{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   ALEMAPSREYWAS D","gend":1,"add":"      EVIRD NOSBIG SALIS   642                              ","city":"BIG STONE GAP                 ","state":"VA","zip":"24219-8170","dob":"1986-09-18","age":"","mstatus":"","insh":"81019412","cliId":"","pno":"5267280949","cno":2762594908,"email":"","ename":"","eno":"","pphy":"ALMATARI, ABDULLATIEF                                       ","ppno":"","pcpadd":"127 Health Care Dr,Ste 100","pcpcity":"Pennington Gap                ","pcpstate":"VA","pcpzip":242772853,"pcpcounty":"","pcpid":"P0060078","pcpname":"PENNINGTON FAMILY HEALTH CENTER","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"SOUTHWEST","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"246   SILAS GIBSON DRIVE                                    ","madd2":"                                                            ","madd3":"","mcity":"BIG STONE GAP                 ","mstate":"VA","mzip":"24219-8170","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K08.89","H92.02","K56.41","K59.00","E66.9","F17.200","M54.5","M25.552","W17.81XA","Y92.488","S30.0XXA","S39.92XA","S39.93XA","H66.92","Z79.899","E87.6","R42","R53.1","F17.210","F41.9","J02.9","J06.9","M72.2","S91.311A","W25.XXXA","Z04.3","D50.9","E78.2","R94.7","M25.50","Z13.89","Z13.9","Z00.8","Z48.02","S59.911A","W19.XXXA","S59.901A","S69.91XA"],"date":["2019-05-15","2020-05-15","2019-06-16","2019-06-16","2019-06-16","2020-10-01","2019-12-31","2019-12-31","2019-12-31","2019-12-31","2019-12-31","2019-12-31","2019-12-31","2020-05-15","2020-06-19","2020-06-19","2020-06-19","2020-06-19","2020-09-19","2020-06-19","2020-08-24","2020-08-24","2020-09-19","2020-09-19","2020-09-19","2020-09-19","2020-10-01","2020-10-01","2020-10-01","2020-10-01","2020-10-01","2020-10-01","2020-10-01","2020-10-01","2021-11-18","2021-11-18","2021-11-18","2021-11-18"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",null,null,null,null]}},{"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","20MG","60","Select","Select",""],["","68462019005","NAPROXEN","500MG","20","Select","Select",""],["","65862018501","CLINDAMYCIN","150MG","40","Select","Select",""],["","00591354060","BUPROPION","100MG SR","60","Select","Select",""],["","45802065087","LORATADINE","10MG","30","Select","Select",""],["","65862019399","FLUOXETINE ","CAP 20MG","60","Select","Select",""],["","00591354060","BUPROPION ","TAB 100MG SR","60","Select","Select",""],["","68462019005","NAPROXEN ","TAB 500MG","20","Select","Select",""],["","65862018501","CLINDAMYCIN ","CAP 150MG","40","Select","Select",""],["","45802065087","LORATADINE ","TAB 10MG","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","",""],["N\/A","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":""}]}]}