{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"REBECCA   R MONAST","gend":1,"add":"31 TUCSON LANE","city":"ARRINGTON","state":"VA","zip":"22922-2834","dob":"1973-07-12","age":"","mstatus":"","insh":10067267,"cliId":"","pno":4342420357,"cno":"               ","email":"","ename":"","eno":"","pphy":"KOHLI, PRIYA","ppno":5402457950,"pcpadd":"3300 Rivermont Ave, ","pcpcity":"Lynchburg","pcpstate":"VA","pcpzip":245032030,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":4342635154,"add2":"                                                            ","add3":"","madd1":"31 TUCSON LANE","madd2":"                                                            ","madd3":"","mcity":"ARRINGTON","mstate":"VA","mzip":"22922-2834","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R06.2","J06.9","I10","K21.9","K59.04","G58.9","B97.89","M54.2","D50.8","G89.29","R53.1","K44.9","R05","Z95.0","R55","R07.9","Z95.810","I49.01","F17.210","E78.2","I25.5","I25.10","I25.2","Z79.82","Z72.0","H66.92","R93.89","N93.9","R42","F17.200","Z60.9","R41.3","R74.8","R91.8","J43.9","Z12.4","E05.90","R87.610","J20.9","I47.2","G93.1","I42.9","Q24.5","Z86.74","E78.5","I49.3","Z79.899","Z88.2","Z82.49","Z86.2","J44.9","Z23","R79.89","Z86.39"],"date":["2019-05-31","2019-05-31","2021-01-26","2019-12-13","2019-09-13","2019-05-31","2019-05-31","2019-12-13","2021-01-26","2019-12-13","2020-03-11","2020-03-11","2020-03-14","2020-03-14","2020-03-16","2020-03-16","2021-02-04","2021-02-04","2021-02-04","2020-03-25","2020-03-25","2020-03-25","2020-03-25","2021-02-04","2021-02-04","2020-04-30","2021-02-03","2021-02-03","2021-02-04","2021-01-04","2019-09-13","2019-09-13","2020-03-16","2020-03-11","2020-03-11","2021-01-26","2021-01-26","2021-01-26","2019-03-04","2020-03-11","2020-03-11","2020-03-11","2020-03-11","2020-03-11","2020-03-11","2020-03-11","2020-03-11","2020-03-11","2020-03-11","2019-06-28","2019-06-28","2020-12-09","2020-03-10","2019-06-28"],"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":[["","00378668977","PANTOPRAZOLE ","TAB 40MG","30","Select","Select",""],["","43547035510","LISINOPRIL ","TAB 30MG","30","Select","Select",""],["","66993001968","ALBUTEROL ","AER HFA","18","Select","Select",""],["","70010075401","METHOCARBAM ","TAB 500MG","90","Select","Select",""],["","00054001125","FLECAINIDE ","TAB 100MG","270","Select","Select",""],["","57896070301","IRON ","TAB 325MG","30","Select","Select",""],["","00904759080","FEROSUL ","TAB 325MG","30","Select","Select",""],["","00904645760","DOK ","CAP 100MG","60","Select","Select",""],["","11822013729","RA ","CAP 100MG","60","Select","Select",""],["","76385011350","CARVEDILOL ","TAB 25MG","90","Select","Select",""],["","70377003012","ATORVASTATIN ","TAB 80MG","30","Select","Select",""],["","65862018730","ONDANSETRON ","TAB 4MG","20","Select","Select",""],["","67405065155","DOXYCYCL ","CAP 100MG","20","Select","Select",""],["","00173068220","VENTOLIN ","AER ","18","Select","Select",""],["","00054001825","PREDNISONE ","TAB 20MG","10","Select","Select",""],["","43598044828","NICOTINE ","DIS 21MG\/24H","28","Select","Select",""],["","59746012206","MECLIZINE ","TAB 12.5MG","30","Select","Select",""],["","68180072003","AMLODIPINE ","TAB 5MG","30","Select","Select",""],["","59762005601","MEDROXYPR ","TAB 10MG","63","Select","Select",""],["","00245010801","FERROUS ","TAB 325MG EC","30","Select","Select",""],["","42571016242","AMOX\/K ","TAB 875-125","14","Select","Select",""],["","59779044374","CVS ","DIS 7MG\/24HR","28","Select","Select",""],["","11822033209","ALLERGY ","CAP 25MG","30","Select","Select",""],["","60505036302","OFLOXACIN ","DRO 0.3%OTIC","10","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":""}]}]}