{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TANTENIA   J POWELL","gend":1,"add":"2132   HUELL MATTHEWS HIGHWAY                               ","city":"SOUTH BOSTON                  ","state":"VA","zip":"24592-7104","dob":"1991-04-18","age":"","mstatus":"","insh":10121201,"cliId":"","pno":4342227276,"cno":4342227276,"email":"","ename":"","eno":"","pphy":"SUSLICK, RANDALL H                                          ","ppno":"","pcpadd":"115 College St","pcpcity":"Clarksville                   ","pcpstate":"VA","pcpzip":239279125,"pcpcounty":"","pcpid":"P0060096","pcpname":"CLARKSVILLE FAMILY PRACTICE","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"APT 308                                                     ","add3":"","madd1":"2132   HUELL MATTHEWS HIGHWAY                               ","madd2":"APT 308                                                     ","madd3":"","mcity":"SOUTH BOSTON                  ","mstate":"VA","mzip":"24592-7104","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M48.02","S63.612A","M79.644","M79.641","X58.XXXA","S69.91XA","M54.12","M50.30","M25.78","M50.10","E66.01","Z68.42","Z20.828","D64.9","M50.322","I10","M54.2","R10.30","R30.0","R03.0","Z86.79","G43.809","M75.51","Z98.890","J98.8","R05","R50.9","Z20.822","R07.9","U07.1","R43.9","M54.5","R10.31","R10.32","R10.2","R51.9","R10.9","R11.0","Z90.49","R19.8","D25.1","N93.9","E66.9","Z68.41","R00.0","Z97.5","R10.84","D72.829","D25.9","T83.32XA"],"date":["2020-10-28","2020-08-21","2020-08-21","2020-08-21","2020-08-21","2020-08-21","2020-12-18","2020-11-12","2020-10-28","2020-10-28","2021-02-17","2021-02-17","2020-10-28","2020-10-28","2020-10-23","2021-08-23","2020-10-28","2021-08-23","2020-12-10","2020-12-10","2020-12-10","2020-12-18","2021-01-06","2021-01-06","2021-01-08","2021-01-08","2021-01-08","2021-09-19","2021-01-08","2021-01-08","2021-01-08","2021-07-17","2021-07-17","2021-07-17","2021-08-26","2021-07-17","2021-08-24","2021-08-24","2021-07-17","2021-07-17","2021-08-23","2021-08-24","2021-08-23","2021-08-23","2021-08-24","2021-08-23","2021-08-24","2021-08-26","2021-08-24","2021-08-26"],"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":[["","23155000810","HYDROCHLOROT","25MG","30","Select","Select",""],["","31722070090","LOSARTAN","25MG","30","Select","Select",""],["","00603533831","PREDNISONE","10MG","48","Select","Select",""],["","53746010901","HYDROCO\/APAP","5-325MG","30","Select","Select",""],["","00832105410","BACLOFEN","10MG","90","Select","Select",""],["","42858010201","OXYCOD\/APAP","5-325MG","42","Select","Select",""],["","49483060450","IBUPROFEN","800MG","90","Select","Select",""],["","00406048410","APAP\/CODEINE","300-30MG","18","Select","Select",""],["","63304069205","CLINDAMYCIN","150MG","28","Select","Select",""],["","00603254428","BUT\/APAP\/CAF","","28","Select","Select",""],["","00591565810","CYCLOBENZAPR","10MG","90","Select","Select",""],["","69097015807","MELOXICAM","7.5MG","14","Select","Select",""],["","68382033405","TRAMADL\/APAP","37.5-325","30","Select","Select",""],["","63824005632","MUCINEX","30-600ER","20","Select","Select",""],["","62332014930","OLM","20-12.5","12","Select","Select",""],["","65862039010","ONDANSETRON","4MG ODT","30","Select","Select",""],["","00143992801","CIPROFLOXACN","500MG","14","Select","Select",""],["","68462030529","NORETHINDRON","0.35MG","84","Select","Select",""],["","53489011905","DOXYCYCL","100MG","28","Select","Select",""],["","50111033401","METRONIDAZOL","500MG","28","Select","Select",""],["","69918030130","TRANEX","650MG","30","Select","Select",""],["","23155000810","HYDROCHLOROT ","TAB 25MG","30","Select","Select",""],["","31722070090","LOSARTAN ","TAB 25MG","30","Select","Select",""],["","00603533831","PREDNISONE ","PAK 10MG","48","Select","Select",""],["","53746010901","HYDROCO\/APAP ","TAB 5-325MG","30","Select","Select",""],["","00832105410","BACLOFEN ","TAB 10MG","90","Select","Select",""],["","42858010201","OXYCOD\/APAP ","TAB 5-325MG","42","Select","Select",""],["","49483060450","IBUPROFEN ","TAB 800MG","90","Select","Select",""],["","00406048410","APAP\/CODEINE ","TAB 300-30MG","18","Select","Select",""],["","63304069205","CLINDAMYCIN ","CAP 150MG","28","Select","Select",""],["","00603254428","BUT\/APAP\/CAF ","TAB ","28","Select","Select",""],["","00591565810","CYCLOBENZAPR ","TAB 10MG","90","Select","Select",""],["","69097015807","MELOXICAM ","TAB 7.5MG","14","Select","Select",""],["","68382033405","TRAMADL\/APAP ","TAB 37.5-325","30","Select","Select",""],["","63824005632","MUCINEX ","TAB 30-600ER","20","Select","Select",""],["","62332014930","OLM ","TAB 20-12.5","12","Select","Select",""],["","65862039010","ONDANSETRON ","TAB 4MG ODT","30","Select","Select",""],["","00143992801","CIPROFLOXACN ","TAB 500MG","14","Select","Select",""],["","68462030529","NORETHINDRON ","TAB 0.35MG","84","Select","Select",""],["","53489011905","DOXYCYCL ","CAP 100MG","28","Select","Select",""],["","50111033401","METRONIDAZOL ","TAB 500MG","28","Select","Select",""],["","69918030130","TRANEX ","TAB 650MG","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":""}]}]}