{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ROBERT WHITFIELD","gend":0,"add":"1988 PRESTWOOD ROAD                                         ","city":"ALBERTA                       ","state":"VA","zip":"23821-2025","dob":"1988-11-18","age":"","mstatus":"","insh":10051635,"cliId":"","pno":8049431442,"cno":8049431442,"email":"","ename":"","eno":"","pphy":"POWERS, GRAHAM H","ppno":"","pcpadd":"200 E 5th St,Ste E","pcpcity":"Chase City                    ","pcpstate":"VA","pcpzip":239241456,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"CENTRAL","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"1988 PRESTWOOD ROAD                                         ","madd2":"                                                            ","madd3":"","mcity":"ALBERTA                       ","mstate":"VA","mzip":"23821-2025","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R41.9","J30.2","Z68.27","J45.909","R81","R73.9","R82.71","F41.9","Z00.01","E66.3","Z68.26","E11.9","R31.21","E11.65","I10","Z23","Z68.25","E78.5","J45.20","Z79.84","Z68.28","E11.29","Z68.29"],"date":["2019-04-10","2020-08-13","2019-04-10","2019-09-25","2019-06-19","2019-06-19","2019-06-19","2020-08-13","2021-09-15","2019-07-11","2020-05-07","2021-02-25","2019-07-11","2019-09-25","2021-11-16","2021-09-15","2019-09-25","2021-11-16","2020-05-07","2020-11-19","2021-11-16","2021-11-16","2021-09-15"],"priorHcc":["","","","","","","","","","","","","","",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":[["","00310620530","FARXIGA","5MG","90","Select","Select",""],["","16714008110","HYDROXYZ","10MG","60","Select","Select",""],["","00006008061","JANUMET","50-1000","60","Select","Select",""],["","68645055254","LISINOPRIL","10MG","30","Select","Select",""],["","68645058459","METFORMIN","1000MG","180","Select","Select",""],["","00487950125","ALBUTEROL","0.08%","150","Select","Select",""],["","68645048054","ATORVASTATIN","10MG","30","Select","Select",""],["","49035056314","ASPIRIN","81MG EC","30","Select","Select",""],["","00193731150","CONTOUR","NEXT","50","Select","Select",""],["","00193658621","MICROLET","LANCETS","100","Select","Select",""],["","55111078401","FEXOFENADINE","180MG","90","Select","Select",""],["","00002143380","TRULICITY","0.75\/0.5","2","Select","Select",""],["","49348098023","SM","81MG EC","90","Select","Select",""],["","00310620530","FARXIGA ","TAB 5MG","90","Select","Select",""],["","16714008110","HYDROXYZ ","TAB 10MG","60","Select","Select",""],["","00002143380","TRULICITY ","INJ 0.75\/0.5","2","Select","Select",""],["","00006008061","JANUMET ","TAB 50-1000","60","Select","Select",""],["","68645055254","LISINOPRIL ","TAB 10MG","30","Select","Select",""],["","68645058459","METFORMIN ","TAB 1000MG","180","Select","Select",""],["","00487950125","ALBUTEROL ","NEB 0.00083","150","Select","Select",""],["","68645048054","ATORVASTATIN ","TAB 10MG","30","Select","Select",""],["","49035056314","ASPIRIN ","TAB 81MG EC","30","Select","Select",""],["","00193731150","CONTOUR ","TES NEXT","50","Select","Select",""],["","00193658621","MICROLET ","MIS LANCETS","100","Select","Select",""],["","55111078401","FEXOFENADINE ","TAB 180MG","90","Select","Select",""],["","49348098023","SM ","TAB 81MG EC","90","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":[[["Yes","Select","","","","","Select","",""],["Yes","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":""}]}]}