{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"NANCY   A COBLE","gend":1,"add":"6107 WESLEY STREET                                          ","city":"DUBLIN                        ","state":"VA","zip":"24084-2053","dob":"1965-12-10","age":"","mstatus":"","insh":10055246,"cliId":"","pno":5406749439,"cno":5406749439,"email":"","ename":"","eno":"","pphy":"KAATZ, MATTHEW S                                            ","ppno":"","pcpadd":"101 1st St NW","pcpcity":"PULASKI                       ","pcpstate":"VA","pcpzip":243015603,"pcpcounty":"","pcpid":"P9058766","pcpname":"KAATZ MATTHEW S MD PC","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"6107 WESLEY STREET                                          ","madd2":"                                                            ","madd3":"","mcity":"DUBLIN                        ","mstate":"VA","mzip":"24084-2053","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["L03.116","M79.89","R79.89","R79.1","I10","E78.00","M79.605","R60.9","D50.9","I87.2","R68.89","R60.0","Z12.31","E61.1","Z72.3","Z23","F32.9","E66.9","M19.90","Z00.00","E03.9","Z68.39","E11.9","Z79.899","Z68.41","E66.01","R53.83"],"date":["2019-05-01","2019-05-02","2019-05-01","2019-05-01","2021-08-05","2019-05-01","2019-05-02","2020-10-02","2019-09-03","2019-09-03","2021-01-04","2019-09-03","2021-10-29","2021-04-05","2021-08-05","2019-12-04","2021-08-05","2021-04-05","2021-08-05","2021-08-05","2021-08-05","2019-12-23","2021-08-05","2020-10-02","2021-08-05","2021-08-05","2021-08-05"],"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":[["","00378180010","LEVOTHYROXIN","25MCG","30","Select","Select",""],["","00378020810","FUROSEMIDE","20MG","60","Select","Select",""],["","68180098103","LISINOPRIL","20MG","30","Select","Select",""],["","00904759080","FEROSUL","325MG","60","Select","Select",""],["","16714072103","FLUOXETINE","20MG","30","Select","Select",""],["","00832532510","POT CL MICRO","20MEQ ER","30","Select","Select",""],["","65862042005","SMZ\/TMP","800-160","14","Select","Select",""],["","57896070310","IRON","325MG","60","Select","Select",""],["","00536100901","FERROUS","325MG","60","Select","Select",""],["","00245531911","KLOR-CON","20MEQ ER","60","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","14","Select","Select",""],["","00378180010","LEVOTHYROXIN ","TAB 25MCG","30","Select","Select",""],["","00904759080","FEROSUL ","TAB 325MG","60","Select","Select",""],["","68180098103","LISINOPRIL ","TAB 20MG","30","Select","Select",""],["","00832532510","POT  CL MICRO","TAB 20MEQ ER","30","Select","Select",""],["","16714072103","FLUOXETINE ","CAP 20MG","30","Select","Select",""],["","43547040111","FUROSEMIDE ","TAB 20MG","60","Select","Select",""],["","57896070310","IRON ","TAB 325MG","60","Select","Select",""],["","00536100901","FERROUS ","TAB 325MG","60","Select","Select",""],["","00245531911","KLOR-CON ","TAB 20MEQ ER","60","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":[[["Yes","Select","","","","","Select","",""],["Yes","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":""}]}]}