{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TIFFANY   D TYREE","gend":1,"add":"57 NEWTON LANE                                              ","city":"RAPHINE                       ","state":"VA","zip":"24472-2834","dob":"1988-05-16","age":"","mstatus":"","insh":10053169,"cliId":"","pno":4348497133,"cno":4348497133,"email":"","ename":"","eno":"","pphy":"BOLUSA-SABUGO, AHGNES U                                     ","ppno":"","pcpadd":"320 Federal St","pcpcity":"Lynchburg                     ","pcpstate":"VA","pcpzip":245042306,"pcpcounty":"","pcpid":"P0124712","pcpname":"AMHERST COUNTY COMMUNITY HEALTH CENTER","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"57 NEWTON LANE                                              ","madd2":"                                                            ","madd3":"","mcity":"RAPHINE                       ","mstate":"VA","mzip":"24472-2834","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z01.419","Z11.51","F39","R07.89","R00.0","T18.9XXA","F41.9","R07.9","R06.00","F90.0","R45.4","H91.93","H90.3","Z13.31","J45.20","Z45.321","F31.60","F33.2","F43.23","F31.81","F31.9","F32.9","R45.851","F17.290","F41.0","Z79.899","F43.10","R10.31","R68.89","Z23","N76.0","B96.89","Z11.3","Z11.8","Z11.59","Z13.220","Z76.89"],"date":["2019-01-17","2019-01-17","2020-04-20","2019-02-05","2019-02-05","2019-02-05","2021-08-11","2019-02-05","2019-02-05","2021-08-13","2019-12-12","2019-12-12","2019-07-17","2019-06-28","2019-06-28","2019-07-17","2021-02-02","2020-09-01","2020-01-02","2020-09-29","2019-12-12","2021-08-11","2019-12-12","2019-12-12","2019-12-12","2020-09-29","2021-11-16","2020-08-06","2020-10-13","2020-11-04","2021-06-22","2021-06-22","2021-06-22","2021-06-22","2021-08-11","2021-08-11","2021-08-13"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","",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":[["","13668033005","TRAZODONE","50MG","30","Select","Select",""],["","57237004705","DIVALPROEX","250MG DR","30","Select","Select",""],["","63402030230","LATUDA","20MG","30","Select","Select",""],["","00781237101","AMPHET\/DEXTR","30MG ER","30","Select","Select",""],["","68462013901","OXCARBAZEPIN","600MG","30","Select","Select",""],["","61874017008","VRAYLAR","1.5-3MG","14","Select","Select",""],["","13668021730","ARIPIPRAZOLE","5MG","30","Select","Select",""],["","43547040650","CLONAZEPAM","0.5MG","15","Select","Select",""],["","00093317431","ALBUTEROL","E","8.5","Select","Select",""],["","13668033005","TRAZODONE ","TAB 50MG","30","Select","Select",""],["","57237004705","DIVALPROEX ","TAB 250MG DR","30","Select","Select",""],["","63402030230","LATUDA ","TAB 20MG","30","Select","Select",""],["","00781237101","AMPHET\/DEXTR ","CAP 30MG ER","30","Select","Select",""],["","68462013901","OXCARBAZEPIN ","TAB 600MG","30","Select","Select",""],["","61874017008","VRAYLAR ","CAP 1.5-3MG","14","Select","Select",""],["","13668021730","ARIPIPRAZOLE ","TAB 5MG","30","Select","Select",""],["","43547040650","CLONAZEPAM ","TAB 0.5MG","15","Select","Select",""],["","00093317431","ALBUTEROL ","FAT E","8.5","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":""}]}]}