOLE","200MG","42","Select","Select",""],["","00406324301","HYDROMORPHON","2MG","25","Select","Select",""],["","60505025203","TIZANIDINE","4MG","25","Select","Select",""],["","68462010530","ONDANSETRON","4MG","25","Select","Select",""],["","69238110005","DOXYCYCL","100MG","14","Select","Select",""],["","68308015260","NYSTATIN ","POW 100000","60","Select","Select",""],["","42858010201","OXYCOD\/APAP ","TAB 5-325MG","25","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","14","Select","Select",""],["","68180012202","CEPHALEXIN ","CAP 500MG","28","Select","Select",""],["","53746010901","HYDROCO\/APAP ","TAB 5-325MG","7","Select","Select",""],["","70710114003","FLUCONAZOLE ","TAB 200MG","42","Select","Select",""],["","00406324301","HYDROMORPHON ","TAB 2MG","25","Select","Select",""],["","60505025203","TIZANIDINE ","TAB 4MG","25","Select","Select",""],["","68462010530","ONDANSETRON ","TAB 4MG","25","Select","Select",""],["","69238110005","DOXYCYCL ","CAP 100MG","14","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":""}]}]}