{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"M   CIRESIRROM ","gend":0,"add":"YNAHTEB 85341DAOR HCRUHC ","city":"MONTPELIER","state":"VA","zip":"23192-2606","dob":"1966-10-31","age":"","mstatus":"","insh":"30015270","cliId":"","pno":"5640801031","cno":"","email":"","ename":"","eno":"","pphy":"COOK, JAMES S","ppno":8047629646,"pcpadd":"2105 E Parham Rd Ste 109, ","pcpcity":"Henrico","pcpstate":"VA","pcpzip":232282236,"pcpcounty":"","pcpid":"","pcpname":"VIRGINIA FAMILY PRACTICE PC","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"14358 BETHANY CHURCH ROAD","madd2":"","madd3":"","mcity":"MONTPELIER","mstate":"VA","mzip":"23192-2606","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["S42.202A","S49.92XA","W01.0XXA","Y93.01","S42.232A","W19.XXXA","T14.8XXA","S42.292A","M25.512","R68.89","S42.202D","S42.232D","M85.812","M48.56XA","M51.26","W18.30XA","M25.552","S32.028A","M54.16","S32.029A","M54.5","W10.8XXA","Y92.009","M51.16","M51.17","E80.7","E87.6","E83.42","R53.1","I45.10","K74.1","F10.10","R18.8","R16.0","E87.1","I95.9","F14.90","D72.829","K74.60","N39.0","F10.99","E87.8","K76.9","N28.9","R78.81","R64","Z20.822","K70.40","K70.31","D69.59","B96.1","D64.9","I73.00","E55.9","E03.9","R94.31","F14.10","F17.200","I49.9","M79.89","R60.0","K70.30","Z87.440","Z23","Z11.59","I08.8","I10","T84.84XA","Z96.643","M61.552","R53.81","Z47.1"],"date":["2020-02-23","2020-02-23","2020-02-23","2020-02-23","2020-02-24","2020-12-07","2020-02-24","2020-02-24","2020-06-04","2020-09-28","2020-06-04","2020-06-04","2020-06-04","2020-12-07","2020-12-07","2020-12-07","2020-12-07","2020-12-07","2020-12-07","2020-12-07","2020-12-07","2020-12-07","2020-12-07","2020-12-07","2020-12-07","2021-04-10","2021-04-13","2021-04-10","2021-04-11","2021-04-10","2021-04-11","2021-04-13","2021-04-11","2021-04-11","2021-04-13","2021-04-13","2021-04-11","2021-04-11","2021-07-15","2021-04-11","2021-04-11","2021-04-11","2021-04-11","2021-04-11","2021-04-11","2021-04-11","2021-04-11","2021-04-11","2021-04-11","2021-04-11","2021-04-13","2021-04-12","2021-04-11","2021-04-11","2021-04-11","2021-04-11","2021-06-04","2021-04-13","2021-04-14","2021-05-17","2021-05-17","2021-06-04","2021-06-04","2021-06-04","2021-06-04","2021-07-15","2019-01-31","2019-10-16","2019-10-16","2019-10-16","2019-10-16","2019-10-16"],"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":[["","61314054701","LATANOPROST","SOL 0.00005","2.50","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","16.00","Select","Select",""],["","42858010250","OXYCOD\/APAP","TAB 5-325MG","8","Select","Select",""],["","68382091601","METHYLPRED","TAB 4MG","21","Select","Select",""],["","51672401801","ETODOLAC","TAB 400MG","20","Select","Select",""],["","00603188016","LIDOCAINE","PAD 0.05","20","Select","Select",""],["","65862056090","PANTOPRAZOLE","65862056090 PANTOPRAZOLE ","30","Select","Select",""],["","65862053820","LEVOFLOXACIN","65862053820 LEVOFLOXACIN ","7","Select","Select",""],["","62135021010","FOLIC","62135021010 FOLIC ","30","Select","Select",""],["","24385090363","GNP","24385090363 GNP ","4","Select","Select",""],["","69315015501","HYDROCHLOROT","69315015501 HYDROCHLOROT ","7","Select","Select",""],["","00536105224","PEG3350","00536105224 PEG3350 ","238","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":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"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":""}]}]}