{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"AMANDA D BLANKENSHIP","gend":1,"add":"PO BOX 342 ","city":"CRAIGSVILLE ","state":"VA","zip":"24430-0342","dob":"1981-09-30","age":"","mstatus":"","insh":6861120,"cliId":"","pno":5408367729,"cno":"","email":"","ename":"","eno":"","pphy":"LEE, DONALD W ","ppno":5409498241,"pcpadd":"428 S Magnolia Ave Ste 1 , ","pcpcity":"Waynesboro ","pcpstate":"VA","pcpzip":229803629,"pcpcounty":"","pcpid":"","pcpname":"CFM ASSOCIATED PHYSICIANS WAYNESBORO","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"PO BOX 342 ","add3":"","madd1":"PO BOX 342 ","madd2":" ","madd3":"","mcity":"CRAIGSVILLE ","mstate":"VA","mzip":"24430-0342","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M99.01","M54.2","M99.02","M54.6","M99.03","M51.37","K50.813","Z92.25","R51","M54.5","J44.9","G89.29","F32.9","Z72.0","Z88.2","Z88.8","Z01.419","B37.3","Z85.41","Z11.51","Z11.8","Z11.3","K50.019","R07.89","R06.02","R07.9","K50.90","E66.3","Z79.899","Z97.5","Z88.0","N76.0","A59.09","R35.0","K50.919","K58.0","E66.9","Z23","Z86.39","K61.1","F41.9","G47.00","E53.8","E55.9","E61.1","R63.5","F51.01","R19.7","E66.01","D64.9","K43.9","Z90.49","Z68.41","K91.2","M72.2","Z01.411","M54.9","K50.80","T83.32XD","Z30.431","R51.9","M79.672","M79.671","G43.909","K08.89","J45.909","F17.210","R11.0","Z88.1","K04.7","G43.901","H53.8","F32.A","R10.13","S39.011A","R10.84","R10.10","X50.0XXA","Y93.9","Y99.0","Z87.19","Z71.6","R94.31","Z20.822","I25.110","Z79.82","Z79.52","R77.8","Z83.3","I25.9","I10","I51.4","I21.4","I25.10","R74.8","I20.0","E87.6","K58.2","Z79.60","F17.200"],"date":["2022-03-21","2022-03-21","2022-03-21","2021-06-02","2022-03-21","2022-03-21","2020-05-11","2021-09-08","2020-09-23","2020-02-13","2022-08-22","2022-02-16","2022-01-27","2022-11-21","2022-10-21","2022-10-21","2020-03-02","2020-03-02","2020-03-02","2020-03-02","2020-03-02","2020-03-02","2022-11-07","2020-06-08","2020-06-08","2022-10-21","2022-10-22","2020-06-08","2022-09-24","2022-01-27","2020-06-08","2020-06-17","2020-06-17","2020-06-17","2022-11-21","2022-05-26","2021-05-10","2021-11-01","2020-09-23","2020-09-23","2022-02-16","2022-02-16","2022-11-21","2022-02-16","2021-05-10","2020-11-19","2020-11-19","2020-12-29","2022-10-20","2021-05-10","2021-05-10","2022-08-22","2022-10-20","2021-05-10","2021-11-07","2021-07-26","2022-08-22","2021-09-08","2021-09-08","2021-09-27","2022-07-21","2021-11-07","2021-11-07","2022-01-27","2022-01-27","2022-01-27","2022-10-22","2022-01-27","2022-01-27","2022-01-27","2022-07-21","2022-07-21","2022-08-22","2022-08-10","2022-08-10","2022-08-10","2022-08-10","2022-08-10","2022-08-10","2022-08-10","2022-08-10","2022-08-10","2022-08-22","2022-10-21","2022-10-21","2022-10-21","2022-10-21","2022-10-21","2022-10-21","2022-10-20","2022-10-20","2022-10-20","2022-10-21","2022-11-22","2022-10-21","2022-10-22","2022-10-20","2022-11-21","2022-11-21","2022-11-22"],"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":[["","60219107601","AZATHIOPRINE","TAB 50MG","270","Select","Select",""],["","42806054701","VITAMIN","CAP 1.25MG","4","Select","Select",""],["","00186077760","BRILINTA","TAB 90MG","60","Select","Select",""],["","00093505898","ATORVASTATIN","TAB 40MG","30","Select","Select",""],["","68382056510","METOPROL","TAB 50MG ER","30","Select","Select",""],["","49035056314","ASPIRIN","TAB 81MG EC","30","Select","Select",""],["","00832059011","DIPHEN\/ATROP","TAB 2.5MG","90","Select","Select",""],["","69315012710","FOLIC","TAB 1000MCG","30","Select","Select",""],["","00904759080","FEROSUL","TAB 325MG","90","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":""}]}]}