{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DEBORAH LUNDBLAD","gend":1,"add":"422 OWEN DRIVE","city":"SUGAR GROVE","state":"VA","zip":"24375-3274","dob":"1966-04-18","age":"","mstatus":"","insh":10122746,"cliId":"","pno":2767808396,"cno":2767808396,"email":"","ename":"","eno":"","pphy":"POWERS, WILLIAM T","ppno":2769352080,"pcpadd":"1532 SLATE CREEK RD, SUITE 101","pcpcity":"GRUNDY","pcpstate":"VA","pcpzip":246146975,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"SOUTHWEST","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"422 OWEN DRIVE","madd2":"                                                            ","madd3":"","mcity":"SUGAR GROVE","mstate":"VA","mzip":"24375-3274","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F33.2","F10.14","R10.9","G89.4","M54.10","M25.512","M25.511","M47.812","M19.012","M19.011","Z01.818","L93.0","Z79.899","I10","D17.9","R11.0","M54.5","G89.29","M54.16","R20.2","M79.604","M79.605","F32.9","Z12.31","G62.9","L29.9","R63.5","F41.1","M32.9","K21.9","M25.519","J04.0","J02.9","F17.210","Z23","S46.912A","M75.22","Z72.0","G56.00","E78.5","S54.00XA","M70.61","G56.03","M54.2","K59.00","J44.9","S39.012A","R06.02","R23.2"],"date":["2021-03-10","2019-03-20","2020-05-21","2019-05-29","2019-11-19","2020-02-24","2019-11-19","2019-11-19","2020-02-24","2019-11-19","2020-02-05","2021-03-16","2021-04-28","2020-12-09","2019-08-13","2019-08-13","2020-12-09","2020-12-09","2020-07-28","2020-07-28","2020-08-18","2020-08-18","2020-08-31","2020-08-31","2020-08-31","2020-08-31","2021-04-29","2020-12-09","2021-04-28","2020-04-08","2020-04-08","2019-07-28","2019-07-28","2019-07-28","2019-10-16","2019-10-16","2019-10-16","2019-07-28","2020-01-03","2020-01-03","2020-01-03","2020-01-03","2020-01-29","2020-02-24","2021-04-29","2021-04-29","2019-04-08","2019-04-08","2020-07-17"],"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":[["","65862066230","ARIPIPRAZOLE ","TAB 5MG","30","Select","Select",""],["","65862001305","SERTRALINE ","TAB 100MG","60","Select","Select",""],["","31604002743","MELATONIN ","TAB 5MG","60","Select","Select",""],["","66993001968","ALBUTEROL ","AER HFA","18","Select","Select",""],["","00781107710","ALPRAZOLAM ","TAB 0.5MG","30","Select","Select",""],["","68462012605","GABAPENTIN ","TAB 600MG","180","Select","Select",""],["","27241009903","DULOXETINE ","CAP 60MG","60","Select","Select",""],["","69238154401","HYDROXYCHLOR ","TAB 200MG","60","Select","Select",""],["","68180098003","LISINOPRIL ","TAB 10MG","90","Select","Select",""],["","31722071390","PANTOPRAZOLE ","TAB 40MG","30","Select","Select",""],["","50111043302","TRAZODONE ","TAB 50MG","30","Select","Select",""],["","00186037220","SYMBICORT ","AER 80-4.5","10.2","Select","Select",""],["","55111018015","TIZANIDINE ","TAB 4MG","540","Select","Select",""],["","00173068220","VENTOLIN ","AER ","18","Select","Select",""],["","70710122700","AMITRIPTYLIN ","TAB 50MG","30","Select","Select",""],["","00046110511","PREMPRO ","TAB 0.3-1.5","28","Select","Select",""],["","23155050105","HYDROXYZ ","TAB 25MG","120","Select","Select",""],["","65862078330","ESOMEPRA ","CAP 20MG DR","90","Select","Select",""],["","70710134403","RAMELTEON ","TAB 8MG","30","Select","Select",""],["","43386048024","ORPHENADRINE ","TAB 100MG ER","60","Select","Select",""],["","00054001825","PREDNISONE ","TAB 20MG","14","Select","Select",""],["","00093101042","MUPIROCIN ","OIN 0.02","22","Select","Select",""],["","00472082902","FLUOCINONIDE ","SOL 0.0005","60","Select","Select",""],["","00591252001","CHLORZOXAZON ","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":""}]}]}