{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"  SINNEDEROOM J ","gend":0,"add":"OTHSA 165EUNEVA N","city":"FRANKLIN                      ","state":"VA","zip":"23851-2001","dob":"1961-01-12","age":"","mstatus":"","insh":"50016010","cliId":"","pno":"5575724516","cno":7575620312,"email":"","ename":"","eno":"","pphy":"BELLOVIN, SABRA","ppno":8047259191,"pcpadd":"10980 BUCKLEY HALL ROAD,","pcpcity":"MATHEWS                       ","pcpstate":"VA","pcpzip":231092319,"pcpcounty":"","pcpid":"","pcpname":"FRANKLIN COMMUNITY HEALTH CENTER","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"CENTRAL","aligned":"","ano":"","add2":"561 ASHTON AVENUE","add3":"","madd1":"561 ASHTON AVENUE","madd2":"                                                            ","madd3":"","mcity":"FRANKLIN                      ","mstate":"VA","mzip":"23851-2001","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I10","E78.5","Z72.0","I48.91","N18.3","R80.9","I12.9","R07.9","K52.9","Z23","N18.9","F10.10","M25.50","K92.1","Z12.5","Z71.9","Z71.89","I25.10","I48.0","I51.7","I50.30","I36.1","I37.1","F17.200","N18.30","N18.31","F17.290","R00.2","I25.2","N18.2","N17.9","Z68.23","I11.0"],"date":["2021-10-06","2021-11-16","2021-08-23","2021-09-09","2020-03-26","2021-08-23","2021-12-13","2019-06-25","2019-06-25","2021-09-09","2021-07-22","2020-10-29","2021-07-22","2020-02-04","2021-07-22","2020-03-26","2020-07-21","2021-11-16","2021-11-16","2020-09-25","2021-11-16","2020-09-25","2020-09-25","2020-10-20","2020-10-26","2021-12-13","2021-04-20","2021-07-20","2021-11-16","2021-09-09","2021-12-13","2021-10-06","2021-11-16"],"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":[]},{"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":[["","72205000390","ROSUVASTATIN","TAB 10MG","90","Select","Select",""],["","68645055254","LISINOPRIL","TAB 10MG","90","Select","Select",""],["","31722052201","HYDRALAZINE","TAB 100MG","270","Select","Select",""],["","68382009405","CARVEDILOL","TAB 12.5MG","180","Select","Select",""],["","68645051654","AMLODIPINE","TAB 10MG","90","Select","Select",""],["","68382005005","MELOXICAM","TAB 7.5MG","90","Select","Select",""],["","05388062842","VITAMIN","CAP 1000UNIT","30","Select","Select",""],["","00006483703","PNEUMOVAX","INJ 25\/0.5","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":[]}},{"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":""}]}]}