{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BETHANY   C SURRATT","gend":1,"add":"6074 WILLIAMSBURG ROAD                                      ","city":"LINVILLE                      ","state":"VA","zip":"22834-2232","dob":"2002-08-12","age":"","mstatus":"","insh":6887392,"cliId":"","pno":5407056024,"cno":5409086502,"email":"","ename":"","eno":"","pphy":"MORGAN, ALAN J                                              ","ppno":5405647300,"pcpadd":"1661 S Main St                                              ,                                                            ","pcpcity":"Harrisonburg                  ","pcpstate":"VA","pcpzip":228012728,"pcpcounty":"","pcpid":"","pcpname":"SRMH SOUTH MAIN HEALTH CENTER","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"6074 WILLIAMSBURG ROAD                                      ","add3":"","madd1":"6074 Williamsburg Rd                                        ","madd2":"                                                            ","madd3":"","mcity":"Linville                      ","mstate":"VA","mzip":"22834-2232","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z34.00","J11.1","N39.0","R31.9","O99.89","O21.9","R51","R68.89","O23.42","Z3A.19","Z36.89","Z3A.20","R30.0","Z13.0","Z13.1","N89.8","Z3A.36","O16.3","O48.0","Z37.0","Z3A.40","O99.824","O70.0","O66.0","O80","Z11.3","Z30.430","Z32.02","Z34.90","O99.345","F53.0","R63.5","R07.9","F41.9","F41.0","R55","R73.09","R53.83","M54.5","G89.29","R42","R06.02","E28.2","N92.6","Z30.431","Z11.52","Z11.59","B37.3","M25.512","S46.912A","S46.002A","J06.9","H66.003","T78.09XD","Z91.018","K30","Z28.21","Z71.9","E66.9","N76.0","B96.89","R53.82","Z30.432","R10.2","Z01.419","E66.01","Z68.41","H66.002","F41.8","R05.8","R09.81","Z00.00","G47.00"],"date":["2020-01-02","2020-01-08","2020-01-08","2020-01-08","2020-01-08","2020-01-08","2020-01-08","2021-02-05","2020-01-08","2020-01-08","2020-05-05","2020-01-14","2020-01-31","2020-03-11","2020-03-11","2021-11-11","2020-05-05","2020-06-02","2020-06-03","2020-06-03","2020-06-03","2020-06-03","2020-06-03","2020-06-03","2020-06-03","2020-08-10","2022-02-08","2022-11-06","2020-08-31","2020-11-05","2020-11-05","2021-03-09","2021-02-17","2022-11-15","2021-01-25","2021-02-05","2021-02-05","2021-02-05","2021-01-25","2021-01-25","2021-02-17","2021-02-17","2022-11-15","2021-03-09","2022-06-16","2021-03-09","2021-05-04","2021-08-30","2021-07-14","2021-07-14","2021-07-14","2021-07-26","2022-05-22","2021-08-10","2021-08-10","2021-08-10","2021-08-10","2021-08-10","2021-08-10","2021-08-30","2021-08-30","2021-11-11","2022-02-08","2022-06-16","2022-07-26","2022-11-15","2022-11-15","2022-11-06","2022-11-06","2022-11-06","2022-11-06","2022-11-15","2022-11-15"],"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":[["","16714029904","AMOXICILLIN","CAP 500MG","15","Select","Select",""],["","47469016068","MELATONIN","TAB 3MG","30","Select","Select",""],["","68645058259","METFORMIN","TAB 500MG","90","Select","Select",""],["","69238111501","BUSPIRONE","TAB 5MG","90","Select","Select",""],["","57237000511","FLUCONAZOLE","TAB 150MG","2","Select","Select",""],["","00406117003","NALTREXONE","TAB 50MG","30","Select","Select",""],["","67877054360","CEFDINIR","CAP 300MG","14","Select","Select",""],["","68180089173","ENSKYCE","TAB ","84","Select","Select",""],["","50111033402","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","00115169449","EPINEPHRINE","INJ 0.3MG","2","Select","Select",""],["","50228043605","NAPROXEN","TAB 500MG","30","Select","Select",""],["","69452015120","VITAMIN","CAP 50000UNT","8","Select","Select",""],["","00781808926","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","65162046550","IBUPROFEN","TAB 600MG","24","Select","Select",""],["","00904645780","DOK","CAP 100MG","60","Select","Select",""],["","59762444002","METHYLPRED","TAB 4MG","21","Select","Select",""],["","00406048410","APAP\/CODEINE","TAB 300-30MG","12","Select","Select",""],["","00185041060","BUPROPION","TAB 100MG SR","60","Select","Select",""],["","59365512801","PARAGARD","IUD T380A","1","Select","Select",""],["","65862037401","ESCITALOPRAM","TAB 10MG","30","Select","Select",""],["","00406012305","HYDROCO\/APAP","TAB 5-325MG","8","Select","Select",""],["","33342025866","OSELTAMIVIR","CAP 75MG","10","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","28","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":""}]}]}