{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BRITTANY   L ANDERSON","gend":1,"add":"1007   HALL STREET                                          ","city":"STAUNTON                      ","state":"VA","zip":"24401-4712","dob":"1984-11-22","age":"","mstatus":"","insh":4495585,"cliId":"","pno":5405602371,"cno":"","email":"","ename":"","eno":"","pphy":"MARIA A HERNANDEZ MD LLC                                    ","ppno":5404426144,"pcpadd":"129 University Blvd Ste E                                   ,                                                            ","pcpcity":"Harrisonburg                  ","pcpstate":"VA","pcpzip":228013751,"pcpcounty":"","pcpid":"","pcpname":"MARIA A HERNANDEZ MD","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"1007   HALL STREET                                          ","add3":"","madd1":"1007   HALL STREET                                          ","madd2":"                                                            ","madd3":"","mcity":"STAUNTON                      ","mstate":"VA","mzip":"24401-4712","pcpfaxno":"                    ","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I10","K21.0","G43.909","F41.9","F31.81","E55.9","F41.1","M51.37","N39.41","R60.0","Z23","J06.9","F33.9","H93.13","R21","R53.83","R10.30","R06.83","D72.829","R06.81","G25.81","R35.1","G47.19","G47.33","E66.9","Z68.44","F32.9","K21.9","U07.1","Z68.42","R03.0","F41.8","N39.3","M54.50","Z11.59","Z60.9","Z11.4","E66.01","R73.03","J30.9","N39.46","R82.998"],"date":["2022-11-14","2020-06-19","2022-11-14","2021-02-26","2021-02-26","2021-02-26","2021-02-26","2021-02-26","2021-02-26","2022-11-14","2021-02-26","2020-03-03","2020-04-28","2020-05-07","2020-05-07","2022-11-14","2021-02-26","2020-09-18","2020-06-19","2020-09-18","2020-09-18","2020-09-18","2020-08-19","2022-12-02","2020-09-18","2022-11-14","2020-09-18","2022-11-14","2022-01-12","2022-01-12","2022-01-12","2022-11-14","2022-11-14","2022-11-14","2022-10-21","2022-10-06","2022-10-21","2022-10-21","2022-11-14","2022-11-14","2022-11-21","2022-11-21"],"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":[["","00054429731","FUROSEMIDE","TAB 20MG","30","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","70954000520","OXYBUTYNIN","TAB 5MG","60","Select","Select",""],["","62332003960","LAMOTRIGINE","TAB 150MG","30","Select","Select",""],["","65862014736","SUMATRIPTAN","TAB 50MG","10","Select","Select",""],["","68645055554","LISINOPRIL","TAB 40MG","30","Select","Select",""],["","00115166001","PROPRANOLOL","TAB 20MG","60","Select","Select",""],["","60505006501","OMEPRAZOLE","CAP 20MG","30","Select","Select",""],["","16729018317","HYDROCHLOROT","TAB 25MG","30","Select","Select",""],["","68382009810","PAROXETINE","TAB 20MG","60","Select","Select",""],["","43598081115","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","00832105415","BACLOFEN","TAB 10MG","90","Select","Select",""],["","13668033005","TRAZODONE","TAB 50MG","60","Select","Select",""],["","49035045875","ALLERGY","TAB 10MG","90","Select","Select",""],["","11917017183","VITAMIN","CAP 5000UNIT","30","Select","Select",""],["","65862086001","FAMOTIDINE","TAB 40MG","30","Select","Select",""],["","59267100001","PFIZER","INJ COVID-19","0.3","Select","Select",""],["","45802006435","TRIAMCINOLON","CRE 0.001","15","Select","Select",""],["","64380080307","RANITIDINE","TAB 150MG","30","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":""}]}]}