{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CIARA MILES","gend":1,"add":"3040 KIM DRIVE","city":"N CHESTERFIELD","state":"VA","zip":"23224-5643","dob":"1997-03-21","age":"","mstatus":"","insh":10140199,"cliId":"","pno":8045361149,"cno":8045361149,"email":"","ename":"","eno":"","pphy":"SALMAN AKBAR MD","ppno":8043305452,"pcpadd":"949 PINEY FOREST RD, ","pcpcity":"DANVILLE","pcpstate":"VA","pcpzip":245411591,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"CENTRAL","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"3040 KIM DRIVE","madd2":"                                                            ","madd3":"","mcity":"N CHESTERFIELD","mstate":"VA","mzip":"23224-5643","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["P07.39","P22.9","Q61.4","N17.9","N18.4","P61.4","D72.829","P92.8","P74.32","Z97.8","P78.83","Q64.2","Q21.1","I36.1","I37.1","N18.3","Q62.0","Q63.0","N47.1","N47.8","Z98.890","N18.9","Z93.51","Z93.1","Z95.828","Z34.80","Q33.6","P78.89","K63.89","P74.21","P74.421","R06.03","R14.0","N19","R93.429","P81.9","N13.30","G93.0","D64.9","P96.2","N18.5","Z79.899","R13.10","Z96.89","N13.9","D63.1","E87.0","E87.8","N18.6","O80","P84","N13.70","Z46.82","P22.1","R91.8","R63.3"],"date":["2020-09-19","2020-09-15","2020-09-24","2020-09-23","2020-12-07","2020-09-24","2020-09-23","2020-09-24","2020-09-23","2020-09-24","2020-09-10","2020-12-07","2020-09-10","2020-09-10","2020-09-10","2020-09-20","2020-09-07","2020-09-07","2020-09-11","2020-09-11","2020-09-14","2020-09-19","2020-12-07","2020-11-23","2020-11-11","2020-06-30","2020-09-15","2020-09-19","2020-09-19","2020-09-21","2020-09-21","2020-09-25","2020-09-25","2020-09-08","2020-09-08","2020-09-08","2020-09-19","2020-09-20","2020-09-20","2020-09-22","2020-11-11","2020-11-23","2020-11-23","2020-11-23","2020-12-07","2020-12-07","2020-12-07","2020-12-07","2020-09-24","2020-08-24","2020-09-09","2020-09-10","2020-09-11","2020-09-14","2020-09-20","2020-11-03"],"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":[["","00054312041","CALCITRIOL ","SOL 1MCG\/ML","15","Select","Select",""],["","00121059516","SOD ","SOL CITR ACD","270","Select","Select",""],["","00781604158","AMOXICILLIN ","SUS 250\/5ML","80","Select","Select",""],["","55513012610","EPOGEN ","INJ 2000\/ML","9","Select","Select",""],["","55111012960","RANITIDINE ","CAP 150MG","30","Select","Select",""],["","10702001050","HYDROXYZ ","TAB 10MG","60","Select","Select",""],["","45802091987","CETIRIZINE ","TAB 10MG","30","Select","Select",""],["","00052027303","NUVARING ","MIS ","1","Select","Select",""],["","68180071160","CEFDINIR ","CAP 300MG","20","Select","Select",""],["","00378064110","PREDNISONE ","TAB 10MG","60","Select","Select",""],["","50383062750","FERROUS ","DRO 15MG\/ML","50","Select","Select",""],["","70710101002","OSELTAMIVIR ","CAP 75MG","10","Select","Select",""],["","45802005611","GENTAMICIN ","CRE 0.001","30","Select","Select",""],["","59779014175","ACID ","TAB 10MG","60","Select","Select",""],["","51672416403","METRONIDAZOL ","GEL 0.01","60","Select","Select",""],["","43547040611","CLONAZEPAM ","TAB 0.5MG","60","Select","Select",""],["","00054327099","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","65862049647","SMZ-TMP ","SUS 200-40\/5","30","Select","Select",""],["","54859051608","NEPHRONEX ","LIQ 0.9\/5ML","30","Select","Select",""],["","65162019050","NAPROXEN ","TAB 500MG","60","Select","Select",""],["","67877032005","IBUPROFEN ","TAB 600MG","15","Select","Select",""],["","57896010210","ACETAMINOPHE ","TAB 325MG","30","Select","Select",""],["","67877025145","TRIAMCINOLON ","CRE 0.001","454","Select","Select",""],["","67877057305","BENZONATATE ","CAP 100MG","30","Select","Select",""],["","59779035926","TUSSIN "," ","118","Select","Select",""],["","16729020201","BUSPIRONE ","10MG","60","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":""}]}]}