{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MAURICE   A BRITT","gend":0,"add":"209 BANK STREET","city":"FRANKLIN","state":"VA","zip":"23851-2203","dob":"1976-06-29","age":"","mstatus":"","insh":4300693,"cliId":"","pno":7573758672,"cno":7575693812,"email":"","ename":"","eno":"","pphy":"PONDER, JAMES MICHAEL","ppno":7576532007,"pcpadd":"102 Fairview Dr, Ste B","pcpcity":"Franklin","pcpstate":"VA","pcpzip":238511206,"pcpcounty":"","pcpid":"","pcpname":"SOUTHAMPTON FAMILY PRACTICE","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"209 BANK STREET","madd2":"","madd3":"","mcity":"FRANKLIN","mstate":"VA","mzip":"23851-2203","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F33.1","R06.02","R00.2","R07.89","D72.829","I10","F32.9","F41.9","F43.10","F17.210","Z79.899","F12.90","F14.90","R07.9","F14.10","F41.8","F19.90","R06.00","R42","Z72.0","R00.1","I25.9","K21.9","J30.9","L30.9","N52.9","Z75.8","K52.9","R10.10","R13.10","R10.9","J06.9","R50.9","R05","Z20.828","F14.19","F60.2","R19.7","F31.32","J30.89","E78.41","M25.561","M25.562","G89.29","F19.10","Z00.00","M25.572","M79.89","S93.402A","M79.646","X50.1XXA","Z87.891","W19.XXXA","Z20.822","F17.200","Z82.49","Z83.3","Z79.51","E87.6","J41.0","R05.9","J34.89","E55.9","Z12.5","Z68.28","N20.0","I88.0","R10.11","R11.2","R51.9","M54.59","Z87.09","Z86.19","Z71.3","F43.12","F12.288","R35.1","Z23","R74.8","J40","E87.0","R51","M79.645","M79.643","M79.644","S76.012A","G89.11","M25.552","V49.49XA","F31.9","S79.912A","M16.0","J45.909","M54.5","R30.0","Z11.3","Z11.4","A60.9","N48.9"],"date":["2020-07-14","2022-03-25","2021-10-26","2021-10-26","2021-10-18","2021-12-15","2020-01-21","2020-01-25","2020-01-21","2021-12-15","2021-08-10","2020-01-21","2020-01-21","2022-03-25","2021-10-26","2020-01-22","2020-01-22","2020-01-25","2020-01-25","2020-01-25","2020-01-28","2020-02-06","2021-12-15","2020-02-10","2020-02-10","2020-02-10","2020-02-10","2020-02-17","2020-02-17","2020-04-23","2020-02-17","2021-10-12","2020-04-19","2020-04-19","2021-08-26","2022-04-01","2022-03-11","2022-03-25","2021-03-08","2021-06-24","2021-03-08","2021-07-02","2021-07-02","2021-12-15","2021-06-29","2021-06-29","2021-08-04","2021-08-04","2021-08-04","2021-08-04","2021-08-04","2021-08-04","2021-08-04","2021-08-10","2021-08-10","2021-08-10","2021-08-10","2021-08-10","2022-03-25","2021-10-12","2021-10-12","2021-10-12","2021-10-18","2021-10-18","2021-10-18","2021-12-15","2021-12-15","2021-12-15","2021-12-15","2021-12-15","2021-12-15","2021-12-15","2021-12-15","2021-12-15","2019-11-21","2019-01-07","2019-01-08","2019-01-08","2019-01-14","2019-02-04","2019-02-20","2019-03-06","2019-02-20","2019-02-20","2019-02-20","2019-04-02","2019-03-19","2019-03-20","2019-03-19","2019-09-24","2019-03-20","2019-03-20","2019-04-02","2019-06-28","2019-09-18","2019-09-18","2019-09-18","2019-10-08","2019-10-08"],"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":{"indx":[false,false],"comment":["",""],"score":["",""]}},{"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":[["","55111015930","OMEPRAZOLE","CAP 40MG","30","Select","Select",""],["","29300022019","MONTELUKAST","TAB 10MG","30","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","45802006335","TRIAMCINOLON","CRE 0.00025","15","Select","Select",""],["","16714079904","CETIRIZINE","TAB 10MG","90","Select","Select",""],["","65862044830","VALACYCLOVIR","TAB 500MG","30","Select","Select",""],["","69543038810","KETOROLAC","TAB 10MG","15","Select","Select",""],["","68645051554","AMLODIPINE","TAB 5MG","90","Select","Select",""],["","13668021730","ARIPIPRAZOLE","TAB 5MG","30","Select","Select",""],["","50111078751","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","67877031901","IBUPROFEN","TAB 400MG","20","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","Select","Select",""],["","50111033402","METRONIDAZOL","TAB 500MG","30","Select","Select",""],["","68462015713","ONDANSETRON","TAB 4MG ODT","14","Select","Select",""],["","68645014059","FAMOTIDINE","TAB 20MG","10","Select","Select",""],["","13668010401","ISOSORB","TAB 30MG ER","30","Select","Select",""],["","00406048410","APAP\/CODEINE","TAB 300-30MG","10","Select","Select",""],["","42806054701","VITAMIN","CAP 1.25MG","4","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","69315090401","LORAZEPAM","TAB 0.5MG","10","Select","Select",""],["","59267100001","PFIZER","INJ COVID-19","0.3","Select","Select",""],["","16714048203","LORATADINE","TAB 10MG","30","Select","Select",""],["","59310057922","PROAIR","AER ","8.5","Select","Select",""],["","69452014430","BENZONATATE","CAP 200MG","15","Select","Select",""],["","68645052154","SERTRALINE","TAB 25MG","14","Select","Select",""],["","00067611730","ALLERGY","TAB 10MG","30","Select","Select",""],["","65162019011","NAPROXEN","TAB 500MG","30","Select","Select",""],["","68645051890","CYCLOBENZAPR","TAB 10MG","15","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":""}]}]}