{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JEANNIE   L JOHNSON","gend":1,"add":"205   CHURCH STREET                                         ","city":"FREDERICKSBURG                ","state":"VA","zip":"22408-2307","dob":"1990-10-27","age":"","mstatus":"","insh":10049582,"cliId":"","pno":5409073205,"cno":"","email":"","ename":"","eno":"","pphy":"ANDERSON, JOHN R                                            ","ppno":"","pcpadd":"12101 Carol Ln,Ste 130","pcpcity":"Fredericksburg                ","pcpstate":"VA","pcpzip":224076101,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"CENTRAL","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"205   CHURCH STREET                                         ","madd2":"                                                            ","madd3":"","mcity":"FREDERICKSBURG                ","mstate":"VA","mzip":"22408-2307","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J40","J32.9","H66.92","R05","Z77.22","J06.9","R07.9","R50.9","M54.2","S16.1XXA","V43.62XA","Y92.410","J45.909","V29.3XXA","Y92.89","Y93.89","S13.4XXA","N30.90","R10.31","R56.9","R93.5","R10.813","J01.90","R30.0","Z30.011","N30.00","R10.9","N83.202","Z87.440","R10.32","R10.12","N83.8","N20.0","J01.40","J02.9","N93.8","Z30.42","S90.562A","R21","W57.XXXA","J32.0","Z87.442","Z03.818","J01.00","Z20.828","Z01.419","Z20.2","Z11.51","N30.01","R39.198","F79","Z20.822","J01.41","Z11.52"],"date":["2020-01-20","2019-01-03","2019-01-04","2021-01-12","2021-06-17","2021-11-17","2020-01-20","2020-02-20","2019-04-26","2019-01-08","2019-01-08","2019-01-08","2021-09-08","2019-01-08","2020-07-10","2020-07-10","2019-01-18","2019-10-20","2019-10-20","2019-10-20","2019-10-20","2019-10-20","2019-10-31","2020-01-20","2019-12-10","2020-01-20","2021-06-17","2020-01-20","2021-06-17","2020-01-20","2020-01-20","2020-01-20","2021-06-17","2020-02-20","2021-11-17","2020-06-19","2021-10-15","2020-07-10","2020-07-10","2020-07-10","2020-11-18","2020-11-18","2021-09-16","2021-01-12","2021-01-12","2021-02-16","2021-02-16","2021-02-16","2021-06-17","2021-06-17","2021-06-17","2021-09-08","2021-11-17","2021-11-17"],"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":[]},{"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":[["","59762453701","MEDROXYPR","150MG\/ML","1","Select","Select",""],["","00378064110","PREDNISONE","10MG","10","Select","Select",""],["","50428661736","CVS","25MG","24","Select","Select",""],["","65862042005","SMZ\/TMP","800-160","10","Select","Select",""],["","65162019050","NAPROXEN","500MG","30","Select","Select",""],["","00093005805","TRAMADOL","50MG","12","Select","Select",""],["","49281072010","FLUBLOK","2020-21","0.5","Select","Select",""],["","65862001501","AMOXICILLIN","875MG","14","Select","Select",""],["","71930002643","BROM\/PSE\/DM","","120","Select","Select",""],["","65862050320","AMOX\/K","875-125","20","Select","Select",""],["","00555901658","SPRINTEC","28 DAY","28","Select","Select",""],["","47781030301","NITROFURANTN","100MG","10","Select","Select",""],["","67877057505","BENZONATATE","200MG","30","Select","Select",""],["","00093770198","LEVOCETIRIZI","5MG","20","Select","Select",""],["","65162089129","MOMETASONE","50MCG","51","Select","Select",""],["","59762453701","MEDROXYPR ","INJ 150MG\/ML","1","Select","Select",""],["","00378064110","PREDNISONE ","TAB 10MG","10","Select","Select",""],["","50428661736","CVS ","CAP 25MG","24","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","10","Select","Select",""],["","65162019050","NAPROXEN ","TAB 500MG","30","Select","Select",""],["","00093005805","TRAMADOL ","TAB 50MG","12","Select","Select",""],["","49281072010","FLUBLOK ","INJ 2020-21","0.5","Select","Select",""],["","65862001501","AMOXICILLIN ","TAB 875MG","14","Select","Select",""],["","71930002643","BROM\/PSE\/DM ","SYP ","120","Select","Select",""],["","65862050320","AMOX\/K ","TAB 875-125","20","Select","Select",""],["","00555901658","SPRINTEC ","TAB 28 DAY","28","Select","Select",""],["","47781030301","NITROFURANTN ","CAP 100MG","10","Select","Select",""],["","19515081852","FLULAVAL ","INJ 2021-22","0.5","Select","Select",""],["","67877057505","BENZONATATE ","CAP 200MG","30","Select","Select",""],["","00093770198","LEVOCETIRIZI ","TAB 5MG","20","Select","Select",""],["","65162089129","MOMETASONE ","SPR 50MCG","51","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","",""],["No","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":""}]}]}