{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BRITTANY   N NORTHAN","gend":1,"add":"26160   SAVAGEVILLE  ROAD                                   ","city":"ONANCOCK                      ","state":"VA","zip":"23417-3844","dob":"1988-10-28","age":"","mstatus":"","insh":10047541,"cliId":"","pno":7573877329,"cno":7573877329,"email":"","ename":"","eno":"","pphy":"BRADLEY, THOMAS                                             ","ppno":"","pcpadd":"20280 Market St","pcpcity":"Onancock                      ","pcpstate":"VA","pcpzip":234171331,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"TIDEWATER","aligned":"","ano":"","add2":"APARTMENT B                                                 ","add3":"","madd1":"26160   SAVAGEVILLE  ROAD                                   ","madd2":"APARTMENT B                                                 ","madd3":"","mcity":"ONANCOCK                      ","mstate":"VA","mzip":"23417-3844","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R68.89","Z11.3","I10","Z30.42","Z79.899","E01.0","I51.7","I51.89","E04.2","R53.83","Z68.41","E66.01","F32.0","Z12.4","S80.11XA","N64.4","Z80.3","R92.8","D24.2","L65.9","B35.0","Z71.3","J06.9","R51","J10.1","J30.89","Z98.890","R40.0","R06.83","Z20.828","R19.7","K21.9","E55.9","E78.00","Z01.419","L98.9","Z12.31","R35.1","L30.4","Z23","G47.10","J03.90","E66.9","R22.2","R93.89","G47.33","I11.9","Z30.09","R07.89","Z56.0","Z59.6","R07.9","Z92.29","Z99.89","R04.0","B35.4","G47.30","Z68.42","Z97.5"],"date":["2020-03-04","2019-09-10","2021-11-01","2021-07-15","2019-12-15","2019-04-23","2019-04-23","2019-04-23","2019-04-30","2020-08-12","2021-01-22","2021-11-01","2019-06-24","2019-09-10","2019-09-10","2019-10-10","2019-09-10","2019-10-17","2019-10-21","2019-12-04","2019-12-04","2021-11-01","2019-12-15","2020-05-20","2020-03-04","2020-05-20","2020-05-22","2020-08-12","2020-12-14","2020-08-17","2021-01-22","2020-10-29","2021-11-01","2020-10-29","2021-11-01","2020-12-07","2021-07-28","2020-10-29","2020-10-29","2021-05-19","2020-12-14","2020-11-25","2021-04-25","2020-12-11","2020-12-11","2021-06-23","2020-12-15","2021-04-19","2021-04-25","2021-04-25","2021-04-25","2021-04-27","2021-05-19","2021-06-23","2021-07-15","2021-08-21","2021-11-01","2021-11-01","2021-11-01"],"priorHcc":["","",null,"","","","","","","","",null,"","","","","","","","","",null,"","","","","","","","","","",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":[]},{"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":[["","57237002801","AMOXICILLIN","500MG","21","Select","Select",""],["","27808003502","HYDROCO\/APAP","5-325MG","10","Select","Select",""],["","51672128902","NYSTATIN","100000","30","Select","Select",""],["","69452015120","VITAMIN","50000UNT","12","Select","Select",""],["","53489014401","SPIRONO\/HCTZ","25\/25","30","Select","Select",""],["","68180072103","AMLODIPINE","10MG","30","Select","Select",""],["","43547035611","LISINOPRIL","40MG","30","Select","Select",""],["","68382056601","METOPROL","100MG ER","30","Select","Select",""],["","00054327099","FLUTICASONE","50MCG","16","Select","Select",""],["","52565002215","ECONAZOLE","1%","15","Select","Select",""],["","63304069301","CLINDAMYCIN","300MG","28","Select","Select",""],["","51224001050","BENZONATATE","100MG","15","Select","Select",""],["","57237002801","AMOXICILLIN ","TAB 500MG","21","Select","Select",""],["","27808003502","HYDROCO\/APAP ","TAB 5-325MG","10","Select","Select",""],["","51672128902","NYSTATIN ","CRE 100000","30","Select","Select",""],["","69452015120","VITAMIN ","CAP 50000UNT","4","Select","Select",""],["","68180072103","AMLODIPINE ","TAB 10MG","30","Select","Select",""],["","43547035611","LISINOPRIL ","TAB 40MG","30","Select","Select",""],["","53489014401","SPIRONO\/HCTZ ","TAB 25\/25","30","Select","Select",""],["","68382056601","METOPROL ","TAB 100MG ER","30","Select","Select",""],["","00054327099","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","52565002215","ECONAZOLE ","CRE 0.01","15","Select","Select",""],["","63304069301","CLINDAMYCIN ","CAP 300MG","28","Select","Select",""],["","51224001050","BENZONATATE ","CAP 100MG","15","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","",""],["No","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":""}]}]}