{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"A BOCAJHTIMS ","gend":0,"add":"OB O.P3251 X","city":"KING GEORGE","state":"VA","zip":"22485-1379","dob":"2002-11-14","age":"","mstatus":"","insh":"8884750","cliId":"","pno":"6604533663","cno":"","email":"","ename":"","eno":"","pphy":"PERRAUT, MICHAEL EDWARD","ppno":2396915450,"pcpadd":"2565 COWAN BLVD,","pcpcity":"Fredericksburg","pcpstate":"VA","pcpzip":"22401-8440","pcpcounty":"","pcpid":"","pcpname":"CONVENIENCE FAMILY PRACTICE MEDICINE LLC","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"CENTRAL","aligned":"","ano":"","add2":"P.O BOX 1523","add3":"","madd1":"P.O BOX 1523","madd2":"","madd3":"","mcity":"KING GEORGE","mstate":"VA","mzip":"22485-1379","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["L40.0","L20.89","L85.3","R63.5","K92.1","R63.0","Z87.19","Z79.899","R62.7","K29.70","R10.84","R11.0","G90.9","R00.1","R55","R62.50","K59.09","G90.8","G89.29","R32","M47.816","M47.817","M51.37","M41.9","N32.89","R25.1","R29.818","R62.52","R41.3","N31.9","Z13.820","M62.81","G90.1","N32.81","N32.0","R42","G24.9","Z71.3","K59.00","K31.84","F41.9","R68.81","I33.0","R53.82","G44.89","R33.9","R10.11","I49.8","I95.1","Z20.822","U07.1","R09.81","R07.0","R53.81","R53.83","R06.89","Z04.9","R63.4","Z00.01","Z00.00","Z01.89","Z13.220","Z13.1","Z13.29","Z71.89","Z13.31","E46","J06.9","J03.90","J39.9","R05.9","Z11.52","R10.9","R10.30","Z68.51","R39.89","Z51.12","G47.9","M25.50","M54.50","R00.0","G25.2","R51.9","R00.2"],"date":["2021-03-22","2021-01-07","2021-01-07","2021-10-13","2021-04-01","2022-06-08","2021-04-01","2022-03-29","2022-03-02","2021-04-19","2023-04-19","2023-03-29","2023-03-29","2021-04-20","2022-06-08","2021-05-24","2023-04-19","2021-05-24","2023-05-10","2021-08-11","2021-06-07","2021-06-07","2021-06-07","2021-06-07","2021-06-07","2021-08-11","2021-06-28","2021-07-12","2021-07-12","2023-05-10","2021-07-12","2022-06-09","2023-05-10","2021-07-16","2021-07-16","2022-06-29","2021-08-11","2021-08-11","2022-06-08","2021-08-11","2023-03-29","2022-06-15","2021-10-07","2023-05-10","2021-10-07","2021-10-07","2021-10-21","2021-12-03","2023-05-10","2022-05-18","2021-12-12","2021-12-12","2021-12-12","2021-12-12","2023-03-29","2021-12-12","2022-02-22","2022-05-18","2022-03-23","2022-03-23","2022-03-23","2022-03-23","2022-03-23","2022-03-23","2022-03-23","2022-03-23","2022-03-29","2022-04-20","2022-04-20","2022-04-20","2022-04-20","2022-05-18","2022-06-09","2022-06-08","2022-06-08","2022-08-19","2022-10-18","2023-03-29","2023-03-29","2023-03-15","2023-03-29","2023-03-29","2023-03-29","2023-05-10"],"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":[["","47781001101","HYOSCYAMINE","SUB 0.125MG","60","Select","Select",""],["","00115703301","FLUDROCORT","TAB 0.1MG","60","Select","Select",""],["","59651000305","OMEPRAZOLE","CAP 40MG","30","Select","Select",""],["","51991083801","CYPROHEPTAD","TAB 4MG","60","Select","Select",""],["","59779030603","CVS PURELAX","POW","510","Select","Select",""],["","00245021111","MIDODRINE","TAB 2.5MG","30","Select","Select",""],["","13668019030","TOLTERODINE","CAP 4MG ER","30","Select","Select",""],["","42806016005","HYDROXYZ HCL","TAB 25MG","60","Select","Select",""],["","62559043130","HYDROCORTISO","CRE 0.025","30","Select","Select",""],["","69452015120","VITAMIN D","CAP 50000UNT","12","Select","Select",""],["","45802039000","TACROLIMUS","OIN 0.0003","60","Select","Select",""],["","64980030550","DENTA 5000","CRE PLUS","51","Select","Select",""],["","68462018135","CLOTRIMAZOLE","CRE 0.01","30","Select","Select",""],["","65862019805","GABAPENTIN","CAP 100MG","90","Select","Select",""],["","00168035730","LIDO\/PRILOCN","CRE 2.5-2.5%","60","Select","Select",""],["","00536105227","PEG3350","POW","510","Select","Select",""],["","68001050569","POLYETH GLYC","POW 3350 NF","510","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":""}]}]}