{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DONNIE   A RITCHIE","gend":0,"add":"PO BOX 451                                                  ","city":"BROADWAY                      ","state":"VA","zip":"22815-0451","dob":"1959-05-20","age":"","mstatus":"","insh":10053070,"cliId":"","pno":5404218831,"cno":5404218831,"email":"","ename":"","eno":"","pphy":"LONG, KEITH C                                               ","ppno":"","pcpadd":"1661 S Main St","pcpcity":"Harrisonburg                  ","pcpstate":"VA","pcpzip":228012728,"pcpcounty":"","pcpid":"P9059035","pcpname":"RMH TIMBERVILLE HEALTH CENTER","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"PO BOX 451                                                  ","madd2":"                                                            ","madd3":"","mcity":"BROADWAY                      ","mstate":"VA","mzip":"22815-0451","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G89.29","M10.09","M25.50","M13.0","Z51.81","Z79.891","I10","E87.1","E87.5","R94.5","M1A.9XX1","Z13.6","Z12.5","Z79.899","R00.0","K21.9","J01.90","M54.5","M25.551","L72.9","M25.552","M51.17","M46.97","M16.0","M51.37","R68.89","M54.2","F45.42","Z13.89","M54.16","M51.36"],"date":["2021-08-26","2021-08-26","2021-08-26","2019-06-05","2019-06-05","2019-06-05","2020-07-13","2019-04-15","2019-04-15","2019-04-15","2020-07-13","2020-07-13","2020-07-13","2019-06-05","2020-07-13","2020-07-13","2019-11-12","2021-08-26","2020-07-13","2020-07-13","2020-07-13","2019-11-12","2019-11-12","2019-11-12","2019-11-12","2021-01-07","2021-08-26","2021-08-26","2021-08-26","2021-08-26","2021-08-26"],"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":[["","47335072183","FEBUXOSTAT","40MG","28","Select","Select",""],["","00406051205","OXYCOD\/APAP","5-325MG","112","Select","Select",""],["","68462030201","INDOMETHACIN","50MG","60","Select","Select",""],["","60505006501","OMEPRAZOLE","20MG","30","Select","Select",""],["","43547035611","LISINOPRIL","40MG","30","Select","Select",""],["","24510011010","XTAMPZA","9MG","60","Select","Select",""],["","00378001805","METOPROL","25MG","60","Select","Select",""],["","69547035302","NARCAN","","2","Select","Select",""],["","47335072183","FEBUXOSTAT ","TAB 40MG","28","Select","Select",""],["","00406051205","OXYCOD\/APAP ","TAB 5-325MG","112","Select","Select",""],["","68462030201","INDOMETHACIN ","CAP 50MG","60","Select","Select",""],["","60505006501","OMEPRAZOLE ","CAP 20MG","30","Select","Select",""],["","43547035611","LISINOPRIL ","TAB 40MG","30","Select","Select",""],["","24510011010","XTAMPZA ","CAP 9MG","60","Select","Select",""],["","00378001805","METOPROL ","TAB 25MG","60","Select","Select",""],["","69547035302","NARCAN ","SPR ","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","",""],["Yes","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":""}]}]}