{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" JOHN KEENE","gend":0,"add":"NRVCS","city":"RADFORD","state":"VA","zip":"24141-1431","dob":"1993-12-03","age":"","mstatus":"","insh":10064025,"cliId":"","pno":"5402676745, 5402676745","cno":5405055447,"email":"","ename":"","eno":"","pphy":"UNKNOWN PROVIDER QNXT PCP","ppno":"               ","pcpadd":"UNKNOWN STREET, ","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":232190000,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP - VIRGINIA PREMIER","program":"MEDICAID","lob":"MLTSS","region":"ROANOKE","aligned":"","ano":"","add2":"613 2ND STREET","add3":"","madd1":"NRVCS","madd2":"613 2ND STREET","madd3":"","mcity":"RADFORD","mstate":"VA","mzip":"24141-1431","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N17.9","Z46.82","R41.82","T51.92XA","R44.0","E87.2","R45.89","D72.829","F19.90","Z86.59","Z72.0","F20.9","T51.2X1A","F20.0","F33.1","F12.10","Z79.899","R09.02","T43.91XA","T42.4X2A","S00.81XA","M62.82","R74.01","F20.3","F41.8","R73.03","R63.5","Z13.6","F17.200","X83.8XXA","Z51.81","M79.652","R60.9","R68.89","T68.XXXA","R11.2","X31.XXXA","E78.5","F32.9","E78.00","F39","J96.01","G93.40","F12.90","F05","G93.89","R41.89","N17.0","N25.81","D64.9","F19.10","R45.851","F23","F43.22","F28","F17.210","F12.29","Z98.890","Z81.8","Z83.3","Z56.0","Z59.0","R51","F41.9","A41.9","T14.90XA","R40.4","T51.2X2A","T50.902A","Y92.89","R40.20","G21.0","J96.90","J69.0","R40.2313","R40.2113","R40.2213","T44.1X2A","T14.91XA","F29","R05","R79.9","R73.09","E53.8","E55.9","J98.4","R94.31","I49.8","I45.10","N28.9","I47.2","F12.20","R65.21","Z45.82","E87.6","T50.901A","Z20.828","G92","F84.0","S00.12XA","G40.909","J96.00","F14.20","F43.21","Z91.5"],"date":["2019-01-16","2020-10-26","2020-10-26","2019-02-07","2019-03-12","2020-10-28","2019-01-21","2019-01-21","2019-01-21","2019-01-21","2019-08-12","2020-11-04","2019-02-07","2021-03-01","2019-03-25","2020-11-04","2021-02-25","2020-10-26","2020-11-01","2020-11-03","2020-11-03","2020-11-03","2020-11-03","2021-02-25","2021-02-25","2021-02-25","2021-02-25","2021-02-25","2019-04-11","2019-03-13","2019-07-30","2020-10-29","2020-10-29","2020-11-04","2019-01-15","2019-01-15","2019-01-15","2019-04-10","2020-10-25","2019-04-10","2019-04-10","2020-10-26","2020-10-26","2020-10-28","2020-10-28","2019-01-16","2019-01-16","2019-01-16","2019-01-16","2019-01-16","2019-04-10","2019-04-11","2019-04-10","2019-04-10","2019-04-10","2020-10-28","2019-04-10","2019-04-10","2019-04-10","2019-04-10","2019-04-10","2019-04-10","2020-02-11","2020-02-11","2020-10-26","2020-10-26","2020-10-26","2019-01-15","2020-10-28","2019-01-15","2019-01-17","2019-01-15","2019-01-15","2020-10-25","2019-01-15","2019-01-15","2019-01-15","2019-01-15","2019-01-19","2019-04-10","2019-08-12","2019-08-12","2019-08-12","2019-08-12","2019-08-12","2019-01-15","2019-01-15","2019-01-15","2019-01-15","2019-01-17","2019-01-19","2020-10-28","2020-10-28","2019-01-15","2020-10-25","2019-01-22","2020-10-25","2020-10-28","2020-10-28","2020-10-25","2020-10-25","2020-10-28","2020-10-28","2020-10-28","2020-10-28"],"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":[["","45802065087","LORATADINE ","TAB 10MG","1","Select","Select",""],["","65757040303","ARISTADA ","INJ 882MG\/3","3.2","Select","Select",""],["","00536136223","NICOTINE ","GUM 2MG","110","Select","Select",""],["","65162010150","GABAPENTIN ","CAP 100MG","30","Select","Select",""],["","67457035959","FLUPHENAZ ","INJ 25MG\/ML","5","Select","Select",""],["","00536106210","STOOL ","CAP 100MG","30","Select","Select",""],["","00603243821","BENZTROPINE ","TAB 1MG","30","Select","Select",""],["","63739047848","DOCUSATE ","CAP 100MG","30","Select","Select",""],["","13668008630","OLANZAPINE ","TAB 5MG ODT","10","Select","Select",""],["","00093435901","CLOZAPINE ","TAB 25MG","5","Select","Select",""],["","50111043301","TRAZODONE ","TAB 50MG","15","Select","Select",""],["","59148001971","ABILIFY ","INJ 400MG","1","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":""}]}]}