{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ANGELA PIPER","gend":1,"add":"C\/O MPU 1121880                                             ","city":"RICHMOND                      ","state":"VA","zip":"23225-5644","dob":"1980-07-25","age":"","mstatus":"","insh":10050502,"cliId":"","pno":7576336240,"cno":7577426064,"email":"","ename":"","eno":"","pphy":"TAYLOR, FRANCIS MARVIN                                      ","ppno":"","pcpadd":"111 E Main St","pcpcity":"Conway                        ","pcpstate":"NC","pcpzip":278209711,"pcpcounty":"","pcpid":"P0110939","pcpname":"BOYKINS FAMILY PRACTICE","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"CENTRAL","aligned":"","ano":"","add2":"6900   ATMORE DRIVE                                         ","add3":"","madd1":"18268 Bryant Ave                                            ","madd2":"                                                            ","madd3":"","mcity":"Boykins                       ","mstate":"VA","mzip":"23827-2741","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R68.89","J06.9","L30.9","F41.1","H61.21","S81.822A","J04.0","B34.9","J02.9","F32.9","F79","Z79.899","Z20.828","R68.84","Z23","Z01.419","Z11.51","Z13.89","Z12.11","N76.0","Z12.31","H60.503"],"date":["2020-12-08","2019-10-16","2019-04-29","2021-10-07","2019-08-12","2019-08-22","2019-10-23","2020-02-15","2020-02-18","2020-02-15","2020-02-15","2020-02-15","2020-02-15","2020-07-16","2021-10-04","2021-04-26","2021-04-26","2021-04-26","2021-04-26","2021-04-26","2021-05-05","2021-09-06"],"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":[["","64380074106","BUSPIRONE","5MG","60","Select","Select",""],["","16729021716","SERTRALINE","100MG","30","Select","Select",""],["","61314064610","NEO\/POLY\/HC","1% OTIC","10","Select","Select",""],["","69238126601","OSELTAMIVIR","75MG","10","Select","Select",""],["","00093031401","KETOROLAC","10MG","15","Select","Select",""],["","57237003105","AMOXICILLIN","500MG","21","Select","Select",""],["","67405060301","FLUCONAZOLE","150MG","1","Select","Select",""],["","00168008115","NYSTAT\/TRIAM","","15","Select","Select",""],["","00116200116","CHLORHEX","0.12%","473","Select","Select",""],["","27808003503","HYDROCO\/APAP","5-325MG","6","Select","Select",""],["","59762444002","METHYLPRED","4MG","21","Select","Select",""],["","67877032005","IBUPROFEN","600MG","30","Select","Select",""],["","64380074106","BUSPIRONE ","TAB 5MG","60","Select","Select",""],["","16729021716","SERTRALINE ","TAB 100MG","30","Select","Select",""],["","61314064610","NEO\/POLY\/HC ","SOL 1% OTIC","10","Select","Select",""],["","69238126601","OSELTAMIVIR ","CAP 75MG","10","Select","Select",""],["","00093031401","KETOROLAC ","TAB 10MG","15","Select","Select",""],["","57237003105","AMOXICILLIN ","CAP 500MG","21","Select","Select",""],["","67405060301","FLUCONAZOLE ","TAB 150MG","1","Select","Select",""],["","00168008115","NYSTAT\/TRIAM ","CRE ","15","Select","Select",""],["","00116200116","CHLORHEX ","SOL 0.0012","473","Select","Select",""],["","27808003503","HYDROCO\/APAP ","TAB 5-325MG","6","Select","Select",""],["","59762444002","METHYLPRED ","TAB 4MG","21","Select","Select",""],["","67877032005","IBUPROFEN ","TAB 600MG","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","",""],["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":""}]}]}