{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MAKHAILA ROBERTS","gend":1,"add":"321 GEORGETOWN COURT                                        ","city":"STEPHENS CITY                 ","state":"VA","zip":"22655-3812","dob":"1996-05-12","age":"","mstatus":"","insh":10128032,"cliId":"","pno":5407717489,"cno":5407717489,"email":"","ename":"","eno":"","pphy":"MIDDELHOF, CHARLES A                                        ","ppno":"","pcpadd":"640 Warrior Dr Ste 109","pcpcity":"Stephens City                 ","pcpstate":"VA","pcpzip":226554076,"pcpcounty":"","pcpid":"P9059168","pcpname":"VALLEY FAMILY AND PROCEDURAL MEDICINE","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"NORTHERN\/ WINCHESTER","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"321 GEORGETOWN COURT                                        ","madd2":"                                                            ","madd3":"","mcity":"STEPHENS CITY                 ","mstate":"VA","mzip":"22655-3812","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["O23.92","Z3A.16","Z34.82","Z13.79","Z34.81","Z36.86","Z36.9","Z3A.19","Z3A.20","D64.9","Z13.1","Z34.83","Z3A.28","Z3A.35","Z36.85","Z3A.36","O26.893","O48.0","R10.84","Z3A.40","O47.1","O80","Z37.0","O99.019","O99.02","O99.52","J45.909","Z87.891","O69.81X0","Z30.42","M25.531","W19.XXXA","M25.561","S83.004A","X58.XXXA","F41.1","N30.00","Z11.3","Z20.2","Z23"],"date":["2019-01-04","2019-01-04","2019-05-24","2019-01-04","2019-01-04","2019-01-30","2019-01-30","2019-01-30","2019-02-13","2019-02-13","2019-04-01","2019-05-24","2019-04-02","2019-05-16","2019-05-24","2019-05-24","2019-06-23","2019-06-23","2019-06-23","2019-06-24","2019-06-23","2019-06-24","2019-06-24","2019-06-24","2019-06-24","2019-06-24","2019-06-24","2019-06-24","2019-06-24","2019-10-21","2019-11-23","2019-11-23","2020-01-21","2020-01-21","2020-01-21","2020-02-18","2020-09-09","2020-09-09","2020-10-12","2020-10-12"],"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":[["","23155065201","METRONIDAZOL","500MG","4","Select","Select",""],["","00781808931","AZITHROMYCIN","250MG","4","Select","Select",""],["","68180065208","DOXYCYC","100MG","14","Select","Select",""],["","80777027398","MODERNA","COVID-19","0.5","Select","Select",""],["","00006022761","ISENTRESS","400MG","60","Select","Select",""],["","61958070101","TRUVADA","200-300","30","Select","Select",""],["","59762500901","CLINDAMYCIN","2% VAG","40","Select","Select",""],["","70710113908","FLUCONAZOLE","150MG","1","Select","Select",""],["","13668001005","CITALOPRAM","20MG","30","Select","Select",""],["","23155065201","METRONIDAZOL ","TAB 500MG","4","Select","Select",""],["","00781808931","AZITHROMYCIN ","TAB 250MG","4","Select","Select",""],["","68180065208","DOXYCYC ","CAP 100MG","14","Select","Select",""],["","80777027398","MODERNA ","INJ COVID-19","0.5","Select","Select",""],["","00006022761","ISENTRESS ","TAB 400MG","60","Select","Select",""],["","61958070101","TRUVADA ","TAB 200-300","30","Select","Select",""],["","59762500901","CLINDAMYCIN ","CRE 2% VAG","40","Select","Select",""],["","70710113908","FLUCONAZOLE ","TAB 150MG","1","Select","Select",""],["","13668001005","CITALOPRAM ","TAB 20MG","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":""}]}]}