{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"D   EPOHRENTUB ","gend":1,"add":"           YAWHGIH EEL W  7612                              ","city":"WYTHEVILLE                    ","state":"VA","zip":"24382-1357","dob":"1977-12-21","age":"","mstatus":"","insh":"50018294","cliId":"","pno":"1667274723","cno":2763897796,"email":"","ename":"","eno":"","pphy":"MCCONNELL, JAMES J","ppno":2762288951,"pcpadd":"365 W Ridge Rd,","pcpcity":"Wytheville                    ","pcpstate":"VA","pcpzip":243821008,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"APT B                                                       ","add3":"","madd1":"2167 W LEE HIGHWAY","madd2":"APT B","madd3":"","mcity":"WYTHEVILLE                    ","mstate":"VA","mzip":"24382-1357","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F11.20","Z79.899","F15.20","F13.20","F12.10","F13.10","F15.10","F15.21","F13.21","F12.21","F34.1","F41.0","F43.10","M77.32","Z71.89","M79.672","M62.838","M54.9","R53.83","Z68.33","Z71.3","F10.10","F10.21","S61.210A","L03.011","W27.0XXA","S61.411A","L03.113","F41.9","G43.909","M50.30","F51.04","M51.36","F15.11","F13.11","F12.11","M79.7","G57.93","F41.1","F19.20","F12.20","N30.90","R10.9","R10.30","R10.819","Z87.891"],"date":["2020-08-03","2019-09-17","2019-12-05","2019-12-05","2020-08-03","2020-08-03","2020-08-03","2019-06-05","2019-06-05","2019-06-05","2019-04-02","2019-04-02","2019-04-02","2019-04-02","2019-04-02","2019-04-02","2019-04-02","2019-04-02","2019-04-02","2019-04-02","2019-04-02","2019-04-10","2019-05-09","2019-06-24","2019-06-24","2019-06-24","2019-06-24","2019-06-24","2019-08-16","2019-09-17","2019-08-16","2019-09-17","2019-09-17","2019-08-28","2019-08-28","2019-08-28","2019-09-17","2019-09-17","2019-10-15","2019-11-08","2019-12-05","2021-05-07","2021-05-07","2021-05-07","2021-05-07","2021-05-07"],"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":[]},{"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":[["","57237023305","SMZ-TMP","TAB 800-160","14","Select","Select",""],["","10702000310","PROMETHAZINE","TAB 25MG","30","Select","Select",""],["","12496120803","SUBOXONE","MIS 8-2MG","14","Select","Select",""],["","16729014701","QUETIAPINE","TAB 100MG","7","Select","Select",""],["","59762531001","PRAZOSIN","CAP 1MG","60","Select","Select",""],["","00185067401","HYDROXYZ","CAP 25MG","90","Select","Select",""],["","60505025102","TIZANIDINE","TAB 2MG","45","Select","Select",""],["","43598058230","BUPREN\/NALOX","MIS 8-2MG","28","Select","Select",""],["","65162089909","ARIPIPRAZOLE","TAB 15MG","30","Select","Select",""],["","16729017017","ESCITALOPRAM","TAB 20MG","30","Select","Select",""],["","51991045757","POLYETH","POW 3350 NF","527","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","67877057501","BENZONATATE","CAP 200MG","30","Select","Select",""],["","42571016242","AMOX\/K","TAB 875-125","20","Select","Select",""],["","43598051090","ESOMEPRA","CAP 40MG DR","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":[]}},{"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":""}]}]}