{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"A ENITSIRHCDNALILLIG ","gend":1,"add":"GNAH382DAOR RA","city":"CHASE CITY","state":"VA","zip":"23924-4026","dob":"1976-08-12","age":"","mstatus":"","insh":"21013293","cliId":"","pno":"7743458384","cno":"","email":"","ename":"","eno":"","pphy":"DEAL, MARTIN TYLER","ppno":4342063100,"pcpadd":"184 BUFFALO RD,","pcpcity":"Clarksville","pcpstate":"VA","pcpzip":"23927-9010","pcpcounty":"","pcpid":"","pcpname":"LEGACY CARE LLC","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"CENTRAL","aligned":"","ano":"","add2":"283HANGAR ROAD","add3":"","madd1":"283HANGAR ROAD","madd2":"","madd3":"","mcity":"CHASE CITY","mstate":"VA","mzip":"23924-4026","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N95.1","F41.0","F33.42","K90.0","F33.1","G89.4","M77.8","B35.3","Z12.31","F11.20","F41.9","N39.0","G89.29","M54.9","R10.2","Z20.822","F17.210","Z88.0","F11.90","F11.10","F17.200","F13.90","F13.10","F13.20","F19.10","Z00.00","F33.0","B00.1","D72.829","Z12.11","Z13.29","Z11.59","Z11.4","G47.00","K13.79","M06.9","Z72.0","M54.50","M46.1","R63.0","M05.20","R63.4"],"date":["2021-10-12","2021-10-12","2021-10-12","2021-10-12","2021-10-12","2022-11-03","2021-10-12","2021-10-12","2021-10-12","2022-10-12","2022-12-08","2022-02-27","2022-02-27","2022-02-27","2023-02-08","2022-02-27","2022-02-27","2022-02-27","2022-03-01","2022-12-07","2022-03-09","2022-03-01","2022-03-01","2022-03-09","2022-12-07","2022-11-03","2022-12-08","2022-11-03","2022-12-19","2023-05-15","2022-11-03","2022-11-03","2022-11-03","2022-12-07","2022-12-08","2022-12-19","2023-02-08","2023-01-10","2023-02-08","2023-05-15","2023-05-15","2023-05-15"],"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":[["","69097084507","CYCLOBENZAPR","TAB 5MG","90","Select","Select",""],["","65862001305","SERTRALINE","TAB 100MG","30","Select","Select",""],["","00555089902","ESTRADIOL","TAB 0.5MG","90","Select","Select",""],["","00228202950","ALPRAZOLAM","TAB 0.5MG","90","Select","Select",""],["","10702005601","OXYCODONE","TAB 10MG","150","Select","Select",""],["","69097094312","GABAPENTIN","CAP 300MG","90","Select","Select",""],["","49884090738","MEGESTROL AC","SUS 40MG\/ML","240","Select","Select",""],["","68462018117","CLOTRIMAZOLE","CRE 0.01","15","Select","Select",""],["","57664049983","MIRTAZAPINE","TAB 15MG","30","Select","Select",""],["","12496120803","SUBOXONE","MIS 8-2MG","84","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","65862042005","SMZ\/TMP DS","TAB 800-160","14","Select","Select",""],["","68382003416","VENLAFAXINE","CAP 37.5 ER","30","Select","Select",""],["","69584009150","BUSPIRONE","TAB 5MG","90","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":""}]}]}