{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"STEPHANIE   D GOODWIN","gend":1,"add":"265   PINEVIEW ROAD                                         ","city":"DANVILLE                      ","state":"VA","zip":"24541-8602","dob":"1991-02-13","age":"","mstatus":"","insh":10122664,"cliId":"","pno":4342504703,"cno":4346853808,"email":"","ename":"","eno":"","pphy":"LAHURD JR, NEIL J                                           ","ppno":"","pcpadd":"949 PINEY FOREST RD","pcpcity":"DANVILLE                      ","pcpstate":"VA","pcpzip":245401591,"pcpcounty":"","pcpid":"P9058674","pcpname":"GODOCS","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"LOT 41                                                      ","add3":"","madd1":"265   PINEVIEW ROAD                                         ","madd2":"LOT 41                                                      ","madd3":"","mcity":"DANVILLE                      ","mstate":"VA","mzip":"24541-8602","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["L20.89","F11.20","L30.9","L30.1","L81.0","F14.10","F11.10","Z88.2","Z79.899","Z01.419","Z32.01","Z34.81","O34.531","O36.8310","Z3A.08","N85.4","Z3A.09","O99.321","O99.611","Z3A.12","Z36.87","K59.00","O99.322","Z3A.13","Z3A.17","Z34.90","Z3A.20","Z36.89","F41.1","Z68.22","Z13.89","Z3A.24","Z3A.29","O99.323","O26.893","O35.8XX0","O99.343","O28.3","Z3A.31","Z67.11","F41.0","O35.9XX0","Z3A.33","O36.8130","O26.813","R42","O21.2","Z3A.35","F41.9","Z3A.37","Z3A.39","Z11.59","F11.21","O70.0","O99.325","Z37.0","O80","O99.324","O99.02","D64.9","Z39.1","O99.03","D72.829","F40.11","F90.2","Z68.26","Z39.2","F90.0","F32.89","G47.00","G43.019","Z13.9","F31.81"],"date":["2019-01-08","2020-12-23","2019-01-31","2019-01-31","2019-01-31","2019-04-02","2019-04-02","2019-04-02","2020-12-16","2019-10-02","2020-07-29","2020-02-21","2020-02-24","2020-02-24","2020-02-24","2020-02-24","2020-02-24","2020-03-05","2020-03-05","2020-03-05","2020-03-17","2020-09-28","2020-07-16","2020-04-02","2020-04-29","2020-09-25","2020-05-20","2020-07-16","2021-11-21","2020-06-17","2020-06-17","2020-06-18","2020-07-20","2020-09-25","2020-07-29","2020-08-12","2020-08-26","2020-07-16","2020-07-29","2020-09-11","2020-09-25","2020-07-20","2020-08-15","2020-09-11","2020-08-15","2020-08-15","2020-08-15","2020-08-26","2020-08-26","2020-09-11","2020-09-27","2020-09-25","2020-09-25","2020-09-27","2020-09-29","2020-09-29","2020-09-27","2020-09-27","2020-09-27","2020-09-28","2020-09-29","2020-09-28","2020-09-28","2020-11-02","2020-11-02","2021-01-20","2020-11-30","2021-01-20","2021-01-07","2021-01-07","2021-01-07","2021-01-07","2021-11-21"],"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":[["","65862067899","ALPRAZOLAM","1MG","120","Select","Select",""],["","42858050203","BUPRENORPHIN","8MG","11","Select","Select",""],["","43547028111","ESCITALOPRAM","10MG","30","Select","Select",""],["","00555097302","AMPHET\/DEXTR","20MG","60","Select","Select",""],["","59417010510","VYVANSE","50MG","30","Select","Select",""],["","47781030301","NITROFURANTN","100MG","14","Select","Select",""],["","00904645760","DOK","100MG","30","Select","Select",""],["","68462010530","ONDANSETRON","4MG","15","Select","Select",""],["","64380080807","IBUPROFEN","600MG","20","Select","Select",""],["","13668000805","ZOLPIDEM","10MG","30","Select","Select",""],["","63304069201","CLINDAMYCIN","150MG","28","Select","Select",""],["","16729044316","BUPROPN","150MG XL","30","Select","Select",""],["","23155002305","BUSPIRONE","5MG","60","Select","Select",""],["","57237017501","VENLAFAXINE","75MG","30","Select","Select",""],["","29300013201","ZALEPLON","10MG","30","Select","Select",""],["","65162075750","DIVALPROEX","500MG ER","60","Select","Select",""],["","50111043303","TRAZODONE","50MG","30","Select","Select",""],["","65862067899","ALPRAZOLAM ","TAB 1MG","120","Select","Select",""],["","42858050203","BUPRENORPHIN ","SUB 8MG","11","Select","Select",""],["","43547028111","ESCITALOPRAM ","TAB 10MG","30","Select","Select",""],["","00555097302","AMPHET\/DEXTR ","TAB 20MG","60","Select","Select",""],["","13668000810","ZOLPIDEM ","TAB 10MG","30","Select","Select",""],["","59417010510","VYVANSE ","CAP 50MG","30","Select","Select",""],["","47781030301","NITROFURANTN ","CAP 100MG","14","Select","Select",""],["","70461032103","FLUCLVX ","INJ 2021-22","0.5","Select","Select",""],["","00904645760","DOK ","CAP 100MG","30","Select","Select",""],["","68462010530","ONDANSETRON ","TAB 4MG","15","Select","Select",""],["","64380080807","IBUPROFEN ","TAB 600MG","20","Select","Select",""],["","63304069201","CLINDAMYCIN ","CAP 150MG","28","Select","Select",""],["","16729044316","BUPROPN ","TAB 150MG XL","30","Select","Select",""],["","23155002305","BUSPIRONE ","TAB 5MG","60","Select","Select",""],["","57237017501","VENLAFAXINE ","TAB 75MG","30","Select","Select",""],["","29300013201","ZALEPLON ","CAP 10MG","30","Select","Select",""],["","65162075750","DIVALPROEX ","TAB 500MG ER","60","Select","Select",""],["","50111043303","TRAZODONE ","TAB 50MG","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","",""],["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":""}]}]}