{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"AMBER BAKER","gend":1,"add":"PO BOX 101","city":"DANTE","state":"VA","zip":"24237-0101","dob":"1987-04-06","age":"","mstatus":"","insh":10123156,"cliId":"","pno":2763951653,"cno":2762542470,"email":"","ename":"","eno":"","pphy":"YOUSUF, SAMINA","ppno":2768890433,"pcpadd":"142 Highland Dr, ","pcpcity":"Lebanon","pcpstate":"VA","pcpzip":242664636,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"SOUTHWEST","aligned":"","ano":2762542470,"add2":"                                                            ","add3":"","madd1":"PO BOX 101","madd2":"                                                            ","madd3":"","mcity":"DANTE","mstate":"VA","mzip":"24237-0101","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F11.20","R68.89","F33.2","E66.09","Z68.35","J01.90","F17.210","Z79.899","I10","M15.0","F41.1","J20.9","G43.009","F33.0","R30.0","E78.2","M54.5","G89.29","Z13.83","Z51.81","F41.0","E78.5","G43.709","H65.02","L03.319","L98.499","R10.9","F17.200","K59.03","J45.20","F41.9","G47.9","F43.10","J44.9","F32.9","F17.290","N94.10","G43.909","L03.211","M79.89","K08.89","F33.1","F31.61","J30.9","J32.9","H10.45","K21.9","M60.9","E04.1","R73.02","R69","M79.641","L53.9","L02.511","Z23","F19.20","Z76.5","Z90.49","R00.2","Z13.89"],"date":["2021-05-16","2020-07-12","2019-09-13","2019-09-13","2019-09-13","2020-01-03","2021-02-08","2020-07-31","2021-05-06","2021-04-07","2021-04-07","2019-08-14","2021-05-06","2020-07-31","2020-07-31","2021-04-07","2021-05-06","2021-03-08","2021-05-06","2019-06-06","2019-04-30","2020-09-14","2020-07-31","2020-09-14","2020-11-19","2020-11-19","2020-11-19","2020-11-19","2021-05-06","2021-02-08","2019-05-21","2019-04-05","2019-04-05","2019-05-21","2019-04-05","2019-05-21","2020-11-09","2019-07-31","2019-09-17","2019-11-06","2019-09-17","2019-01-25","2019-04-12","2019-04-12","2019-04-12","2019-04-12","2019-04-12","2019-04-12","2019-04-12","2019-04-12","2019-11-06","2019-11-06","2019-11-06","2019-11-06","2020-10-12","2019-03-29","2019-03-29","2019-07-31","2020-01-13","2021-05-06"],"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":[["","42543072701","FLUOXETINE ","CAP 40MG","30","Select","Select",""],["","67877032105","IBUPROFEN ","TAB 800MG","90","Select","Select",""],["","66993001968","ALBUTEROL ","AER HFA","18","Select","Select",""],["","71093011105","GABAPENTIN ","TAB 600MG","120","Select","Select",""],["","00115165901","PROPRANOLOL ","TAB 10MG","60","Select","Select",""],["","00228300311","CLONAZEPAM ","TAB 0.5MG","90","Select","Select",""],["","65862017760","CEFDINIR ","CAP 300MG","20","Select","Select",""],["","65862018730","ONDANSETRON ","TAB 4MG","40","Select","Select",""],["","00173068220","VENTOLIN ","AER ","18","Select","Select",""],["","65162089803","ARIPIPRAZOLE ","TAB 10MG","30","Select","Select",""],["","00536110888","NICOTINE ","DIS 21MG\/24H","28","Select","Select",""],["","00143980350","DOXYCYCL ","CAP 100MG","20","Select","Select",""],["","65862018601","CLINDAMYCIN ","CAP 300MG","40","Select","Select",""],["","00135019402","NICODERM ","DIS 21MG\/24H","28","Select","Select",""],["","69315090401","LORAZEPAM ","TAB 0.5MG","30","Select","Select",""],["","00456120230","LINZESS ","CAP 290MCG","30","Select","Select",""],["","70000041503","CLEARLAX ","POW ","510","Select","Select",""],["","00093220305","METOCLOPRAM ","TAB 10MG","20","Select","Select",""],["","00904555159","BANOPHEN ","TAB 25MG","30","Select","Select",""],["","57664037718","TRAMADOL ","TAB 50MG","12","Select","Select",""],["","53746027205","SMZ\/TMP ","TAB 800-160","20","Select","Select",""],["","00093227534","AMOX\/K ","TAB 875-125","20","Select","Select",""],["","47781030301","NITROFURANTN ","CAP 100MG","20","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":""}]}]}