{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DONALD   S BARON","gend":0,"add":"650   ORANGE STREET                                         ","city":"BEDFORD                       ","state":"VA","zip":"24523-2037","dob":"1953-08-22","age":"","mstatus":"","insh":10054168,"cliId":"","pno":5406501218,"cno":5406501218,"email":"","ename":"","eno":"","pphy":"BRELAND, DANIEL MATTHEW                                     ","ppno":"","pcpadd":"1613 Oakwood St","pcpcity":"Bedford                       ","pcpstate":"VA","pcpzip":245231213,"pcpcounty":"","pcpid":"P9058475","pcpname":"CENTRA MEDICAL GROUP","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"650   ORANGE STREET                                         ","madd2":"                                                            ","madd3":"","mcity":"BEDFORD                       ","mstate":"VA","mzip":"24523-2037","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E03.9","E78.5","K21.9","R25.1","Z71.6","F17.200","E80.6","G21.19","R68.89","F20.9","S76.919A","F32.9","G20","S73.199A","M54.30","M25.552","M54.42","M47.816","M47.817","M51.25","M51.27","M51.16","M99.83","M46.96","M54.32","M51.36","H40.003","H25.13","R41.89","R10.13","R79.89","R73.03","Z72.0","Z23","H40.023","D31.32","M54.5","F51.5","R41.3"],"date":["2021-08-18","2019-03-13","2021-08-18","2019-04-10","2019-04-18","2019-04-18","2019-03-21","2021-04-01","2020-02-03","2021-08-18","2019-04-18","2019-10-14","2021-08-18","2019-04-18","2019-11-01","2019-05-09","2019-05-16","2019-05-31","2019-05-31","2019-05-31","2019-05-31","2019-05-31","2019-05-31","2019-05-31","2019-06-06","2019-06-06","2019-07-18","2021-07-13","2020-12-11","2019-09-16","2019-09-16","2021-08-18","2020-12-11","2019-11-01","2021-07-13","2021-01-14","2020-01-30","2020-08-11","2020-12-11"],"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":[["","43386048024","ORPHENADRINE","100MG ER","30","Select","Select",""],["","24208046325","LATANOPROST","0.01%","2.5","Select","Select",""],["","65862005299","SIMVASTATIN","20MG","60","Select","Select",""],["","00832105410","BACLOFEN","10MG","90","Select","Select",""],["","59651000305","OMEPRAZOLE","40MG","30","Select","Select",""],["","64380080307","RANITIDINE","150MG","60","Select","Select",""],["","70461012003","FLUAD","0.5ML","0.5","Select","Select",""],["","00536589688","NICOTINE","21MG\/24H","28","Select","Select",""],["","66993068330","OLANZAPINE","10MG","30","Select","Select",""],["","00378181710","LEVOTHYROXIN","175MCG","30","Select","Select",""],["","50111056101","TRAZODONE","100MG","30","Select","Select",""],["","16571020106","DICLOFENAC","75MG DR","60","Select","Select",""],["","69097094312","GABAPENTIN","300MG","60","Select","Select",""],["","00378181710","LEVOTHYROXIN ","TAB 175MCG","30","Select","Select",""],["","69097094312","GABAPENTIN ","CAP 300MG","60","Select","Select",""],["","43386048024","ORPHENADRINE ","TAB 100MG ER","30","Select","Select",""],["","24208046325","LATANOPROST ","SOL 0.00005","2.5","Select","Select",""],["","65862005299","SIMVASTATIN ","TAB 20MG","60","Select","Select",""],["","00832105410","BACLOFEN ","TAB 10MG","90","Select","Select",""],["","59651000305","OMEPRAZOLE ","CAP 40MG","30","Select","Select",""],["","64380080307","RANITIDINE ","TAB 150MG","60","Select","Select",""],["","16571020106","DICLOFENAC ","TAB 75MG DR","60","Select","Select",""],["","00536589688","NICOTINE ","DIS 21MG\/24H","28","Select","Select",""],["","66993068330","OLANZAPINE ","TAB 10MG","30","Select","Select",""],["","50111056101","TRAZODONE ","TAB 100MG","30","Select","Select",""],["","70461012003","FLUAD ","INJ 0.5ML","0.5","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","",""],["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":""}]}]}