{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   HAJYALANIFFAHC B","gend":1,"add":"            TRUOC  DOOWDER   4                              ","city":"PETERSBURG                    ","state":"VA","zip":"23803-3688","dob":"1994-11-04","age":"","mstatus":"","insh":"90019819","cliId":"","pno":"8540897195","cno":8045859179,"email":"","ename":"","eno":"","pphy":"LOBB, KEEFE H                                               ","ppno":"","pcpadd":"11601 Iron Bridge Rd Ste 117","pcpcity":"Chester                       ","pcpstate":"VA","pcpzip":238311467,"pcpcounty":"","pcpid":"P0109950","pcpname":"IRONBRIDGE FAMILY PRACTICE","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"CENTRAL","aligned":"","ano":"","add2":"APT D                                                       ","add3":"","madd1":"4   REDWOOD  COURT                                          ","madd2":"APT D                                                       ","madd3":"","mcity":"PETERSBURG                    ","mstate":"VA","mzip":"23803-3688","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R55","D72.829","R82.71","R40.0","F17.200","E87.6","E83.42","R07.89","I65.23","Z04.9","S19.9XXA","V89.2XXA","S29.9XXA","S29.012A","M54.6","V49.49XA","Y92.410","M62.838","M43.6","Z87.891","S29.019A","V49.40XA","R20.0","Z68.28","N39.0","R35.0","F17.210","B96.89","Z01.419","N62","Z11.3","L30.4","M25.519","M54.2","M54.9","R61","K02.9","K08.89","K04.7","N76.0","R10.30"],"date":["2019-09-23","2019-08-21","2019-08-21","2019-08-21","2019-08-21","2019-09-23","2019-09-23","2019-09-23","2019-09-23","2019-12-02","2019-12-03","2019-12-03","2019-12-03","2019-12-03","2019-12-03","2019-12-03","2019-12-03","2019-12-03","2019-12-03","2019-12-03","2019-12-03","2019-12-03","2019-12-12","2019-12-12","2021-02-22","2021-02-22","2021-10-12","2021-10-12","2021-04-06","2021-06-24","2021-04-06","2021-06-24","2021-06-24","2021-06-24","2021-06-24","2021-06-18","2021-07-23","2021-07-23","2021-07-23","2021-10-12","2021-10-12"],"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":[["","65162047810","NITROFURANTN","100MG","6","Select","Select",""],["","16714036004","MONO-LINYAH","0.25-35","84","Select","Select",""],["","45802013970","METRONIDAZOL","0.75%VAG","70","Select","Select",""],["","57664037708","TRAMADOL","50MG","12","Select","Select",""],["","63304069301","CLINDAMYCIN","300MG","21","Select","Select",""],["","10702005601","OXYCODONE","10MG","28","Select","Select",""],["","65162047810","NITROFURANTN ","CAP 100MG","6","Select","Select",""],["","68462011944","FLUCONAZOLE ","TAB 150MG","1","Select","Select",""],["","16571066401","METRONIDAZOL ","TAB 500MG","21","Select","Select",""],["","16714036004","MONO-LINYAH ","TAB 0.25-35","84","Select","Select",""],["","57664037708","TRAMADOL ","TAB 50MG","12","Select","Select",""],["","63304069301","CLINDAMYCIN ","CAP 300MG","21","Select","Select",""],["","10702005601","OXYCODONE ","TAB 10MG","28","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":""}]}]}