{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DWAYNE   E CUNNINGHAM","gend":0,"add":"23 ROCKHAVEN DR                                             ","city":"COLLINSVILLE                  ","state":"VA","zip":"24078-2729","dob":"1973-01-27","age":"","mstatus":"","insh":10055410,"cliId":"","pno":8045917572,"cno":8045917572,"email":"","ename":"","eno":"","pphy":"VINCENT K JONES                                             ","ppno":"","pcpadd":"1856 Virginia Ave","pcpcity":"Martinsville                  ","pcpstate":"VA","pcpzip":241128490,"pcpcounty":"","pcpid":"P0129009","pcpname":"COMMUNITY FAMILY CARE","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"23 ROCKHAVEN DR                                             ","madd2":"                                                            ","madd3":"","mcity":"COLLINSVILLE                  ","mstate":"VA","mzip":"24078-2729","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G40.909","Z76.0","K08.9","K02.9","K05.6","K05.10","R06.00","R07.89","R06.09","R56.9","J45.909","F17.200","K08.89","N43.3","N50.819"],"date":["2019-11-29","2021-05-10","2019-10-08","2019-11-29","2019-11-29","2020-02-26","2020-05-22","2020-05-22","2020-05-22","2020-10-06","2020-12-08","2020-12-08","2021-05-10","2021-07-19","2021-07-19"],"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":[["","51672400501","CARBAMAZEPIN","200MG","70","Select","Select",""],["","63304069205","CLINDAMYCIN","150MG","28","Select","Select",""],["","00116200116","CHLORHEX","0.12%","473","Select","Select",""],["","00093117410","PENICILLN","500MG","20","Select","Select",""],["","66993001968","ALBUTEROL","HFA","18","Select","Select",""],["","51672400501","CARBAMAZEPIN ","TAB 200MG","70","Select","Select",""],["","63304069205","CLINDAMYCIN ","CAP 150MG","28","Select","Select",""],["","00116200116","CHLORHEX ","SOL 0.0012","473","Select","Select",""],["","00093117410","PENICILLN ","TAB 500MG","20","Select","Select",""],["","66993001968","ALBUTEROL ","AER HFA","18","Select","Select",""],["","65162019011","NAPROXEN ","TAB 500MG","20","Select","Select",""],["","69238110002","DOXYCYCL ","CAP 100MG","14","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":""}]}]}