{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CONSUELO HERNANDEZ RAMOS","gend":1,"add":"421 SPRING STREET","city":"WOODSTOCK","state":"VA","zip":"22664-1217","dob":"1957-10-16","age":"","mstatus":"","insh":10062496,"cliId":"","pno":5403358251,"cno":5403358251,"email":"","ename":"","eno":"","pphy":"KOCH, ADRIENNE J","ppno":5405647100,"pcpadd":"1871 Evelyn Byrd Ave, ","pcpcity":"Harrisonburg","pcpstate":"VA","pcpzip":228013487,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"NORTHERN\/ WINCHESTER","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"421 SPRING STREET","madd2":"                                                            ","madd3":"","mcity":"WOODSTOCK","mstate":"VA","mzip":"22664-1217","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M79.674","L60.0","M25.50","B02.9","K64.1","M25.531","R68.89","Z01.419","N63.0","M79.672","L85.8","H10.502","H57.12","G51.0","Z76.89","E11.9","E78.2","I10","R59.1","B20","R59.0","K64.9","R50.9","B34.9","R07.0","N64.89","N64.4","D12.8","Z12.11","Z86.010","M19.072","G89.29","M25.562","G56.03","D12.6","Q43.9","Z71.3","R21","Z23","M17.12","M65.4","E78.5","H01.003","H57.89","K64.8","Z21","B35.1","Z91.89","E78.00","M19.90","Z79.899","Z79.82","Z79.84","N63.10","K62.1","Z80.0","Z80.3","Z87.19","Z88.6","G62.9","J02.9","L02.91","E55.9"],"date":["2020-07-23","2020-07-02","2020-06-11","2019-03-26","2019-07-08","2019-07-24","2021-01-28","2021-04-27","2020-04-03","2020-07-23","2020-10-26","2019-03-07","2019-03-07","2020-08-14","2019-10-01","2021-01-13","2021-01-13","2021-01-13","2020-11-23","2021-01-28","2020-09-28","2020-08-10","2020-03-01","2020-03-01","2020-03-01","2020-04-03","2020-04-03","2020-09-04","2020-09-17","2020-10-26","2020-03-01","2020-06-11","2020-04-17","2020-06-11","2020-09-04","2020-09-04","2019-01-28","2019-03-11","2020-11-23","2019-07-24","2019-07-24","2020-09-04","2020-01-05","2020-01-05","2020-01-05","2020-09-28","2020-10-26","2020-09-17","2021-01-28","2020-03-05","2020-09-28","2020-09-28","2020-09-28","2020-06-11","2020-09-04","2020-09-04","2020-09-04","2020-09-04","2020-09-04","2020-05-15","2020-11-23","2020-11-23","2020-11-23"],"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":[["","49702024213","JULUCA ","TAB 50-25MG","30","Select","Select",""],["","60505014101","GLIPIZIDE ","TAB 5MG","90","Select","Select",""],["","65862042130","TENOFOVIR ","TAB 300MG","30","Select","Select",""],["","00093720298","PRAVASTATIN ","TAB 40MG","90","Select","Select",""],["","31722055760","ABACAVIR ","TAB 300MG","60","Select","Select",""],["","00193707025","CONTOUR ","TES BLD GLUC","25","Select","Select",""],["","49702022813","TIVICAY ","TAB 50MG","30","Select","Select",""],["","68180098003","LISINOPRIL ","TAB 10MG","30","Select","Select",""],["","69097094312","GABAPENTIN ","CAP 300MG","90","Select","Select",""],["","59779061288","ALLERGY ","TAB 10MG","30","Select","Select",""],["","68382076010","METFORMIN ","TAB 1000MG","60","Select","Select",""],["","53885059501","ONETOUCH ","MIS 30G","100","Select","Select",""],["","00193654621","BAYER ","MIS LANCETS","100","Select","Select",""],["","24208091055","ERYTHROMYCIN ","OIN OP","3.5","Select","Select",""],["","45802014167","CICLOPIROX ","SOL 0.08","6.6","Select","Select",""],["","42858010201","OXYCOD\/APAP ","TAB 5-325MG","15","Select","Select",""],["","31722070530","VALACYCLOVIR ","TAB 1GM","21","Select","Select",""],["","58657050016","CODEINE\/GG ","SOL 10-100\/5","60","Select","Select",""],["","69238126601","OSELTAMIVIR ","CAP 75MG","20","Select","Select",""],["","45802065078","LORATADINE ","TAB 10MG","30","Select","Select",""],["","80777027399","MODERNA ","COVID-19","0.5","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":""}]}]}