{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ANDREW   W COMBS","gend":0,"add":"1221 EGGLESTON ROAD                                         ","city":"PEMBROKE                      ","state":"VA","zip":"24136-3123","dob":"2004-05-14","age":"","mstatus":"","insh":4150168,"cliId":"","pno":5409229177,"cno":"","email":"","ename":"","eno":"","pphy":"BOERTH, SCOTT R                                             ","ppno":5408088913,"pcpadd":"3698 S Main St,","pcpcity":"Blacksburg                    ","pcpstate":"VA","pcpzip":240607015,"pcpcounty":"","pcpid":"","pcpname":"FAMILY MEDICINE OF BLACKSBURG LLC","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"APARTMENT 5                                                 ","add3":"","madd1":"1221 EGGLESTON ROAD","madd2":"APARTMENT 5","madd3":"","mcity":"PEMBROKE                      ","mstate":"VA","mzip":"24136-3123","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["A08.4","F43.20","J10.1","R68.89","R19.7","R04.0","M54.5","M54.9","R80.9","H66.001","H69.81","J06.9","B97.89","R10.30","R82.2","Z00.129","Z23","M54.6","X58.XXXA","J30.9","R05","R11.2","M25.571","S99.811A","H00.015","H00.012","J02.9","F43.21","S90.861A","W57.XXXA","J45.20","H00.013","H57.11","L29.9","R22.0","H00.023","R07.81","K92.1","Z86.16"],"date":["2021-12-07","2021-06-01","2020-03-03","2019-01-31","2019-04-18","2019-04-18","2019-03-13","2021-12-17","2019-05-09","2019-03-27","2019-03-27","2021-11-16","2019-04-29","2019-05-09","2019-05-09","2019-07-31","2019-07-31","2019-08-27","2019-08-27","2019-09-09","2019-09-09","2021-11-16","2019-09-17","2019-09-17","2019-10-15","2019-10-17","2021-12-17","2020-10-20","2020-12-02","2020-12-02","2021-06-29","2021-07-11","2021-07-11","2021-07-11","2021-07-11","2021-07-11","2021-08-24","2021-11-16","2021-12-17"],"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":[["","49348086134","SM","SYP DM","118","Select","Select",""],["","50228043605","NAPROXEN","TAB 500MG","30","Select","Select",""],["","16714029904","AMOXICILLIN","CAP 500MG","30","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","69238110002","DOXYCYCL","CAP 100MG","2","Select","Select",""],["","31722063231","OSELTAMIVIR","CAP 75MG","10","Select","Select",""],["","17478071310","OFLOXACIN","DRO 0.3% OP","5","Select","Select",""],["","57237007710","ONDANSETRON","TAB 4MG ODT","10","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","45802065087","LORATADINE","TAB 10MG","30","Select","Select",""],["","00143924920","AMOX\/K","TAB 875-125","20","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":""}]}]}