{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"YOLANDA HERRERA FERNANDEZ","gend":1,"add":"106 SLIPPERY ELM  DRIVE                                     ","city":"STEPHENS CITY                 ","state":"VA","zip":"22655-3400","dob":"1996-10-12","age":"","mstatus":"","insh":5005105,"cliId":"","pno":5408777387,"cno":"","email":"","ename":"","eno":"","pphy":"MIDDELHOF, CHARLES A                                        ","ppno":5408682511,"pcpadd":"640 Warrior Dr Ste 109                                      ,                                                            ","pcpcity":"Stephens City                 ","pcpstate":"VA","pcpzip":226554076,"pcpcounty":"","pcpid":"","pcpname":"VALLEY FAMILY AND PROCEDURAL MEDICINE","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"NORTHERN\/ WINCHESTER","aligned":"","ano":"","add2":"106 SLIPPERY ELM  DRIVE                                     ","add3":"","madd1":"106 SLIPPERY ELM  DRIVE                                     ","madd2":"                                                            ","madd3":"","mcity":"STEPHENS CITY                 ","mstate":"VA","mzip":"22655-3400","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["O99.212","Z3A.17","Z34.90","O99.352","O44.42","Z36.86","Z3A.21","Z82.79","E66.09","O09.92","Z36.9","Z3A.25","Z3A.26","O09.93","Z3A.28","O99.213","Z23","Z3A.30","O99.013","O99.810","O13.3","Z3A.31","Z3A.32","O24.419","O24.410","Z3A.34","Z3A.35","Z3A.36","O24.414","Z3A.37","O24.415","O36.63X0","Z3A.38","Z79.84","O24.425","D62","Z37.0","O99.02","Z83.3","Z79.899","E66.01","O99.214","Z86.59","O65.9","Z3A.39","O62.0","O41.1230","L76.82","G89.18","M54.9","M79.609","U07.1","R09.02","J16.8","R07.9","J18.9","Z20.828","O98.53","J12.89","J96.01","Z68.43","O99.53","G43.909","O99.215","Z82.49","Z80.9","Z88.0","Z88.2","R06.02","Z39.2","Z30.09","Z30.430","Z98.891","Z86.32","O92.79","G56.03","N89.8","Z97.5","Z71.3","M79.641","M79.642","G56.01","Z01.818","Z20.822","L60.0","N76.0","B96.89","R39.9","R11.10","L03.032","M71.572","K52.9","H66.92","H60.392","H92.02","H60.311","H92.01","R22.0","R51.9","Z01.419","Z12.4","Z30.431","B37.31","N92.6"],"date":["2020-07-31","2020-05-27","2020-10-09","2020-06-23","2020-07-22","2020-06-23","2020-06-26","2020-06-23","2020-10-23","2020-08-14","2020-08-14","2020-07-22","2020-08-14","2020-10-19","2020-08-14","2020-10-23","2020-09-25","2020-08-28","2020-08-28","2020-09-02","2020-09-04","2020-09-04","2020-09-11","2020-10-01","2020-10-09","2020-09-25","2020-10-01","2020-10-09","2020-10-09","2020-10-16","2020-10-26","2020-10-25","2020-10-27","2020-10-25","2020-10-27","2020-10-25","2020-10-27","2020-10-25","2020-11-22","2020-10-25","2020-11-23","2020-10-25","2020-10-25","2020-10-25","2020-10-28","2020-10-27","2020-10-28","2021-03-15","2020-11-18","2020-11-18","2020-11-18","2020-11-22","2020-11-21","2020-11-21","2020-11-21","2020-11-23","2020-11-23","2020-11-22","2020-11-22","2020-11-22","2020-11-22","2020-11-22","2020-11-22","2020-11-22","2020-11-22","2020-11-22","2020-11-22","2020-11-22","2020-11-22","2020-12-10","2020-12-10","2020-12-10","2020-12-10","2020-12-15","2020-12-22","2021-02-26","2021-09-09","2021-03-15","2021-09-09","2021-03-30","2021-03-30","2021-04-22","2021-04-19","2021-12-15","2021-05-10","2021-09-09","2021-09-09","2022-10-19","2021-12-15","2022-01-18","2022-02-01","2022-06-30","2022-07-15","2022-07-16","2022-07-16","2022-08-27","2022-08-31","2022-08-27","2022-08-31","2022-10-19","2022-10-19","2022-10-19","2022-10-19","2022-10-19"],"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":[["","55111015330","ONDANSETRON","TAB 4MG","20","Select","Select",""],["","55111014512","FLUCONAZOLE","TAB 150MG","1","Select","Select",""],["","68180071160","CEFDINIR","CAP 300MG","20","Select","Select",""],["","69315030805","CIPROFLOXACN","SOL 0.3% OP","5","Select","Select",""],["","43598032675","CIPRO\/DEXA","SUS 0.3-0.1%","7.5","Select","Select",""],["","65862044930","VALACYCLOVIR","TAB 1GM","21","Select","Select",""],["","16571020150","DICLOFENAC","TAB 75MG DR","20","Select","Select",""],["","50111033402","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","67877021905","CEPHALEXIN","CAP 500MG","30","Select","Select",""],["","31722094101","HYDROCO\/APAP","TAB 5-325MG","30","Select","Select",""],["","00054418625","DEXAMETHASON","TAB 6MG","7","Select","Select",""],["","68180096301","ALBUTEROL","AER HFA","8.5","Select","Select",""],["","99073013001","FREESTYLE    MIS LANCETS","MIS LANCETS","100","Select","Select",""],["","68645056354","IBUPROFEN","TAB 800MG","50","Select","Select",""],["","42858010201","OXYCOD\/APAP","TAB 5-325MG","40","Select","Select",""],["","99073070827","FREESTYLE    TES LITE","TES LITE","100","Select","Select",""],["","99073070805","FREESTYLE    MIS LITE","MIS LITE","1","Select","Select",""],["","68645058259","METFORMIN","TAB 500MG","60","Select","Select",""],["","50111078710","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","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":""}]}]}