{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SHANNON SOLTANI","gend":1,"add":"6811 BLOOMSBURY LANE                                        ","city":"SPOTSYLVANIA                  ","state":"VA","zip":"22553-1919","dob":"1989-08-28","age":"","mstatus":"","insh":10100337,"cliId":"","pno":5403956219,"cno":"","email":"","ename":"","eno":"","pphy":"ALEXANDER, DAWN                                             ","ppno":"","pcpadd":"231 Garrisonville Rd","pcpcity":"Stafford                      ","pcpstate":"VA","pcpzip":225541604,"pcpcounty":"","pcpid":"P0114251","pcpname":"RAPPAHANNOCK FAMILY PHYSICIANS","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"CENTRAL","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"6811 BLOOMSBURY LANE                                        ","madd2":"                                                            ","madd3":"","mcity":"SPOTSYLVANIA                  ","mstate":"VA","mzip":"22553-1919","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J10.1","J40","F17.200","M77.9","M25.562","S62.630B","S62.660A","S62.660B","J02.9"],"date":["2019-01-12","2019-01-12","2019-01-12","2020-03-07","2020-03-07","2020-07-12","2020-07-12","2020-07-14","2021-04-24"],"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":[["","67877032105","IBUPROFEN","800MG","15","Select","Select",""],["","68180012202","CEPHALEXIN","500MG","21","Select","Select",""],["","53746010901","HYDROCO\/APAP","5-325MG","12","Select","Select",""],["","00172392670","DIAZEPAM","5MG","2","Select","Select",""],["","70710113803","FLUCONAZOLE","100MG","1","Select","Select",""],["","00378064110","PREDNISONE","10MG","20","Select","Select",""],["","16571020106","DICLOFENAC","75MG DR","60","Select","Select",""],["","68180016013","AZITHROMYCIN","250MG","6","Select","Select",""],["","67877032105","IBUPROFEN ","TAB 800MG","15","Select","Select",""],["","68180012202","CEPHALEXIN ","CAP 500MG","21","Select","Select",""],["","53746010901","HYDROCO\/APAP ","TAB 5-325MG","12","Select","Select",""],["","00172392670","DIAZEPAM ","TAB 5MG","2","Select","Select",""],["","70710113803","FLUCONAZOLE ","TAB 100MG","1","Select","Select",""],["","00378064110","PREDNISONE ","TAB 10MG","20","Select","Select",""],["","16571020106","DICLOFENAC ","TAB 75MG DR","60","Select","Select",""],["","68180016013","AZITHROMYCIN ","TAB 250MG","6","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","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["No","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":""}]}]}