{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" TERRY L DOWDY","gend":1,"add":"214 EGGLESTON RD","city":"PEMBROKE","state":"VA","zip":"24136-3144","dob":"1954-05-26","age":"","mstatus":"","insh":10054982,"cliId":"","pno":"5406267581, 5406267581","cno":"","email":"","ename":"","eno":"","pphy":"UNKNOWN PROVIDER QNXT PCP","ppno":"               ","pcpadd":"UNKNOWN STREET, ","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":232190000,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP - VIRGINIA PREMIER","program":"MEDICAID","lob":"MLTSS","region":"ROANOKE","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"214 EGGLESTON RD","madd2":"                                                            ","madd3":"","mcity":"PEMBROKE","mstate":"VA","mzip":"24136-3144","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R06.02","R09.02","R10.13","R11.0","K44.9","M25.512","F32.9","K21.9","Z86.19","Z90.710","Z90.49","Z99.81","J45.909","M54.12","G56.22","I95.1","R94.31","J44.9","F41.9","F17.200","M12.812","M54.5","M15.9","K57.90","R10.9","M43.06","R94.5","Z79.899","Z23","H25.13","H52.03","H52.4"],"date":["2019-07-29","2019-07-29","2020-12-22","2019-12-03","2019-10-15","2019-01-09","2019-01-05","2019-01-09","2019-01-05","2019-01-05","2019-01-05","2019-01-05","2019-01-05","2019-01-28","2019-01-28","2020-01-24","2020-01-24","2019-01-16","2019-01-09","2019-01-09","2019-01-16","2019-01-16","2019-01-16","2019-04-15","2019-04-15","2019-04-15","2019-12-03","2019-12-03","2019-12-03","2020-06-18","2020-06-18","2020-06-18"],"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":[["","68645049254","PANTOPRAZOLE ","TAB 40MG","30","Select","Select",""],["","16571040250","CETIRIZINE ","TAB 10MG","30","Select","Select",""],["","68180048502","PRAVASTATIN ","TAB 10MG","30","Select","Select",""],["","00185067401","HYDROXYZ ","CAP 25MG","60","Select","Select",""],["","68180044601","QUETIAPINE ","TAB 50MG","30","Select","Select",""],["","65862014636","SUMATRIPTAN ","TAB 25MG","9","Select","Select",""],["","68645052354","SERTRALINE ","TAB 100MG","30","Select","Select",""],["","00093221005","SUCRALFATE ","TAB 1GM","120","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","20","Select","Select",""],["","70069000801","EPINASTINE ","DRO 0.0005","5","Select","Select",""],["","16571020150","DICLOFENAC ","TAB 75MG DR","60","Select","Select",""],["","68645051890","CYCLOBENZAPR ","TAB 10MG","12","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","",""],["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":""}]}]}