{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DEVAN   L HANCOCK","gend":0,"add":"PO BOX 1563","city":"WYTHEVILLE                    ","state":"VA","zip":"24382-8563","dob":"2003-07-16","age":"","mstatus":"","insh":4494677,"cliId":"","pno":2766991355,"cno":"","email":"","ename":"","eno":"","pphy":"GRIFFIN, SUSAN R","ppno":2762286499,"pcpadd":"1785 W Lee Hwy,","pcpcity":"Wytheville                    ","pcpstate":"VA","pcpzip":243821437,"pcpcounty":"","pcpid":"","pcpname":"FOREST FAMILY CARE","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"PO BOX 1563","add3":"","madd1":"PO BOX 1563","madd2":"","madd3":"","mcity":"WYTHEVILLE                    ","mstate":"VA","mzip":"24382-8563","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M94.0","R07.9","R07.89","L03.90","F32.3","F33.2","F12.10","F13.10","R45.851","F19.10","F17.210","F39","F12.20","G47.00","F42.9","F32.9","Z79.899","F41.9","I45.2","F91.3","Z00.129","L70.0","B36.0","Z23","F34.1","Z71.6","L02.91","M22.2X1","S16.1XXA","M54.2","M54.6","V89.2XXA","S29.012A","V49.49XA","R10.9","R11.0","S22.070A","M54.5","R55","R63.1","S06.0X0A","R10.13","M54.9","F55.8","K02.9","M20.12","M79.672","S83.92XA","M25.562","X58.XXXA","Y93.67","F17.290","S89.92XA","S20.213A","W50.0XXA","S20.219A","R06.02","Y93.75","Z11.4","Z11.59","Z76.89","Z00.00"],"date":["2020-07-12","2021-02-10","2021-09-28","2020-02-19","2021-05-18","2020-06-30","2020-07-02","2020-06-30","2020-07-02","2020-06-30","2021-02-04","2020-07-08","2020-07-15","2020-07-02","2020-07-07","2021-07-23","2020-07-12","2021-07-23","2020-07-12","2021-07-02","2020-07-31","2020-07-31","2020-07-31","2020-07-31","2020-07-31","2020-07-31","2020-12-02","2021-01-12","2021-02-04","2021-02-04","2021-02-10","2021-02-10","2021-02-04","2021-02-04","2021-02-10","2021-02-10","2021-02-12","2021-02-12","2021-08-03","2021-02-27","2021-02-27","2021-02-27","2021-02-27","2021-03-31","2021-03-31","2021-07-22","2021-07-22","2021-07-26","2021-07-23","2021-07-23","2021-07-23","2021-07-23","2021-07-23","2021-09-28","2021-09-28","2021-09-28","2021-09-28","2021-09-28","2021-10-22","2021-10-22","2021-10-22","2021-10-21"],"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":[["","61314064610","NEO\/POLY\/HC","SOL 1% OTIC","10","Select","Select",""],["","50111056002","TRAZODONE","TAB 50MG","15","Select","Select",""],["","00172572960","FAMOTIDINE","TAB 40MG","30","Select","Select",""],["","69315090510","LORAZEPAM","TAB 1MG","1","Select","Select",""],["","16714029904","AMOXICILLIN","CAP 500MG","30","Select","Select",""],["","68462019005","NAPROXEN","TAB 500MG","30","Select","Select",""],["","65862039110","ONDANSETRON","TAB 8MG ODT","9","Select","Select",""],["","00406012401","HYDROCO\/APAP","TAB 7.5-325","12","Select","Select",""],["","00591569550","MINOCYCLINE","CAP 100MG","30","Select","Select",""],["","60432052804","SELENIUM","LOT 0.025","118","Select","Select",""],["","65862037405","ESCITALOPRAM","TAB 10MG","30","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","20","Select","Select",""],["","45802011222","MUPIROCIN","OIN 0.02","22","Select","Select",""],["","00093314705","CEPHALEXIN","CAP 500MG","21","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":""}]}]}