{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JEREMIAH POPE","gend":0,"add":"165   MANOR DRIVE                                           ","city":"KEYSVILLE                     ","state":"VA","zip":"23947-3571","dob":"1977-12-23","age":"","mstatus":"","insh":10053269,"cliId":"","pno":4343903778,"cno":4343903778,"email":"","ename":"","eno":"","pphy":"ALGEIER, RHONDA M","ppno":"","pcpadd":"165 LEGRANDE AVE,Ste 2100","pcpcity":"CHARLOTTE COURT HOUSE         ","pcpstate":"VA","pcpzip":239233747,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"APT 3E                                                      ","add3":"","madd1":"165   MANOR DRIVE                                           ","madd2":"APT 3E                                                      ","madd3":"","mcity":"KEYSVILLE                     ","mstate":"VA","mzip":"23947-3571","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R56.9","F32.9","F41.9","Z86.59","Z23","Z72.0","Q05.9","F90.1","G89.29","M75.100","Z79.899","F11.20","F99","M47.816","M75.101","M75.102","H66.91","L53.9","H92.09","J02.9","R19.7","R19.5","F06.8","M54.9","Z79.891","G89.4","M51.36","K59.03","R45.851","F41.8","F17.210","F32.1","Z63.4","F43.12","M54.5","K04.7","K08.89","M25.512","M25.511","F33.2","R40.4","S02.5XXA","K02.9","G40.909","R11.10","R53.1","R51.9","W22.8XXA","Y92.009","Y93.01","M19.011","M19.012"],"date":["2021-08-10","2020-07-09","2019-01-10","2020-07-09","2019-01-10","2020-09-21","2019-01-10","2021-10-20","2021-10-14","2021-10-14","2021-08-10","2021-10-14","2019-03-29","2021-04-05","2021-01-07","2021-01-07","2019-06-07","2019-06-07","2019-06-07","2019-06-07","2019-06-07","2019-06-07","2019-07-19","2019-08-13","2020-06-29","2019-08-13","2021-10-14","2019-09-12","2019-10-18","2019-10-18","2021-08-10","2021-01-07","2021-01-07","2020-03-09","2021-06-29","2021-08-10","2020-09-21","2021-06-29","2021-06-29","2021-09-17","2021-08-10","2021-08-10","2021-08-10","2021-08-10","2021-08-10","2021-08-10","2021-08-10","2021-08-10","2021-08-10","2021-08-10","2021-10-14","2021-10-14"],"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":[["","13668001001","CITALOPRAM","20MG","30","Select","Select",""],["","00406114401","METHYLPHENID","10MG","120","Select","Select",""],["","53746011005","HYDROCO\/APAP","10-325MG","90","Select","Select",""],["","57237002801","AMOXICILLIN","500MG","21","Select","Select",""],["","65862050320","AMOX\/K","875-125","20","Select","Select",""],["","65162021210","PHENYTOIN","100MG","60","Select","Select",""],["","67877025001","QUETIAPINE","100MG","60","Select","Select",""],["","65862069790","VENLAFAXINE","150MG ER","30","Select","Select",""],["","68462026830","ATOMOXETINE","40MG","30","Select","Select",""],["","50228043605","NAPROXEN","500MG","20","Select","Select",""],["","57237004105","PENICILLN","500MG","40","Select","Select",""],["","69547035302","NARCAN","","2","Select","Select",""],["","13668001105","CITALOPRAM ","TAB 40MG","30","Select","Select",""],["","68462027030","ATOMOXETINE ","CAP 80MG","30","Select","Select",""],["","00406114401","METHYLPHENID ","TAB 10MG","120","Select","Select",""],["","53746011005","HYDROCO\/APAP ","TAB 10-325MG","90","Select","Select",""],["","57237002801","AMOXICILLIN ","TAB 500MG","21","Select","Select",""],["","65862050320","AMOX\/K ","TAB 875-125","20","Select","Select",""],["","65162021210","PHENYTOIN ","CAP 100MG","60","Select","Select",""],["","67877025001","QUETIAPINE ","TAB 100MG","60","Select","Select",""],["","65862069790","VENLAFAXINE ","CAP 150MG ER","30","Select","Select",""],["","50228043605","NAPROXEN ","TAB 500MG","20","Select","Select",""],["","57237004105","PENICILLN ","TAB 500MG","40","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","",""],["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":""}]}]}