{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"RICKY   A NEFF","gend":0,"add":"73 BOWMAN LANE","city":"NEW MARKET","state":"VA","zip":"22844-3229","dob":"1959-07-21","age":"","mstatus":"","insh":10062607,"cliId":"","pno":5404779005,"cno":5404779005,"email":"","ename":"","eno":"","pphy":"CUNNINGHAM, JENNIFER D","ppno":5404773808,"pcpadd":"5173 Main St, ","pcpcity":"Mount Jackson","pcpstate":"VA","pcpzip":228429513,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"NORTHERN\/ WINCHESTER","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"73 BOWMAN LANE","madd2":"                                                            ","madd3":"","mcity":"NEW MARKET","mstate":"VA","mzip":"22844-3229","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J43.2","R44.9","E87.1","R41.82","R47.81","R51","E22.2","I10","F31.9","N40.0","F17.210","J44.9","Z79.82","Z80.1","Z80.9","Z82.49","G89.29","M54.9","F41.9","G93.89","R27.0","R68.89","E78.5","R63.1","M19.90","M54.17","F45.42","Z13.89","M54.5","M54.16","M51.36","M54.2","F17.219","K59.03","R05","Z79.891","Z79.899","Z12.11","Z87.891","Z11.59","G93.40","J44.1","R40.4","R09.02","R06.89","S00.83XA","Z12.5","Z13.220","Z23","Q67.8","R53.1","R52","Z51.81","K59.00","R07.9","M54.6","F31.30","R07.89","I50.31","R42","R06.02","R11.2","J45.909","R91.8","R41.0","R41.89","R33.9","I67.89","Z12.2","J43.9","T40.2X1A","T43.011A","R47.1","Z91.14","N52.9","G92","T42.1X1A","R22.0","Z01.89","I25.10","R47.01","D64.9","Z80.8"],"date":["2019-01-21","2019-01-21","2020-02-13","2020-08-22","2020-08-22","2019-08-07","2019-03-20","2020-02-13","2019-11-17","2019-09-01","2020-08-11","2020-06-25","2019-09-01","2019-06-19","2019-03-20","2019-06-19","2021-04-01","2019-09-01","2019-11-17","2019-05-18","2020-08-22","2021-02-05","2019-11-17","2019-11-17","2021-04-01","2021-04-01","2021-04-01","2021-04-01","2021-04-01","2021-04-01","2021-04-01","2021-04-01","2020-06-25","2021-04-01","2019-03-20","2019-09-11","2019-11-17","2019-08-15","2020-02-13","2019-08-23","2019-11-17","2019-11-17","2019-11-17","2019-11-17","2019-11-17","2019-11-17","2020-06-12","2020-02-13","2020-12-10","2020-12-10","2019-03-20","2019-09-11","2019-09-11","2019-03-13","2019-08-09","2019-09-11","2019-09-02","2020-09-17","2019-05-03","2019-05-18","2019-11-17","2019-11-17","2019-08-07","2019-09-01","2019-09-01","2019-09-01","2020-06-12","2019-05-18","2020-08-11","2019-08-27","2019-09-01","2019-09-01","2019-09-01","2019-09-01","2019-09-01","2019-11-17","2019-11-17","2019-11-19","2020-02-11","2020-08-11","2019-01-21","2019-01-21","2019-01-21"],"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":[["","66993001968","ALBUTEROL ","AER HFA","18","Select","Select",""],["","00597002402","COMBIVENT ","AER 20-100","4","Select","Select",""],["","31722013130","DUTASTERIDE ","CAP 0.5MG","30","Select","Select",""],["","33342007007","OLANZAPINE ","TAB 10MG","30","Select","Select",""],["","65862059805","TAMSULOSIN ","CAP 0.4MG","30","Select","Select",""],["","67877032105","IBUPROFEN ","TAB 800MG","90","Select","Select",""],["","50742061610","METOPROL ","TAB 50MG ER","30","Select","Select",""],["","27241000406","RISPERIDONE ","TAB 2MG","30","Select","Select",""],["","00378875006","DICLOFENAC ","GEL 0.01","200","Select","Select",""],["","49781008499","ASPIRIN ","CHW 81MG","30","Select","Select",""],["","69097017353","IPRATROPIUM\/ ","SOL ALBUTER","360","Select","Select",""],["","29300024310","AMLODIPINE ","TAB 10MG","30","Select","Select",""],["","69618004410","DOCUSATE ","CAP 100MG","120","Select","Select",""],["","53746011005","HYDROCO\/APAP ","TAB 10-325MG","60","Select","Select",""],["","43547035411","LISINOPRIL ","TAB 20MG","30","Select","Select",""],["","00591565805","CYCLOBENZAPR ","TAB 10MG","90","Select","Select",""],["","45802086803","POLYETH ","POW 3350 NF","510","Select","Select",""],["","51672400501","CARBAMAZEPIN ","TAB 200MG","180","Select","Select",""],["","37205061273","CLEARLAX ","POW ","510","Select","Select",""],["","47781042447","FENTANYL ","DIS 25MCG\/HR","10","Select","Select",""],["","43386031214","GAVILAX ","POW ","510","Select","Select",""],["","50111064802","FLUOXETINE ","CAP 20MG","30","Select","Select",""],["","69547035302","NARCAN ","SPR ","2","Select","Select",""],["","76385012401","METHOCARBAM ","TAB 750MG","90","Select","Select",""],["","59310057922","PROAIR ","AER ","8.5","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":[[["No","Select","","","","","Select","",""],["No","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":""}]}]}