{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"GAIL   M VANCE","gend":1,"add":"218 ORCHARD CT                                              ","city":"BERRYVILLE                    ","state":"VA","zip":"22611-1174","dob":"1968-04-13","age":"","mstatus":"","insh":10046083,"cliId":"","pno":5403036761,"cno":5403036761,"email":"","ename":"","eno":"","pphy":"LUONG, LINDA L                                              ","ppno":"","pcpadd":"440 W Jubal Early Dr,Ste 104","pcpcity":"WINCHESTER                    ","pcpstate":"VA","pcpzip":226016319,"pcpcounty":"","pcpid":"P9058922","pcpname":"ORCHARD FAMILY MEDICINE","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"NORTHERN\/ WINCHESTER","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"218 ORCHARD CT                                              ","madd2":"                                                            ","madd3":"","mcity":"BERRYVILLE                    ","mstate":"VA","mzip":"22611-1174","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N12","I10","N39.0","Z85.3","C50.911","Z17.0","D64.9","D51.9","C50.411","Z08","Z12.31","N63.20","N63.21","Z90.11","Z23","L82.1","L81.4","D22.62","D22.61","D22.5","C44.309","L57.0","R09.81","R42","R31.29","R11.0"],"date":["2019-01-28","2021-09-20","2021-02-19","2021-09-20","2020-04-23","2020-04-23","2020-03-21","2021-09-20","2019-12-13","2019-12-13","2019-12-13","2020-02-10","2020-02-10","2020-02-10","2020-09-21","2020-10-16","2020-10-16","2020-10-16","2020-10-16","2020-10-16","2020-10-16","2020-10-16","2021-02-19","2021-02-19","2021-02-19","2021-02-19"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","",""]}},{"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":[]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","45963067611","METOPROLOL","50MG ER","30","Select","Select",""],["","68180098103","LISINOPRIL","20MG","30","Select","Select",""],["","31604001290","VITAMIN","500MCG","30","Select","Select",""],["","00093753656","ANASTROZOLE","1MG","90","Select","Select",""],["","68382056501","METOPROL","50MG ER","30","Select","Select",""],["","11917013972","B-12","500MCG","30","Select","Select",""],["","68180052002","LISINOP\/HCTZ","20-25MG","30","Select","Select",""],["","65862001705","AMOXICILLIN","500MG","21","Select","Select",""],["","64380080807","IBUPROFEN","600MG","40","Select","Select",""],["","00406012305","HYDROCO\/APAP","5-325MG","12","Select","Select",""],["","00116200116","CHLORHEX","0.12%","473","Select","Select",""],["","65862017760","CEFDINIR","300MG","20","Select","Select",""],["","57237007710","ONDANSETRON","4MG ODT","20","Select","Select",""],["","45963067611","METOPROLOL ","TAB 50MG ER","30","Select","Select",""],["","68180098103","LISINOPRIL ","TAB 20MG","30","Select","Select",""],["","31604001290","VITAMIN ","TAB 500MCG","30","Select","Select",""],["","00093753656","ANASTROZOLE ","TAB 1MG","90","Select","Select",""],["","68382056501","METOPROL ","TAB 50MG ER","30","Select","Select",""],["","11917013972","B-12 ","TAB 500MCG","30","Select","Select",""],["","68180052002","LISINOP\/HCTZ ","TAB 20-25MG","30","Select","Select",""],["","65862001705","AMOXICILLIN ","CAP 500MG","21","Select","Select",""],["","64380080807","IBUPROFEN ","TAB 600MG","40","Select","Select",""],["","00406012305","HYDROCO\/APAP ","TAB 5-325MG","12","Select","Select",""],["","00116200116","CHLORHEX ","SOL 0.0012","473","Select","Select",""],["","65862017760","CEFDINIR ","CAP 300MG","20","Select","Select",""],["","57237007710","ONDANSETRON ","TAB 4MG ODT","20","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","",""],["N\/A","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","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":""}]}]}