{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TAMMY   M THOMAS","gend":1,"add":"9532   LAWYERS ROAD                                         ","city":"SPOTSYLVANIA                  ","state":"VA","zip":"22551-5506","dob":"1988-07-04","age":"","mstatus":"","insh":10049010,"cliId":"","pno":5402876406,"cno":5402876406,"email":"","ename":"","eno":"","pphy":"COOLEY, AMY A                                               ","ppno":"","pcpadd":"13198 James Madison Hwy","pcpcity":"Orange                        ","pcpstate":"VA","pcpzip":229602808,"pcpcounty":"","pcpid":"P9307431","pcpname":"ORANGE FAMILY PHYSICIANS","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"CENTRAL","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"9532   LAWYERS ROAD                                         ","madd2":"                                                            ","madd3":"","mcity":"SPOTSYLVANIA                  ","mstate":"VA","mzip":"22551-5506","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M79.89","R73.01","R60.0","Z68.41","K29.70","R10.812","N30.00","E86.0","R10.9","F32.9","F41.9","J45.909","Z87.891","Z88.5","Z88.0","Z88.8","Z91.041","R68.89","N88.8","R10.2","N93.9","N92.0","N94.6","R05","R11.2","Z79.899","R91.8","F33.1","H10.423","H52.13","H52.223","G44.40","Z30.40","R11.0","T38.4X5A","N92.1","Z90.710","Z30.8","R00.2","R07.89","I49.3","J02.9","M54.5","N76.0","T19.2XXA","R39.15","N39.41","N39.3","N39.46","G43.109","J45.20","K21.9","M79.18","R07.9","F41.1","N92.6","N97.1","Z31.83","Z98.51","Z88.6","Z98.891","L30.4","K59.04","K59.00","R14.0","K76.0","K80.20","R74.8","Z01.419","G43.009","E66.01","Z01.812","Z20.822","R10.84","Z11.59","R06.01"],"date":["2019-01-25","2019-01-25","2021-08-31","2021-09-28","2019-02-06","2019-02-06","2019-02-06","2019-02-06","2019-02-06","2019-04-10","2019-02-06","2019-02-06","2019-02-10","2019-02-06","2020-08-24","2020-08-24","2020-08-24","2020-08-24","2019-02-10","2019-02-10","2019-02-10","2019-02-10","2019-02-10","2019-02-10","2021-09-28","2019-02-10","2019-02-10","2019-02-12","2019-02-22","2019-02-22","2019-02-22","2019-04-17","2019-04-17","2019-04-17","2019-04-17","2019-04-17","2019-04-17","2019-04-17","2019-06-20","2020-08-19","2019-08-12","2019-07-08","2020-10-20","2021-01-28","2019-11-15","2019-11-15","2021-03-11","2021-03-11","2021-03-11","2020-06-19","2021-08-31","2021-08-31","2020-06-19","2020-08-19","2020-08-19","2020-08-24","2020-08-24","2020-08-24","2020-08-24","2020-08-24","2020-08-24","2021-01-08","2021-06-28","2021-06-28","2021-06-28","2021-07-08","2021-09-28","2021-07-08","2021-08-31","2021-08-31","2021-09-28","2021-09-28","2021-09-28","2021-09-28","2021-11-10","2021-11-15"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",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":[["","69097012303","TOPIRAMATE","50MG","60","Select","Select",""],["","59651000305","OMEPRAZOLE","40MG","30","Select","Select",""],["","70710113908","FLUCONAZOLE","150MG","2","Select","Select",""],["","68462018135","CLOTRIMAZOLE","1%","30","Select","Select",""],["","68382025601","OXYBUTYNIN","10MG ER","30","Select","Select",""],["","65862085901","FAMOTIDINE","20MG","90","Select","Select",""],["","66993001968","ALBUTEROL","HFA","18","Select","Select",""],["","00591565810","CYCLOBENZAPR","10MG","30","Select","Select",""],["","16729018201","HYDROCHLOROT","12.5MG","30","Select","Select",""],["","69097012303","TOPIRAMATE ","TAB 50MG","60","Select","Select",""],["","65862085901","FAMOTIDINE ","TAB 20MG","90","Select","Select",""],["","59651000305","OMEPRAZOLE ","CAP 40MG","30","Select","Select",""],["","70710113908","FLUCONAZOLE ","TAB 150MG","2","Select","Select",""],["","68462018135","CLOTRIMAZOLE ","CRE 0.01","30","Select","Select",""],["","68382025601","OXYBUTYNIN ","TAB 10MG ER","30","Select","Select",""],["","66993001968","ALBUTEROL ","AER HFA","18","Select","Select",""],["","00591565810","CYCLOBENZAPR ","TAB 10MG","30","Select","Select",""],["","16729018201","HYDROCHLOROT ","TAB 12.5MG","30","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":""}]}]}