{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MARY   R PRICE","gend":1,"add":"205   BANBURY AVENUE                                        ","city":"S PRINCE GEORGE               ","state":"VA","zip":"23805-8754","dob":"1987-11-14","age":"","mstatus":"","insh":10050281,"cliId":"","pno":8045339692,"cno":8045339692,"email":"","ename":"","eno":"","pphy":"FLORIDA, AUDIE CAILING                                      ","ppno":"","pcpadd":"541 S Sycamore St","pcpcity":"Petersburg                    ","pcpstate":"VA","pcpzip":238035039,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"CENTRAL","aligned":"","ano":"","add2":"APT. # 283                                                  ","add3":"","madd1":"205   BANBURY AVENUE                                        ","madd2":"APT. # 283                                                  ","madd3":"","mcity":"S PRINCE GEORGE               ","mstate":"VA","mzip":"23805-8754","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M54.9","Z71.89","Z71.3","M54.5","R11.0","L02.412","Z11.3","Z75.2","R11.10","R11.2","L02.411","K13.0","Z20.2","R63.4","F32.9","Z82.49","Z87.891","R06.00","R07.9","R07.89","F17.200","R10.30","R19.7","Z90.710","Z90.49","S02.611A","R51","R68.84","Y04.0XXA","Z23","S09.93XA","Z01.419","L02.419","F41.0","F17.210","Z63.79","H92.01","H00.014","H00.015","S91.132A","S99.922A","W22.8XXA","Y93.01","S91.135A","L03.113","S50.361S","W57.XXXS","Y92.89","M79.602","V89.2XXA","S40.012A","M25.512","V43.52XA","Y92.410"],"date":["2019-02-21","2019-10-17","2019-10-17","2019-05-02","2019-04-21","2019-04-21","2019-04-30","2019-04-30","2019-12-15","2019-12-15","2019-08-02","2019-10-17","2019-10-17","2019-10-17","2019-10-17","2019-12-15","2021-07-29","2019-11-26","2021-02-20","2019-11-26","2021-09-14","2019-12-15","2019-12-15","2019-12-15","2019-12-15","2020-01-22","2020-01-22","2020-01-22","2020-01-22","2021-04-20","2020-07-22","2020-11-30","2021-01-19","2021-02-19","2021-02-19","2021-02-19","2021-03-03","2021-03-03","2021-03-03","2021-04-20","2021-04-20","2021-04-20","2021-04-20","2021-04-20","2021-07-29","2021-07-29","2021-07-29","2021-07-29","2021-09-14","2021-09-14","2021-09-14","2021-09-14","2021-09-14","2021-09-14"],"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":[["","67877021905","CEPHALEXIN","500MG","20","Select","Select",""],["","68645056354","IBUPROFEN","800MG","15","Select","Select",""],["","00406012301","HYDROCO\/APAP","5-325MG","12","Select","Select",""],["","52817033200","CYCLOBENZAPR","10MG","15","Select","Select",""],["","00555032302","HYDROXYZ","25MG","30","Select","Select",""],["","00143992801","CIPROFLOXACN","500MG","20","Select","Select",""],["","00093101042","MUPIROCIN","2%","22","Select","Select",""],["","67877021905","CEPHALEXIN ","CAP 500MG","20","Select","Select",""],["","00093101042","MUPIROCIN ","OIN 0.02","22","Select","Select",""],["","68645056354","IBUPROFEN ","TAB 800MG","15","Select","Select",""],["","00406012301","HYDROCO\/APAP ","TAB 5-325MG","12","Select","Select",""],["","52817033200","CYCLOBENZAPR ","TAB 10MG","15","Select","Select",""],["","00555032302","HYDROXYZ ","CAP 25MG","30","Select","Select",""],["","00143992801","CIPROFLOXACN ","TAB 500MG","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","",""],["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":""}]}]}