{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" ADNILXXOF M","gend":1,"add":" NOSNHOJ 2555DAOR NIATNUOM","city":"HUDDLESTON","state":"VA","zip":24104,"dob":"1952-10-21","age":"","mstatus":"","insh":"50011045","cliId":"","pno":"2243433831","cno":"","email":"","ename":"","eno":"","pphy":"ROBERTSON, SANDRA JO","ppno":4342213833,"pcpadd":"527 POCKET RD,","pcpcity":"HURT","pcpstate":"VA","pcpzip":24563,"pcpcounty":"","pcpid":"","pcpname":"CVFP STAUNTON RIVER FAMILY","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"ROANOKE\/ALLEGHANY","aligned":"","ano":"","add2":"5552 JOHNSON MOUNTAIN ROAD","add3":"","madd1":"5552 JOHNSON MOUNTAIN ROAD","madd2":"                                                            ","madd3":"","mcity":"HUDDLESTON                    ","mstate":"VA","mzip":"24104-4126","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R07.89","E87.6","I12.9","N18.9","R07.9","E11.22","Z79.84","Z79.899","Z12.31","Z85.038","N63.10","N63.20","E78.2","I10","G54.1","K21.9","G72.9","T46.6X1A","M79.672","M72.2","G89.29","Z23"],"date":["2019-01-29","2019-01-29","2019-01-29","2020-06-11","2019-01-29","2020-06-11","2019-01-29","2019-01-29","2021-12-23","2021-12-23","2021-12-23","2021-12-23","2020-08-04","2020-08-04","2020-06-11","2020-06-11","2020-08-04","2020-08-04","2021-10-06","2021-01-12","2021-10-06","2021-10-08"],"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":[["","80777027399","MODERNA","INJ COVID-19","0.5","Select","Select",""],["","62175061743","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","70377000612","ROSUVASTATIN","TAB 5MG","30","Select","Select",""],["","00245531911","KLOR-CON","TAB 20MEQ ER","60","Select","Select",""],["","57664016758","METOPROL","TAB 100MG","60","Select","Select",""],["","68382075810","METFORMIN","TAB 500MG","60","Select","Select",""],["","68180097903","LISINOPRIL","TAB 40MG","30","Select","Select",""],["","68180072103","AMLODIPINE","TAB 10MG","90","Select","Select",""],["","23155000101","HYDRALAZINE","TAB 10MG","60","Select","Select",""],["","23155000810","HYDROCHLOROT","TAB 25MG","90","Select","Select",""],["","00193709021","CONTOUR","TES BLD GLUC","100","Select","Select",""],["","69097081312","GABAPENTIN","CAP 100MG","90","Select","Select",""],["","70461012003","FLUAD","INJ 0.5ML","0.5","Select","Select",""],["","49281040565","FLUZONE","INJ PF 19-20","0.5","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":""}]}]}