{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DAVIS   B HURD","gend":0,"add":"108   OLD QUARRY ROAD                                       ","city":"BASSETT                       ","state":"VA","zip":"24055-4728","dob":"1970-03-11","age":"","mstatus":"","insh":10055452,"cliId":"","pno":2762247521,"cno":2762247521,"email":"","ename":"","eno":"","pphy":"NKEMBE, KWAMBA EKWA                                         ","ppno":"","pcpadd":"324 T B Stanley Hwy Ste B","pcpcity":"Bassett                       ","pcpstate":"VA","pcpzip":240556109,"pcpcounty":"","pcpid":"P0110944","pcpname":"BASSETT FAMILY PRACTICE","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"108   OLD QUARRY ROAD                                       ","madd2":"                                                            ","madd3":"","mcity":"BASSETT                       ","mstate":"VA","mzip":"24055-4728","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E78.2","F90.0","F41.3","Z92.29","Z12.5","M77.8","J30.2","M25.561","M25.562","M25.522","N41.0","N40.1","R35.1","E16.2","N40.0","N41.1","K21.9","H10.45","H17.89","H52.223","H52.03","N50.3","N50.812","N50.82","N49.2","N43.41","J45.909","F31.9","F20.9","F41.9","Z88.5","Z88.1","Z88.2","Z88.8","Z09","Z79.899","F41.0","Z71.89","Z71.3","N50.89","Z00.00","M25.532","M25.531","Z13.6","E55.9","R39.12","H52.4","D51.0","K52.9","R10.9","R10.84","R20.2","Z20.822","M25.50","L03.213","J30.1","T78.1XXD","J45.20","Z13.29","B37.9","R39.11"],"date":["2021-10-20","2020-05-28","2020-04-30","2019-01-10","2021-10-28","2019-04-25","2020-04-30","2019-04-25","2019-04-25","2021-10-28","2019-04-26","2021-09-17","2020-09-17","2021-10-20","2020-09-10","2019-07-18","2019-09-24","2020-12-16","2020-12-16","2020-12-16","2020-12-16","2020-01-27","2020-03-02","2020-01-17","2020-01-27","2020-06-17","2020-03-18","2020-03-18","2020-03-18","2020-03-18","2020-03-18","2020-03-18","2020-03-18","2021-04-12","2020-04-30","2020-04-30","2020-08-06","2021-10-28","2021-10-28","2020-06-17","2020-08-06","2020-08-06","2020-08-06","2021-10-28","2021-10-20","2020-09-17","2020-12-16","2021-10-20","2021-04-12","2021-04-12","2021-04-12","2021-04-12","2021-04-12","2021-07-16","2021-08-16","2021-09-09","2021-09-09","2021-09-09","2021-10-28","2021-10-28","2021-09-17"],"priorHcc":["","","","","","","","","","","",null,"","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",null]}},{"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":[["","00527150237","AMPHET\/DEXTR","10MG","60","Select","Select",""],["","55111015810","OMEPRAZOLE","20MG","60","Select","Select",""],["","61442011201","ACYCLOVIR","400MG","60","Select","Select",""],["","00093598627","EPINEPHRINE","0.3MG","2","Select","Select",""],["","45802065078","LORATADINE","10MG","30","Select","Select",""],["","00168000680","TRIAMCINOLON","0.10%","80","Select","Select",""],["","00904671839","MUCUS","600MG ER","20","Select","Select",""],["","00172392670","DIAZEPAM","5MG","15","Select","Select",""],["","65862050220","AMOX\/K","500-125","20","Select","Select",""],["","68180046807","LOVASTATIN","20MG","30","Select","Select",""],["","24208060110","ALAWAY","0.025%OP","10","Select","Select",""],["","65862007701","CIPROFLOXACN","500MG","10","Select","Select",""],["","65862039010","ONDANSETRON","4MG ODT","12","Select","Select",""],["","50111033401","METRONIDAZOL","500MG","10","Select","Select",""],["","62175061743","PANTOPRAZOLE","40MG","30","Select","Select",""],["","68180012202","CEPHALEXIN","500MG","6","Select","Select",""],["","00093005805","TRAMADOL","50MG","10","Select","Select",""],["","53489011905","DOXYCYCL","100MG","20","Select","Select",""],["","59779070501","EYE","0.03%","5","Select","Select",""],["","00527150237","AMPHET\/DEXTR ","TAB 10MG","60","Select","Select",""],["","55111015810","OMEPRAZOLE ","CAP 20MG","60","Select","Select",""],["","61442011201","ACYCLOVIR ","TAB 400MG","60","Select","Select",""],["","00093598627","EPINEPHRINE ","INJ 0.3MG","2","Select","Select",""],["","45802065078","LORATADINE ","TAB 10MG","30","Select","Select",""],["","00168000680","TRIAMCINOLON ","OIN 0.001","80","Select","Select",""],["","00904671839","MUCUS ","TAB 600MG ER","20","Select","Select",""],["","00172392670","DIAZEPAM ","TAB 5MG","15","Select","Select",""],["","65862050220","AMOX\/K ","TAB 500-125","20","Select","Select",""],["","68180046807","LOVASTATIN ","TAB 20MG","30","Select","Select",""],["","24208060110","ALAWAY ","DRO 0.025%OP","10","Select","Select",""],["","68462018117","CLOTRIMAZOLE ","CRE 0.01","15","Select","Select",""],["","65862007701","CIPROFLOXACN ","TAB 500MG","10","Select","Select",""],["","65862039010","ONDANSETRON ","TAB 4MG ODT","12","Select","Select",""],["","50111033401","METRONIDAZOL ","TAB 500MG","10","Select","Select",""],["","62175061743","PANTOPRAZOLE ","TAB 40MG","30","Select","Select",""],["","68180012202","CEPHALEXIN ","CAP 500MG","6","Select","Select",""],["","00093005805","TRAMADOL ","TAB 50MG","10","Select","Select",""],["","70710113908","FLUCONAZOLE ","TAB 150MG","3","Select","Select",""],["","53489011905","DOXYCYCL ","CAP 100MG","20","Select","Select",""],["","59779070501","EYE ","DRO 0.00025","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":[[["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":""}]}]}