{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"C YNITSEDWALLETSA","gend":1,"add":"KRAP 705TEERTS ","city":"ASHLAND","state":"VA","zip":"23005-1235","dob":"1997-02-13","age":"","mstatus":"","insh":"0546668","cliId":"","pno":"1740816244","cno":"","email":"","ename":"","eno":"","pphy":"JOSEPH, LERLA G","ppno":"8042304913          ","pcpadd":"849 S Sycamore St Ste A, ","pcpcity":"Petersburg","pcpstate":"VA","pcpzip":"238035801","pcpcounty":"","pcpid":"","pcpname":"CHARLES CITY MEDICAL GROUP","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"507 PARK STREET","madd2":"","madd3":"","mcity":"ASHLAND","mstate":"VA","mzip":"23005-1235","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F33.1","S22.41XA","J93.9","S30.810A","S40.212A","M25.531","M54.2","M25.511","M54.9","F41.9","G40.909","V43.62XA","Y92.410","S22.49XA","G89.11","S22.41XD","M95.4","Z79.899","E04.1","R07.81","N92.6","Z32.02","H01.005","R56.9","O36.80X0","Z3A.09","Z36.89","O99.352","Z3A.19","O23.42","O99.282","O21.9","E87.6","Z3A.21","O99.891","R50.9","R79.9","O21.2","Z20.822","R11.2","E86.9","B37.3","Z3A.23","Z34.83","Z3A.28","Z23","N39.0","L29.9","O99.353","Z3A.36","O99.713","Z3A.38","Z3A.39","Z3A.40","O26.893","O48.0","R10.2","Z3A.41","O42.92","O47.1","N89.8","O34.219","O34.211","O70.0","Z37.0","Z87.891","D50.9","O99.02","U07.1","F53.0","P96.89"],"date":["2021-12-15","2020-05-08","2020-03-23","2020-03-23","2020-03-23","2020-03-23","2020-03-23","2020-03-23","2020-03-23","2021-10-14","2020-03-23","2020-03-23","2020-03-23","2020-04-06","2020-05-08","2020-05-08","2020-05-08","2020-05-08","2020-05-08","2020-05-08","2020-08-26","2020-08-26","2020-09-29","2021-06-08","2021-07-08","2021-07-08","2022-01-13","2021-09-21","2021-09-21","2021-09-29","2021-09-29","2021-09-29","2021-09-29","2021-09-29","2022-02-20","2021-09-29","2021-09-29","2021-09-29","2021-09-29","2021-09-29","2021-09-29","2021-10-04","2021-10-14","2021-11-19","2021-11-19","2021-11-19","2021-11-19","2022-01-13","2022-02-10","2022-01-13","2022-01-13","2022-01-28","2022-02-03","2022-02-10","2022-02-17","2022-02-20","2022-02-17","2022-02-20","2022-02-17","2022-02-17","2022-02-20","2022-02-20","2022-02-20","2022-02-20","2022-02-20","2022-02-20","2022-02-20","2022-02-20","2022-03-01","2022-03-07","2022-03-07"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}}]},{"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":[]},{"a":[]},{"a":{"indx":[false,false],"comment":["",""],"score":["",""]}},{"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":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","31722053705","LEVETIRACETA","TAB 500MG","60.00","Select","Select",""],["","70010075401","METHOCARBAM","TAB 500MG","15.00","Select","Select",""],["","00172392570","DIAZEPAM","TAB 2MG","90.00","Select","Select",""],["","00406055201","OXYCODONE","TAB 5MG","10.00","Select","Select",""],["","50111064801","FLUOXETINE","CAP 20MG","30.00","Select","Select",""],["","11534016503","FOLIC","TAB 1MG","120.00","Select","Select",""],["","00093506201","HYDROXYZ","TAB 50MG","90.00","Select","Select",""],["","00093005401","BUSPIRONE","TAB 10MG","60.00","Select","Select",""],["","57237007710","ONDANSETRON","TAB 4MG ODT","15.00","Select","Select",""],["","45802006435","TRIAMCINOLON","CRE 0.001","45.00","Select","Select",""],["","00591352530","LIDOCAINE","PAD 0.05","7.00","Select","Select",""],["","64380080807","IBUPROFEN","TAB 600MG","30.00","Select","Select",""],["","00228202996","ALPRAZOLAM","TAB 0.5MG","30.00","Select","Select",""],["","00093314705","CEPHALEXIN","CAP 500MG","14.00","Select","Select",""],["","62037099901","POT  CL MICRO","TAB 20MEQ ER","3.00","Select","Select",""],["","24208091055","ERYTHROMYCIN","OIN OP","3.50","Select","Select",""],["","00168034720","TERCONAZOLE","CRE 0.008","20.00","Select","Select",""],["","61314062810","POLYMYXIN","SOL TRIMETHP","10.00","Select","Select",""]]}},{"a":[]},{"a":[]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":[]}]},{"t":"Mini-Cog","q":[{"a":[]},{"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":"","a13":""}]}]}