{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JALISHA   S MADDOX","gend":1,"add":"P O BOX 264                                                 ","city":"SOUTH HILL                    ","state":"VA","zip":"23970-9998","dob":"1995-11-11","age":"","mstatus":"","insh":10102683,"cliId":"","pno":4348653440,"cno":4344301092,"email":"","ename":"","eno":"","pphy":"WILLOUGHBY S HUNDLEY III                                    ","ppno":"","pcpadd":"125 Buena Vista Cir","pcpcity":"South Hill                    ","pcpstate":"VA","pcpzip":239701431,"pcpcounty":"","pcpid":"P0124551","pcpname":"CMH PHYSICIAN SERVICES LLC","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"CENTRAL","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"P O BOX 264                                                 ","madd2":"                                                            ","madd3":"","mcity":"SOUTH HILL                    ","mstate":"VA","mzip":"23970-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["A60.00","N39.0","Z68.21","R19.7","F32.1","F41.1","Z01.411","N64.3","Z32.02","Z11.3","R63.5","E01.0","N92.6","Z12.4","Z68.22","U07.1","R43.2","M79.18","S19.9XXA","S49.92XA","S59.902A","S43.402A","R25.2","M25.522","V89.2XXA","S16.1XXA","Z28.21","Z68.24","R10.31","O20.0","O46.91","Z3A.01","O20.8","O23.41","R11.2","O21.9","Z3A.08","J06.9","O21.0","Z87.440","Z3A.09","Z20.822","Z33.1","Z39.1","Z34.82","Z34.83","J32.9","K08.89","K05.10","O47.9","Z3A.00","Z3A.18","Z11.1","Z68.20"],"date":["2019-12-24","2021-08-22","2020-02-05","2020-02-11","2020-09-28","2020-09-28","2020-07-06","2020-07-06","2020-07-06","2020-07-06","2020-07-06","2020-07-06","2020-07-06","2021-07-14","2020-07-06","2020-07-10","2020-07-10","2020-07-10","2020-09-18","2020-09-18","2020-09-18","2020-09-18","2020-09-18","2020-09-25","2020-09-18","2020-09-25","2020-09-25","2020-09-25","2021-06-06","2021-06-22","2021-06-22","2021-06-27","2021-06-22","2021-06-27","2021-07-06","2021-07-06","2021-07-09","2021-07-06","2021-07-09","2021-07-09","2021-07-09","2021-07-09","2021-09-27","2021-08-12","2021-08-12","2021-08-12","2021-09-14","2021-09-14","2021-09-14","2021-09-22","2021-09-22","2021-09-14","2021-10-12","2021-10-12"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",null,null]}},{"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":[["","65162047810","NITROFURANTN","100MG","10","Select","Select",""],["","68382004101","PROMETHAZINE","25MG","60","Select","Select",""],["","00781261305","AMOXICILLIN","500MG","30","Select","Select",""],["","00093220301","METOCLOPRAM","10MG","60","Select","Select",""],["","10702000709","CYCLOBENZAPR","10MG","15","Select","Select",""],["","69784050001","EC-NAPROXEN","500MG","28","Select","Select",""],["","67877021905","CEPHALEXIN","500MG","28","Select","Select",""],["","70010075401","METHOCARBAM","500MG","21","Select","Select",""],["","68382005005","MELOXICAM","7.5MG","15","Select","Select",""],["","57237007710","ONDANSETRON","4MG ODT","6","Select","Select",""],["","00527058601","DICYCLOMINE","10MG","15","Select","Select",""],["","65862044830","VALACYCLOVIR","500MG","30","Select","Select",""],["","65162047810","NITROFURANTN ","CAP 100MG","10","Select","Select",""],["","00093220301","METOCLOPRAM ","TAB 10MG","60","Select","Select",""],["","68382004101","PROMETHAZINE ","TAB 25MG","60","Select","Select",""],["","00781261305","AMOXICILLIN ","CAP 500MG","30","Select","Select",""],["","10702000709","CYCLOBENZAPR ","TAB 10MG","15","Select","Select",""],["","69784050001","EC-NAPROXEN ","TAB 500MG","28","Select","Select",""],["","67877021905","CEPHALEXIN ","CAP 500MG","28","Select","Select",""],["","70010075401","METHOCARBAM ","TAB 500MG","21","Select","Select",""],["","68382005005","MELOXICAM ","TAB 7.5MG","15","Select","Select",""],["","57237007710","ONDANSETRON ","TAB 4MG ODT","6","Select","Select",""],["","00527058601","DICYCLOMINE ","CAP 10MG","15","Select","Select",""],["","65862044830","VALACYCLOVIR ","TAB 500MG","30","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","",""],["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":""}]}]}