{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BRIDGET SILVIOUS","gend":1,"add":"145 JACKSON AVENUE                                          ","city":"NEW MARKET                    ","state":"VA","zip":"22844-9538","dob":"2001-10-23","age":"","mstatus":"","insh":10121770,"cliId":"","pno":5403258254,"cno":5403258254,"email":"","ename":"","eno":"","pphy":"PERKINS, JASON F                                            ","ppno":"","pcpadd":"13737 Spotswood Trl","pcpcity":"Elkton                        ","pcpstate":"VA","pcpzip":228273200,"pcpcounty":"","pcpid":"P9307490","pcpname":"RMH SOUTH MAIN HEALTH CENTER","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"NORTHERN\/ WINCHESTER","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"145 Jackson Ave                                             ","madd2":"                                                            ","madd3":"","mcity":"New Market                    ","mstate":"VA","mzip":"22844-9538","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H66.91","N92.6","N94.6","B34.9","R21","M76.62","M24.572","T78.40XD","R30.0","N39.0","Z01.818","M21.6X2","R20.0","M79.605","M25.572","M67.02","Z98.890","M62.81","Z53.20","J01.90","L25.9","G44.309","F07.81","R51","H57.12","H53.142","Z88.0","Z88.1","Z88.5","Z88.2","Z88.8","H57.89","S06.0X0D","H46.9","G43.109","H74.8X1","M62.830","M53.3","Z11.3","Z30.41","N90.89","M17.12","M89.472","M25.872","M85.872","M19.072","Z11.59","R10.2","N89.8","N76.0","B96.89","R53.83","G43.909"],"date":["2019-01-04","2019-09-18","2019-04-02","2019-03-08","2019-03-08","2019-03-11","2019-07-29","2019-03-14","2021-01-27","2019-04-02","2019-04-10","2019-04-16","2019-04-12","2020-06-08","2021-01-25","2019-08-01","2019-08-01","2019-08-01","2019-07-03","2019-08-26","2019-09-13","2019-10-17","2019-10-17","2019-10-17","2019-10-25","2019-10-25","2019-10-25","2019-10-25","2019-10-25","2019-10-25","2019-10-25","2019-10-25","2019-10-28","2019-10-28","2019-11-26","2019-11-26","2020-01-17","2020-01-17","2020-02-25","2021-09-09","2020-02-25","2020-06-08","2020-06-08","2020-06-08","2020-06-08","2021-01-25","2021-01-27","2021-01-27","2021-01-27","2021-01-27","2021-01-27","2021-09-09","2021-09-09"],"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":[["","00555902658","JUNEL","Jan-20","28","Select","Select",""],["","65162027250","SMZ\/TMP","800-160","10","Select","Select",""],["","68462046599","RIZATRIPTAN","5MG","15","Select","Select",""],["","50111033402","METRONIDAZOL","500MG","14","Select","Select",""],["","63304069301","CLINDAMYCIN","300MG","14","Select","Select",""],["","80777027398","MODERNA","COVID-19","0.5","Select","Select",""],["","00555902658","JUNEL ","TAB 43831","28","Select","Select",""],["","65162027250","SMZ\/TMP ","TAB 800-160","10","Select","Select",""],["","68462046599","RIZATRIPTAN ","TAB 5MG","15","Select","Select",""],["","50111033402","METRONIDAZOL ","TAB 500MG","14","Select","Select",""],["","16714040604","LARIN ","TAB 43831","84","Select","Select",""],["","63304069301","CLINDAMYCIN ","CAP 300MG","14","Select","Select",""],["","80777027398","MODERNA ","INJ COVID-19","0.5","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":""}]}]}