{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" MAILLIWSREYM C","gend":0,"add":"RAW   69683DAOR EUQIR","city":"IVOR","state":"VA","zip":23866,"dob":"1975-03-08","age":"","mstatus":"","insh":"40017399","cliId":"","pno":"7275738294","cno":"","email":"","ename":"","eno":"","pphy":"PONDER, JAMES MICHAEL","ppno":7572749283,"pcpadd":"100 FAIRVIEW DR,","pcpcity":"FRANKLIN","pcpstate":"VA","pcpzip":23851,"pcpcounty":"","pcpid":"","pcpname":"FRANKLIN CLINIC CORPORATION","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"CENTRAL","aligned":"","ano":"","add2":"38696   WARRIQUE ROAD","add3":"","madd1":"38696 WARRIQUE ROAD","madd2":"                                                            ","madd3":"","mcity":"IVOR                          ","mstate":"VA","mzip":"23866-2705","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I71.4","I72.4","I71.2","E66.01","N20.0","J44.9","F17.290","G47.30","J90","R91.8","R06.02","R06.2","M79.671","F43.20","J91.8","G47.33","R06.00","Z13.31","R06.09","F17.209","Z68.44","I50.20","Z68.43","I11.0","I50.23","I73.9","Z99.89","Z87.891","Z79.51","Z79.82","Z79.02","I50.21","J81.0","R61","R07.9","Z01.89","K21.0","F17.200","E78.5","I10","E78.2","F17.210","J45.901","H53.8","E11.9","I50.9","E66.9","R51.9","H53.9"],"date":["2019-07-01","2019-07-01","2019-07-01","2021-04-21","2019-01-07","2021-05-25","2019-01-08","2019-01-08","2019-01-08","2019-01-08","2019-07-01","2019-01-08","2019-01-22","2019-01-22","2019-01-22","2021-10-21","2019-03-11","2019-03-11","2019-06-26","2019-04-08","2019-04-08","2019-05-22","2021-05-25","2021-05-25","2021-04-21","2019-07-01","2019-07-01","2019-07-01","2019-07-01","2019-07-01","2019-07-01","2019-07-01","2019-07-01","2019-07-01","2019-07-01","2019-07-01","2020-05-27","2020-05-27","2020-05-27","2021-05-25","2021-04-21","2021-05-25","2021-04-21","2021-05-25","2021-06-01","2021-05-25","2021-05-25","2021-05-25","2021-05-25"],"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":[]},{"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":[["","00378967130","IPRATROPIUM\/","SOL ALBUTER","360","Select","Select",""],["","65862035705","CLOPIDOGREL","TAB 75MG","90","Select","Select",""],["","99073070822","FREESTYLE    TES LITE","TES LITE","50","Select","Select",""],["","00832054211","BUMETANIDE","TAB 2MG","30","Select","Select",""],["","76385011150","CARVEDILOL","TAB 6.25MG","180","Select","Select",""],["","70377003012","ATORVASTATIN","TAB 80MG","90","Select","Select",""],["","68382076010","METFORMIN","TAB 1000MG","60","Select","Select",""],["","00245531911","KLOR-CON","TAB 20MEQ ER","90","Select","Select",""],["","57237016199","OMEPRAZOLE","CAP 20MG","90","Select","Select",""],["","99073070805","FREESTYLE    MIS LITE","MIS LITE","1","Select","Select",""],["","00173086910","ANORO","AER 62.5-25","60","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","Select","Select",""],["","00143974010","PREDNISONE","TAB 5MG","84","Select","Select",""],["","00186037020","SYMBICORT","AER 160-4.5","10.2","Select","Select",""],["","00378020810","FUROSEMIDE","TAB 20MG","30","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":{"indx":[["","",""],[""],[""],[""],[""]],"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":""}]}]}