{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MENA SUTPHIN","gend":1,"add":"526 SWEENEY CIRCLE                                          ","city":"FOREST                        ","state":"VA","zip":"24551-1467","dob":"2004-04-14","age":"","mstatus":"","insh":4239584,"cliId":"","pno":4342293520,"cno":"","email":"","ename":"","eno":"","pphy":"COMBS, KIMBERLY H                                           ","ppno":4348467374,"pcpadd":"2019 Tate Springs Rd Ste A                                  ,                                                            ","pcpcity":"Lynchburg                     ","pcpstate":"VA","pcpzip":245011131,"pcpcounty":"","pcpid":"","pcpname":"PIEDMONT FAMILY PRACTICE","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"526 SWEENEY CIRCLE                                          ","add3":"","madd1":"526 SWEENEY CIRCLE                                          ","madd2":"                                                            ","madd3":"","mcity":"FOREST                        ","mstate":"VA","mzip":"24551-1467","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z01.411","Z00.129","F41.9","L70.9","R11.2","H92.02","Z30.41","J02.0","J02.9","Z11.59","F32.0","F41.1","G47.9","N39.0","J06.9","B34.9","R05","J40","H66.91","L72.3","R11.0","Z01.00","Z23","F41.8","R10.30","M54.50","S69.92XA","S60.032A","M79.645","R39.9","R11.10","N90.89","R10.9","Z87.440","N94.6","Z20.822","R05.8","J01.80"],"date":["2020-01-07","2021-06-16","2022-03-22","2020-03-03","2020-05-05","2020-05-22","2020-05-22","2020-08-09","2022-02-19","2020-08-09","2021-06-16","2022-04-25","2020-09-02","2022-07-25","2022-02-19","2021-04-24","2021-04-24","2021-06-08","2021-06-08","2021-06-16","2022-03-16","2021-06-16","2021-07-06","2022-01-10","2022-01-25","2022-01-25","2022-02-22","2022-02-23","2022-02-23","2022-05-26","2022-03-16","2022-04-16","2022-05-26","2022-07-25","2022-08-03","2022-10-18","2022-09-17","2022-10-18"],"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":[["","75826011510","PHENAZOPYRID","TAB 200MG","6","Select","Select",""],["","47781030301","NITROFURANTN","CAP 100MG","10","Select","Select",""],["","53489011905","DOXYCYCL","CAP 100MG","14","Select","Select",""],["","69097083412","SERTRALINE","TAB 50MG","30","Select","Select",""],["","68382003516","VENLAFAXINE","CAP 75MG ER","90","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","14","Select","Select",""],["","68462010530","ONDANSETRON","TAB 4MG","60","Select","Select",""],["","31722054201","INDOMETHACIN","CAP 25MG","30","Select","Select",""],["","00228202750","ALPRAZOLAM","TAB 0.25MG","90","Select","Select",""],["","49281042250","FLUZONE","INJ 2022-23","0.5","Select","Select",""],["","70710113908","FLUCONAZOLE","TAB 150MG","1","Select","Select",""],["","68180071160","CEFDINIR","CAP 300MG","20","Select","Select",""],["","00378064205","PREDNISONE","TAB 20MG","5","Select","Select",""],["","67877057305","BENZONATATE","CAP 100MG","21","Select","Select",""],["","00168020230","CLINDAMYCIN","GEL 0.01","30","Select","Select",""],["","00093317431","ALBUTEROL","FAT E","8.5","Select","Select",""],["","68180016013","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","68462030529","NORETHINDRON","TAB 0.35MG","28","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","20","Select","Select",""],["","00555904358","APRI","TAB ","28","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":""}]}]}