{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"AMANDA   S TAYLOR","gend":1,"add":"410 VIRGINIA AVENUE NE","city":"NORTON","state":"VA","zip":"24273-1516","dob":"1983-04-19","age":"","mstatus":"","insh":10061002,"cliId":"","pno":2762200614,"cno":2763654965,"email":"","ename":"","eno":"","pphy":"BEVINS, ASHLEY R","ppno":2766798890,"pcpadd":"716 Spring Ave SE, Ste 204","pcpcity":"Wise","pcpstate":"VA","pcpzip":242935702,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"SOUTHWEST","aligned":"","ano":2763286523,"add2":"                                                            ","add3":"","madd1":"410 VIRGINIA AVENUE NE","madd2":"                                                            ","madd3":"","mcity":"NORTON","mstate":"VA","mzip":"24273-1516","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R63.4","K04.7","K03.81","I10","Z72.0","F41.9","E87.6","Z79.899","F11.20","Z23","F33.9","E78.5","G43.909","R23.2","Z00.00","R14.0","Z51.81","Z03.89","G47.00","R51","R03.0","Z80.3","N39.3","R21","F31.9","K08.89","S02.5XXA","K02.9","F32.9","B19.20","F31.62","F51.02"],"date":["2019-02-07","2020-07-25","2020-07-25","2021-03-01","2020-07-25","2021-03-01","2019-01-03","2019-06-07","2019-06-07","2020-11-30","2021-03-01","2021-03-01","2021-03-01","2020-11-30","2020-11-30","2019-02-07","2019-06-07","2019-06-07","2021-03-01","2019-01-03","2019-01-03","2020-07-20","2020-07-20","2020-07-20","2020-08-18","2020-07-25","2020-07-25","2020-07-25","2020-07-25","2019-01-23","2019-01-23","2019-01-23"],"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":[["","00093083210","CLONAZEPAM ","TAB 0.5MG","14","Select","Select",""],["","16714061304","SERTRALINE ","TAB 100MG","60","Select","Select",""],["","50111043301","TRAZODONE ","TAB 50MG","20","Select","Select",""],["","55111029298","SUMATRIPTAN ","TAB 50MG","10","Select","Select",""],["","00378521077","AMLODIPINE ","TAB 10MG","30","Select","Select",""],["","43547035611","LISINOPRIL ","TAB 40MG","30","Select","Select",""],["","29300012810","HYDROCHLOROT ","TAB 25MG","30","Select","Select",""],["","00832532511","POT  CL MICRO","TAB 20MEQ ER","4","Select","Select",""],["","16729000515","SIMVASTATIN ","TAB 20MG","30","Select","Select",""],["","00228212710","CLONIDINE ","TAB 0.1MG","30","Select","Select",""],["","00093005405","BUSPIRONE ","TAB 10MG","90","Select","Select",""],["","68180051901","LISINOP\/HCTZ ","TAB 20-12.5","30","Select","Select",""],["","65862052890","VENLAFAXINE ","CAP 75MG ER","30","Select","Select",""],["","00093744105","DIVALPROEX ","TAB 500MG DR","60","Select","Select",""],["","23155010610","HYDROXYZ ","TAB 25MG","60","Select","Select",""],["","00603548221","PROPRANOLOL ","TAB 10MG","30","Select","Select",""],["","00456111030","VIIBRYD ","TAB 10MG","30","Select","Select",""],["","45802006535","TRIAMCINOLON ","CRE 0.005","30","Select","Select",""],["","00406012301","HYDROCO\/APAP ","TAB 5-325MG","4","Select","Select",""],["","63304069205","CLINDAMYCIN ","CAP 150MG","60","Select","Select",""],["","00116200116","CHLORHEX ","SOL 0.0012","473","Select","Select",""],["","00093310905","AMOXICILLIN ","CAP 500MG","30","Select","Select",""],["","00069047103","CHANTIX ","PAK 0.5& 1MG","53","Select","Select",""],["","51991029301","OXCARBAZEPIN ","TAB 300MG","30","Select","Select",""],["","67877022305","GABAPENTIN ","300MG","14","Select","Select",""],["","12496120803","SUBOXONE ","8-2MG","7","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","",""],["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":""}]}]}