{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"VANESSA SNYDER","gend":1,"add":"7550 GARDEN PLACE                                           ","city":"DAYTON                        ","state":"VA","zip":"22821-9361","dob":"1985-09-01","age":"","mstatus":"","insh":4218056,"cliId":"","pno":5406302673,"cno":"","email":"","ename":"","eno":"","pphy":"SCHUBERT, RONALD L                                          ","ppno":5408792585,"pcpadd":"15 Killdeer Ln                                              ,                                                            ","pcpcity":"Dayton                        ","pcpstate":"VA","pcpzip":228219745,"pcpcounty":"","pcpid":"","pcpname":"CARILION FAMILY MEDICINE DAYTON","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"7550 GARDEN PLACE                                           ","add3":"","madd1":"7550 GARDEN PLACE                                           ","madd2":"                                                            ","madd3":"","mcity":"DAYTON                        ","mstate":"VA","mzip":"22821-9361","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F29","L40.9","R21","F17.210","Z85.41","Z88.0","F41.9","F32.9","F19.11","Z72.0","Z72.9","Z79.899","F15.21","K04.7","K08.89","R10.10","R11.2","R10.11","R10.9","R19.5","E66.9","Z87.891","R06.09","J98.4","R06.02","L40.8","Z51.81","K20.90","K44.9","K31.89","R10.13","K92.1","L40.0","L40.50","Z71.89"],"date":["2020-01-28","2022-10-25","2020-02-06","2020-02-06","2020-02-06","2021-11-18","2020-06-01","2020-06-01","2020-06-01","2020-06-01","2020-06-01","2021-11-18","2022-02-01","2020-12-25","2020-12-25","2021-11-18","2021-11-18","2021-11-18","2021-11-18","2021-12-17","2021-11-18","2021-11-18","2021-12-02","2021-12-06","2021-12-06","2021-12-15","2022-07-07","2021-12-17","2021-12-17","2021-12-17","2021-12-17","2021-12-17","2022-07-07","2022-07-07","2022-10-25"],"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":[["","57894006003","STELARA","INJ 45MG\/0.5","0.5","Select","Select",""],["","33342033354","TRIAMCINOLON","OIN 0.001","454","Select","Select",""],["","66993087761","CALCIPOTRIEN","CRE 0.00005","120","Select","Select",""],["","70710123304","BETAMETH","CRE 0.0005","90","Select","Select",""],["","00781286810","OMEPRAZOLE","CAP 20MG","30","Select","Select",""],["","00172572880","FAMOTIDINE","TAB 20MG","60","Select","Select",""],["","00597008717","ATROVENT","AER 17MCG","12.9","Select","Select",""],["","50228017405","BUPROPION","TAB 100MG SR","60","Select","Select",""],["","70954002110","PRAZOSIN","CAP 5MG","30","Select","Select",""],["","67877025001","QUETIAPINE","TAB 100MG","30","Select","Select",""],["","58657015101","FOLIC","TAB 1MG","30","Select","Select",""],["","00093506110","HYDROXYZ","TAB 25MG","120","Select","Select",""],["","58406003204","ENBREL","INJ 50MG\/ML","8","Select","Select",""],["","51672125903","CLOBETASOL","OIN 0.0005","120","Select","Select",""],["","00168014630","HYDROCORT","OIN 0.025","56.7","Select","Select",""],["","00054001829","PREDNISONE","TAB 20MG","14","Select","Select",""],["","00002144527","TALTZ","INJ 80MG\/ML","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":""}]}]}