{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"AUGUSTINA   I SHEPHERD","gend":1,"add":"BEVERLY SUTHERS","city":"WYTHEVILLE                    ","state":"VA","zip":"24382-2874","dob":"2004-03-26","age":"","mstatus":"","insh":4163614,"cliId":"","pno":2766201504,"cno":5408189368,"email":"","ename":"","eno":"","pphy":"SAMPLES, RANDALL GARY","ppno":5406749359,"pcpadd":"5562 Cougar Trail Rd,","pcpcity":"Dublin                        ","pcpstate":"VA","pcpzip":240843849,"pcpcounty":"","pcpid":"","pcpname":"CHILDRENS CHOICE PC","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"BEVERLY SUTHERS","add3":"","madd1":"BEVERLY SUTHERS","madd2":"840 S 18TH STREET","madd3":"","mcity":"WYTHEVILLE                    ","mstate":"VA","mzip":"24382-2874","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z01.812","Z00.129","Z23","N39.0","R10.9","E78.00","E11.9","Z79.84","R10.33","R10.2","N85.4","N32.89","R30.0","N20.9","B37.3","Z11.3","Z11.8","M54.9","R31.29","R10.31","R31.9","N30.01","R31.0","N29","Z03.89","J06.9","J30.2"],"date":["2020-03-10","2020-06-16","2020-06-16","2020-10-21","2021-04-05","2020-07-28","2020-07-28","2020-07-28","2020-07-28","2020-10-21","2020-10-21","2020-10-21","2021-03-16","2020-10-21","2021-03-16","2021-03-16","2021-03-16","2021-03-16","2021-03-16","2021-03-17","2021-03-17","2021-04-05","2021-04-05","2021-04-05","2021-05-06","2021-05-06","2021-05-06"],"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":[["","50111078751","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","16714079904","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","42192060716","BROM\/PSE\/DM","SYP 2\/30\/10","120","Select","Select",""],["","65862001501","AMOXICILLIN","TAB 875MG","20","Select","Select",""],["","55111014512","FLUCONAZOLE","TAB 150MG","2","Select","Select",""],["","57237007710","ONDANSETRON","TAB 4MG ODT","12","Select","Select",""],["","68382055901","NITROFUR","CAP 50MG","30","Select","Select",""],["","68382013201","TAMSULOSIN","CAP 0.4MG","30","Select","Select",""],["","51293081001","PHENAZOPYRID","TAB 100MG","9","Select","Select",""],["","67877021905","CEPHALEXIN","CAP 500MG","30","Select","Select",""],["","65162027250","SMZ\/TMP","TAB 800-160","14","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":""}]}]}