{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"  YHTORODETIHW D ","gend":1,"add":"            EUNEVA AROMLA 9124                              ","city":"HENRICO                       ","state":"VA","zip":"23228-3601","dob":"1987-03-21","age":"","mstatus":"","insh":"71017854","cliId":"","pno":"0540898833","cno":8045033889,"email":"","ename":"","eno":"","pphy":"GLADFELTER, BAMBI L                                         ","ppno":"","pcpadd":"12018 W Broad St Ste 100","pcpcity":"Henrico                       ","pcpstate":"VA","pcpzip":232337796,"pcpcounty":"","pcpid":"P0114248","pcpname":"PRIMARY CARE OF WEST END LLC","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"CENTRAL","aligned":"","ano":"","add2":"APARTMENT 109                                               ","add3":"","madd1":"4219 ALMORA AVENUE                                          ","madd2":"                                                            ","madd3":"","mcity":"HENRICO                       ","mstate":"VA","mzip":"23228-3601","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R10.11","R11.2","R19.7","R50.9","R10.13","M25.562","M79.605","F17.200","K21.9","Z32.01","Z20.822"],"date":["2020-05-28","2020-05-28","2020-05-28","2020-05-28","2020-05-28","2020-10-29","2020-10-29","2020-10-29","2020-10-29","2020-10-29","2021-09-27"],"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":[["","59267100003","PFIZER","COVID-19","0.3","Select","Select",""],["","00093227434","AMOX\/K","500-125","20","Select","Select",""],["","68462019005","NAPROXEN","500MG","20","Select","Select",""],["","55111017915","TIZANIDINE","2MG","15","Select","Select",""],["","65162010150","GABAPENTIN","100MG","30","Select","Select",""],["","68180016013","AZITHROMYCIN","250MG","6","Select","Select",""],["","49483060350","IBUPROFEN","600MG","40","Select","Select",""],["","00555901658","SPRINTEC","28 DAY","28","Select","Select",""],["","57237007710","ONDANSETRON","4MG ODT","9","Select","Select",""],["","00591079501","DICYCLOMINE","20MG","20","Select","Select",""],["","59267100003","PFIZER ","INJ COVID-19","0.3","Select","Select",""],["","00093227434","AMOX\/K ","TAB 500-125","20","Select","Select",""],["","68462019005","NAPROXEN ","TAB 500MG","20","Select","Select",""],["","55111017915","TIZANIDINE ","TAB 2MG","15","Select","Select",""],["","65162010150","GABAPENTIN ","CAP 100MG","30","Select","Select",""],["","68180016013","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","49483060350","IBUPROFEN ","TAB 600MG","40","Select","Select",""],["","00555901658","SPRINTEC ","TAB 28 DAY","28","Select","Select",""],["","57237007710","ONDANSETRON ","TAB 4MG ODT","9","Select","Select",""],["","00591079501","DICYCLOMINE ","TAB 20MG","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":""}]}]}