{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TYMATHA   L AYERS","gend":1,"add":"1609 2ND STREET                                             ","city":"STAUTON                       ","state":"VA","zip":"24401-3019","dob":"1987-01-02","age":"","mstatus":"","insh":10051304,"cliId":"","pno":5403242427,"cno":5403242427,"email":"","ename":"","eno":"","pphy":"BOLUSA-SABUGO, AHGNES U                                     ","ppno":"","pcpadd":"320 Federal St","pcpcity":"Lynchburg                     ","pcpstate":"VA","pcpzip":245042306,"pcpcounty":"","pcpid":"P9058759","pcpname":"JOHNSON HEALTH CENTER","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"1609 2ND STREET                                             ","madd2":"                                                            ","madd3":"","mcity":"STAUTON                       ","mstate":"VA","mzip":"24401-3019","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F41.1","H53.002","T39.315A","R06.02","F17.200","J30.81","J30.1","J30.89","H91.90","M54.31","S80.11XA","W50.1XXA","Y93.83","J06.9","R68.89","Z72.0","R11.2","N83.201","R10.30","K62.5","Z85.028","R07.89","R10.9","R10.31","Z71.6","N83.291","J20.9","F17.210","H91.93","R05","R50.9","N39.0","K80.20","Z87.42","R10.32","R11.0","Z91.048","N12","R82.998","M54.9","B96.1","Z88.6","Z91.018","N83.209","K81.0","B82.0","R10.84","F43.12","H90.3","Z91.410","Z62.810","R33.9","N30.00","F43.20","J02.9","J40","M54.6","G89.29","H57.11","S05.00XA","S05.01XD","M25.531","M65.4","X50.3XXA","Y93.89","Y92.9","S69.91XA","R93.6","F41.9","R58","N94.6","T14.8XXD","M77.8","M77.9","R10.2","Z87.442","Z79.899","K56.609","Z20.828","Z79.891","Z53.20","Z03.818","R00.0","R93.3","K56.600","K56.7","R11.10","K56.690","R63.4","R19.4","N92.0","J45.909","Z87.19","Z20.822","D13.2","D13.1","D13.30","D12.2","K31.89","N83.202","K59.00","R19.5","R93.89","R19.7","R59.0"],"date":["2019-01-04","2019-01-22","2019-01-23","2019-03-06","2020-01-03","2019-03-06","2019-03-06","2019-03-06","2021-01-07","2019-02-13","2019-02-13","2019-02-13","2019-02-13","2019-03-27","2019-03-27","2021-08-16","2021-02-06","2019-08-17","2021-02-06","2021-01-29","2019-08-06","2019-08-06","2021-03-05","2021-01-11","2020-09-20","2019-08-11","2019-08-17","2021-01-27","2019-10-08","2019-08-17","2019-09-14","2019-09-12","2020-02-18","2021-01-04","2019-09-12","2021-01-04","2019-09-14","2019-09-14","2019-09-14","2020-02-18","2019-09-14","2021-02-06","2019-09-14","2019-09-18","2019-09-25","2019-10-01","2021-02-06","2020-02-12","2021-01-27","2020-02-12","2020-02-12","2019-10-21","2019-10-21","2020-02-12","2021-08-16","2020-01-03","2020-02-20","2020-02-20","2020-03-14","2020-03-16","2020-03-17","2020-09-20","2020-07-22","2020-07-22","2020-07-22","2020-07-22","2020-09-10","2020-08-20","2021-01-27","2020-09-01","2020-09-01","2020-11-12","2020-09-20","2020-09-20","2021-02-06","2021-01-04","2021-01-11","2021-05-19","2021-01-07","2021-01-07","2021-01-07","2021-01-07","2021-01-07","2021-01-29","2021-01-10","2021-01-11","2021-01-11","2021-01-27","2021-01-29","2021-01-29","2021-01-27","2021-01-27","2021-01-27","2021-01-27","2021-01-29","2021-01-29","2021-01-29","2021-01-29","2021-01-29","2021-02-06","2021-05-19","2021-03-15","2021-05-19","2021-05-19","2021-08-16"],"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":[["","65862042005","SMZ\/TMP","800-160","14","Select","Select",""],["","10702001801","OXYCODONE","5MG","20","Select","Select",""],["","00093005805","TRAMADOL","50MG","20","Select","Select",""],["","61314063136","NEO\/POLY\/DEX","0.1% OP","3.5","Select","Select",""],["","51991074790","DULOXETINE","30MG","50","Select","Select",""],["","59746000103","METHYLPRED","4MG","21","Select","Select",""],["","65162019050","NAPROXEN","500MG","28","Select","Select",""],["","67877057505","BENZONATATE","200MG","30","Select","Select",""],["","68180016013","AZITHROMYCIN","250MG","6","Select","Select",""],["","00254100752","ALBUTEROL","HFA","6.7","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","14","Select","Select",""],["","10702001801","OXYCODONE ","TAB 5MG","20","Select","Select",""],["","00093005805","TRAMADOL ","TAB 50MG","20","Select","Select",""],["","61314063136","NEO\/POLY\/DEX ","OIN 0.1% OP","3.5","Select","Select",""],["","51991074790","DULOXETINE ","CAP 30MG","50","Select","Select",""],["","59746000103","METHYLPRED ","TAB 4MG","21","Select","Select",""],["","65162019050","NAPROXEN ","TAB 500MG","28","Select","Select",""],["","67877057505","BENZONATATE ","CAP 200MG","30","Select","Select",""],["","68180016013","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","00254100752","ALBUTEROL ","AER HFA","6.7","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":""}]}]}