{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"M   YDNARGNINNAM ","gend":0,"add":"DERF N 0539EKIP KCIRE","city":"CROSS JUNCTION","state":"VA","zip":"22625-1823","dob":"1973-01-05","age":"","mstatus":"","insh":"81019448","cliId":"","pno":"5804594096","cno":"","email":"","ename":"","eno":"","pphy":"LISK, MATTHEW","ppno":5405365114,"pcpadd":"333 W Cork St Unit 230, ","pcpcity":"Winchester","pcpstate":"VA","pcpzip":226013871,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"NORTHERN\/ WINCHESTER","aligned":"","ano":"","add2":"OFC BOX","add3":"","madd1":"9350 N FREDERICK PIKE","madd2":"OFC BOX","madd3":"","mcity":"CROSS JUNCTION","mstate":"VA","mzip":"22625-1823","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K28.9","Z98.84","R13.10","K95.89","K91.89","Y83.2","K65.1","A41.9","E66.01","R11.10","K91.0","E66.9","F11.90","R11.0","R19.02","L30.9","E53.8","Z01.818","Z68.41","K31.89","K30","K31.1","Z93.1","F41.8","I10","G89.18","K31.84","Z87.448","Z86.19","F41.9","F32.9","R42","R51","K66.0","K95.09","K52.9","K43.9","E87.6","Z79.891","Z87.891","R10.13","K94.23","D62","Y83.8","L03.311","Z68.39","K94.21","K94.22","Z90.49","Z43.1","Z48.815","K76.0","K94.20","Z46.82","Z01.810","E66.8","Z68.37","J96.01","J96.02","F05","B37.89","Z16.23","K91.71","T81.43XA","K91.850","K65.8","T81.44XA","A41.89","Z98.0","K63.89","B37.7","K25.1","Z45.2","Z46.59","Z48.03","Z79.2","T81.89XA","K65.2","R13.14"],"date":["2020-03-17","2020-04-06","2020-01-30","2021-06-23","2020-02-24","2020-02-24","2020-01-30","2020-01-30","2020-01-30","2020-01-30","2020-01-30","2021-06-23","2020-02-05","2020-03-17","2020-04-06","2020-08-10","2019-07-12","2019-10-04","2019-08-08","2019-10-16","2019-08-29","2019-09-05","2019-10-04","2019-10-04","2019-12-01","2019-07-31","2019-07-31","2019-07-31","2019-07-31","2019-12-01","2019-12-01","2019-10-04","2019-08-06","2019-10-15","2019-08-08","2019-08-08","2019-08-08","2019-10-15","2019-08-08","2019-08-08","2019-08-28","2019-08-28","2019-08-29","2019-10-15","2019-08-29","2019-08-29","2019-08-29","2019-08-29","2019-08-29","2019-09-05","2019-08-29","2019-08-29","2019-08-31","2019-09-04","2019-10-04","2019-10-04","2019-10-15","2019-10-15","2019-10-15","2019-10-15","2019-10-25","2019-10-15","2019-10-15","2019-10-15","2019-10-16","2019-11-07","2019-12-01","2019-11-21","2019-10-24","2019-10-21","2019-10-25","2019-12-01","2019-12-01","2019-12-01","2019-12-01","2019-12-01","2019-10-28","2019-11-21","2019-12-12"],"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":[["","13668000810","ZOLPIDEM","TAB 10MG","30","Select","Select",""],["","50111064702","FLUOXETINE","CAP 10MG","30","Select","Select",""],["","65162063711","PANTOPRAZOLE","TAB 40MG","60","Select","Select",""],["","00228202996","ALPRAZOLAM","TAB 0.5MG","20","Select","Select",""],["","65862001305","SERTRALINE","TAB 100MG","30","Select","Select",""],["","68001016100","PROMETHAZINE","TAB 12.5MG","40","Select","Select",""],["","00904673080","ACETAMIN","TAB 500MG","90","Select","Select",""],["","00406324301","HYDROMORPHON","TAB 2MG","12","Select","Select",""],["","68001039800","FAMOTIDINE","TAB 40MG","30","Select","Select",""],["","57237007710","ONDANSETRON","TAB 4MG ODT","30","Select","Select",""],["","57664037718","TRAMADOL","TAB 50MG","12","Select","Select",""],["","00093220305","METOCLOPRAM","TAB 10MG","15","Select","Select",""],["","43547039950","CYCLOBENZAPR","TAB 5MG","30","Select","Select",""],["","65862053401","AMOX\/K","SUS 400\/5ML","300","Select","Select",""],["","59762040105","SUCRALFATE","TAB 1GM","120","Select","Select",""],["","00406055201","OXYCODONE","TAB 5MG","6","Select","Select",""],["","43386091710","POT  CHLORIDE","TAB 20MEQ ER","60","Select","Select",""],["","57664050658","METOPROL","TAB 25MG","28","Select","Select",""],["","69547035302","NARCAN","SPR ","2","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":""}]}]}