{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"NATHAN   P JEROW","gend":0,"add":"9814 MOHAWK DRIVE                                           ","city":"KING GEORGE                   ","state":"VA","zip":"22485-3636","dob":"2003-05-22","age":"","mstatus":"","insh":10049730,"cliId":"","pno":5409036131,"cno":5409036131,"email":"","ename":"","eno":"","pphy":"DEDWYLDER, ROSIER D                                         ","ppno":"","pcpadd":"5254 Potomac Dr","pcpcity":"King George                   ","pcpstate":"VA","pcpzip":224855832,"pcpcounty":"","pcpid":"P0149790","pcpname":"MARY WASHINGTON MEDICAL GROUP","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"CENTRAL","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"9814 MOHAWK DRIVE                                           ","madd2":"                                                            ","madd3":"","mcity":"KING GEORGE                   ","mstate":"VA","mzip":"22485-3636","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R05","F90.2","J45.909","J30.9","H50.07","H53.022","J06.9","Z20.828","H66.002","H10.023","J45.41","J02.9","R07.0","R50.9","R43.2","Z00.129","Z23","I73.89","Z03.818","I36.1","E78.00","R00.2","Z82.49","L55.1","Z00.01","Z01.89","Z13.220","Z13.1","Z13.29","Z71.89","Z13.31","E78.5","F90.8","J45.30","Z00.00","Z01.812","Z71.2","Z71.3","Z20.822","Z11.52","R19.7","Z76.0","Q67.6","Z83.49","Z82.79"],"date":["2019-01-04","2021-09-12","2019-05-08","2019-05-08","2021-10-27","2021-10-27","2021-09-02","2020-11-30","2019-09-13","2019-09-13","2019-09-13","2020-07-16","2020-07-17","2020-07-17","2020-07-17","2020-09-29","2020-09-29","2020-11-11","2020-11-30","2021-10-26","2021-10-22","2021-10-26","2021-02-25","2021-03-22","2021-07-12","2021-07-12","2021-07-12","2021-07-12","2021-07-12","2021-07-28","2021-07-12","2021-07-12","2021-07-09","2021-07-09","2021-07-12","2021-07-12","2021-07-28","2021-07-28","2021-09-02","2021-09-02","2021-09-02","2021-09-12","2021-10-26","2021-10-26","2021-10-26"],"priorHcc":["","","","",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":[["","00093317431","ALBUTEROL","E","8.5","Select","Select",""],["","00228212750","CLONIDINE","0.1MG","90","Select","Select",""],["","59417010710","VYVANSE","70MG","30","Select","Select",""],["","45802091987","CETIRIZINE","10MG","30","Select","Select",""],["","59779045870","CVS","10MG","90","Select","Select",""],["","00115169449","EPINEPHRINE","0.3MG","2","Select","Select",""],["","70377002711","ATORVASTATIN","10MG","30","Select","Select",""],["","70377002711","ATORVASTATIN ","TAB 10MG","30","Select","Select",""],["","00093317431","ALBUTEROL ","FAT E","8.5","Select","Select",""],["","00228212750","CLONIDINE ","TAB 0.1MG","90","Select","Select",""],["","59417010710","VYVANSE ","CAP 70MG","30","Select","Select",""],["","45802091987","CETIRIZINE ","TAB 10MG","30","Select","Select",""],["","59779045870","CVS ","TAB 10MG","90","Select","Select",""],["","00115169449","EPINEPHRINE ","INJ 0.3MG","2","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":""}]}]}