{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SHANNON   L MCARTHUR","gend":1,"add":"5222 WHETSTONE ROAD                                         ","city":"NORTH CHESTERFIEL             ","state":"VA","zip":"23234-4324","dob":"1984-06-17","age":"","mstatus":"","insh":10099908,"cliId":"","pno":8047289873,"cno":8047289873,"email":"","ename":"","eno":"","pphy":"REHMAN, SYED A                                              ","ppno":"","pcpadd":"500 Hioaks Rd,SUITE 611","pcpcity":"Richmond                      ","pcpstate":"VA","pcpzip":232254061,"pcpcounty":"","pcpid":"P0114198","pcpname":"PRIMARY HEALTH GROUP INC","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"CENTRAL","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"5222 WHETSTONE ROAD                                         ","madd2":"                                                            ","madd3":"","mcity":"NORTH CHESTERFIEL             ","mstate":"VA","mzip":"23234-4324","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R00.0","R59.1","K11.6","R59.0","E11.9","K11.9","R22.1","E66.9","Z68.32","Z88.2","Z79.4","R05","R06.2","R06.02","Z87.09","K11.8","F17.290"],"date":["2020-09-24","2020-09-24","2020-10-02","2021-08-09","2020-10-12","2020-10-12","2020-10-12","2020-10-12","2020-10-12","2020-10-12","2020-10-12","2020-12-17","2020-12-17","2020-12-17","2020-12-17","2021-08-09","2021-08-09"],"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":[["","00002143480","TRULICITY","1.5\/0.5","6","Select","Select",""],["","00378427577","VALACYCLOVIR","500MG","90","Select","Select",""],["","57237000511","FLUCONAZOLE","150MG","1","Select","Select",""],["","00006027731","JANUVIA ","TAB 100MG","30","Select","Select",""],["","00002143480","TRULICITY ","INJ 1.5\/0.5","6","Select","Select",""],["","00378427577","VALACYCLOVIR ","TAB 500MG","90","Select","Select",""],["","57237000511","FLUCONAZOLE ","TAB 150MG","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":[[["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","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":""}]}]}