{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KAYLA MILLS","gend":1,"add":"26 LAPIS DRIVE ","city":"FALMOUTH ","state":"VA","zip":"22406-9998","dob":"1995-07-14","age":"","mstatus":"","insh":11014316,"cliId":"7UY9XK4PM37","pno":5407602159,"cno":5407602159,"email":"","ename":"","eno":"","pphy":"HERNANDEZ, RAFAEL O  ","ppno":5403745200,"pcpadd":"120 Executive Center Pkwy","pcpcity":"Fredericksburg ","pcpstate":"VA","pcpzip":224013100,"pcpcounty":"","pcpid":"P0114164","pcpname":"RAPPAHANNOCK FAMILY PHYSICIANS","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"26 LAPIS DR","add3":"","madd1":"26 LAPIS DRIVE ","madd2":"C\/o Melissa Mills","madd3":"","mcity":"FREDERICKSBURG ","mstate":"VA","mzip":"22406-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["R56.9","F32.9","F29","F42.9","G24.01","N30.01","R10.30","R30.9","Z90.49","G40.009","N39.0","R31.9","R30.0","H51.8","F25.9","G40.909","Z97.3","F79","F33.9","G47.00","H52.13","F39","F41.9","Z68.23","R45.1","G25.71"],"date":["2021-11-02","2021-10-25","2021-11-16","2020-08-18","2021-11-16","2021-01-10","2021-01-10","2021-01-10","2021-01-10","2021-04-07","2021-02-09","2021-02-09","2021-02-09","2021-06-01","2021-06-01","2020-10-21","2020-10-21","2020-10-21","2021-11-16","2020-10-21","2020-10-21","2020-10-21","2020-10-21","2020-10-21","2021-10-25","2021-11-16"],"priorHcc":[null,"",null,"",null,"","","","","","","","","","","","","",null,"","","","","","",null]}},{"a":[]}]},{"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":{"indx":["","",""],"comment":["","",""],"sub":[]}},{"a":{"indx":["","",""],"comment":["","",""],"sub":[]}}]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","65162068784","LORAZEPAM","CON 2MG\/ML","","Select","Select",""],["","228212750","CLONIDINE","TAB 0.1MG","","Select","Select",""],["","121072104","FLUOXETINE","SOL 20MG\/5ML","","Select","Select",""],["","33342008507","OLANZAPINE","TAB 15MG ODT","","Select","Select",""],["","70370204001","INGREZZA","CAP 40MG","","Select","Select",""],["","121064616","AMANTADINE","SYP 50MG\/5ML","","Select","Select",""],["","74611413","DEPAKOTE SPR","CAP 125MG","","Select","Select",""],["","65862022801","LAMOTRIGINE","TAB 100MG","","Select","Select",""],["","47781030301","NITROFURANTN","CAP 100MG","","Select","Select",""],["","131541072","VIMPAT","SOL 10MG\/ML","","Select","Select",""],["","70461042010","FLUCLVX QUAD","INJ 2020-21","","Select","Select",""],["","131541072","VIMPAT ","SOL 10MG\/ML","300","Select","Select",""],["","121072104","FLUOXETINE ","SOL 20MG\/5ML","113","Select","Select",""],["","65162068784","LORAZEPAM ","CON 2MG\/ML","30","Select","Select",""],["","228212750","CLONIDINE ","TAB 0.1MG","270","Select","Select",""],["","33342008407","OLANZAPINE ","TAB 10MG ODT","90","Select","Select",""],["","70370204001","INGREZZA ","CAP 40MG","30","Select","Select",""],["","74611413","DEPAKOTE ","CAP 125MG","540","Select","Select",""],["","121064616","AMANTADINE ","SYP 50MG\/5ML","2,000.00","Select","Select",""],["","65862022801","LAMOTRIGINE ","TAB 100MG","180","Select","Select",""],["","47781030301","NITROFURANTN ","CAP 100MG","14","Select","Select",""],["","70461042010","FLUCLVX ","2020-21","0.5","Select","Select",""],["","00074611413","DEPAKOTE","125MG","540","Select","Select",""],["","70461042010","FLUCLVX","2020-21","0.5","Select","Select",""]]}},{"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":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[[["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""]]]},{"t":"Mini-Cog","q":[{"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":""}]}]}