{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"AIYANA   Q WILLIAMS","gend":1,"add":"110 SPRING HILL DRIVE                                       ","city":"EMPORIA                       ","state":"VA","zip":"23847-6750","dob":"1997-12-03","age":"","mstatus":"","insh":10141320,"cliId":"","pno":4343781971,"cno":4343781971,"email":"","ename":"","eno":"","pphy":"MARCELIN, FITZGERALD ","ppno":"","pcpadd":"702 N Main St","pcpcity":"Emporia                       ","pcpstate":"VA","pcpzip":238471242,"pcpcounty":"","pcpid":"P9409736","pcpname":"EMPORIA GREENSVILLE MEDICAL CENTER","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"CENTRAL","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"110 SPRING HILL DRIVE                                       ","madd2":"                                                            ","madd3":"","mcity":"EMPORIA                       ","mstate":"VA","mzip":"23847-6750","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["O20.8","O41.8X90","O46.8X9","Z3A.32","Z3A.34","Z3A.36","Z3A.37","O26.893","O64.5XX0","Z3A.38","Z37.0","P78.89","P02.69","K21.9","K59.00"],"date":["2020-08-05","2020-08-05","2020-08-05","2020-08-05","2020-08-05","2020-08-05","2020-09-08","2020-09-08","2020-09-15","2020-09-15","2020-09-15","2020-10-10","2020-10-10","2020-10-19","2020-10-19"],"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":[["","69784018014","POLYETH","3350 NF","28","Select","Select",""],["","65162047810","NITROFURANTN","100MG","14","Select","Select",""],["","59746011506","PROCHLORPER","10MG","20","Select","Select",""],["","49035030882","PAIN","500MG","30","Select","Select",""],["","00904530660","BANOPHEN","25MG","24","Select","Select",""],["","49483060450","IBUPROFEN","800MG","30","Select","Select",""],["","57896070310","IRON","325MG","30","Select","Select",""],["","69784018014","POLYETH ","POW 3350 NF","28","Select","Select",""],["","65162047810","NITROFURANTN ","CAP 100MG","14","Select","Select",""],["","59746011506","PROCHLORPER ","TAB 10MG","20","Select","Select",""],["","49035030882","PAIN ","TAB 500MG","30","Select","Select",""],["","00904530660","BANOPHEN ","CAP 25MG","24","Select","Select",""],["","49483060450","IBUPROFEN ","TAB 800MG","30","Select","Select",""],["","57896070310","IRON ","TAB 325MG","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":""}]}]}