{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MARY   A BRYSON","gend":1,"add":"324   SPRING VALLEY LANE                                    ","city":"STUART                        ","state":"VA","zip":"24171-3051","dob":"1974-07-24","age":"","mstatus":"","insh":10053633,"cliId":"","pno":2762298002,"cno":5404820770,"email":"","ename":"","eno":"","pphy":"COLE, RICHARD C                                             ","ppno":"","pcpadd":"18877 JEB STUART HWY","pcpcity":"STUART                        ","pcpstate":"VA","pcpzip":241711019,"pcpcounty":"","pcpid":"P0060199","pcpname":"PATRICK COUNTY FAMILY PRACTICE","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"APT 2                                                       ","add3":"","madd1":"324   SPRING VALLEY LANE                                    ","madd2":"APT 2                                                       ","madd3":"","mcity":"STUART                        ","mstate":"VA","mzip":"24171-3051","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E78.00","I10","G89.21","F41.0","G40.89","S06.2X9S","R39.81","R68.89","Z51.81","S06.2X9D","R63.5","B34.9"],"date":["2020-04-09","2020-08-04","2020-08-04","2020-07-03","2020-08-04","2020-08-04","2020-07-28","2019-11-08","2020-05-08","2020-03-06","2019-10-17","2020-08-04"],"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":[["","62559049001","DIPHEN\/ATROP","2.5MG","40","Select","Select",""],["","45802065087","LORATADINE","10MG","30","Select","Select",""],["","69097052444","DICLOFENAC","1%","200","Select","Select",""],["","68180051703","LISINOPRIL","40MG","90","Select","Select",""],["","64380080707","IBUPROFEN","800MG","120","Select","Select",""],["","62175011843","OMEPRAZOLE","20MG","30","Select","Select",""],["","60505082901","FLUTICASONE","50MCG","16","Select","Select",""],["","31722088530","ROSUVASTATIN","40MG","30","Select","Select",""],["","68180011302","LEVETIRACETA","500MG","120","Select","Select",""],["","55111012205","ATORVASTATIN","20MG","30","Select","Select",""],["","00406012305","HYDROCO\/APAP","5-325MG","90","Select","Select",""],["","55111046601","METOPROL","25MG ER","30","Select","Select",""],["","16729013816","CLONAZEPAM","2MG","120","Select","Select",""],["","00143145505","PHENOBARB","60MG","90","Select","Select",""],["","68462012605","GABAPENTIN","600MG","180","Select","Select",""],["","00591207030","LIDO\/PRILOCN","2.5-2.5%","60","Select","Select",""],["","69315013401","IMIPRAM","25MG","60","Select","Select",""],["","29300013510","CLONIDINE","0.1MG","30","Select","Select",""],["","62559049001","DIPHEN\/ATROP ","TAB 2.5MG","40","Select","Select",""],["","45802065087","LORATADINE ","TAB 10MG","30","Select","Select",""],["","69097052444","DICLOFENAC ","GEL 0.01","200","Select","Select",""],["","68180051703","LISINOPRIL ","TAB 40MG","90","Select","Select",""],["","64380080707","IBUPROFEN ","TAB 800MG","120","Select","Select",""],["","62175011843","OMEPRAZOLE ","CAP 20MG","30","Select","Select",""],["","60505082901","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","31722088530","ROSUVASTATIN ","TAB 40MG","30","Select","Select",""],["","68180011302","LEVETIRACETA ","TAB 500MG","120","Select","Select",""],["","55111012205","ATORVASTATIN ","TAB 20MG","30","Select","Select",""],["","00406012305","HYDROCO\/APAP ","TAB 5-325MG","90","Select","Select",""],["","55111046601","METOPROL ","TAB 25MG ER","30","Select","Select",""],["","16729013816","CLONAZEPAM ","TAB 2MG","120","Select","Select",""],["","00143145505","PHENOBARB ","TAB 60MG","90","Select","Select",""],["","68462012605","GABAPENTIN ","TAB 600MG","180","Select","Select",""],["","00591207030","LIDO\/PRILOCN ","CRE 2.5-2.5%","60","Select","Select",""],["","69315013401","IMIPRAM ","TAB 25MG","60","Select","Select",""],["","29300013510","CLONIDINE ","TAB 0.1MG","30","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","",""],["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":""}]}]}