{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TOM   D SHELTON","gend":0,"add":"340 EAST COURT","city":"ROCKY MOUNT","state":"VA","zip":"24151-1722","dob":"1996-10-14","age":"","mstatus":"","insh":10143862,"cliId":"","pno":4349416624,"cno":4349416624,"email":"","ename":"","eno":"","pphy":"WATERS, MICHAEL G","ppno":4346562224,"pcpadd":"305 N Main St, ","pcpcity":"Gretna","pcpstate":"VA","pcpzip":245574176,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":4347134715,"add2":"APT A7","add3":"","madd1":"340 EAST COURT","madd2":"APT A7","madd3":"","mcity":"ROCKY MOUNT","mstate":"VA","mzip":"24151-1722","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["T50.914A","R41.82","W18.30XA","G92","I49.8","G24.01","F15.129","F11.120","F12.129","D72.823","F17.210","Z78.1","Z95.810","Z91.19","Z81.1","Z81.8","F41.0","R07.2","F19.10","F31.9","Z86.718","Z79.899","F11.20","R06.02","R91.8","F11.99","F11.23","F32.9","F11.11","R40.4","F11.90","Z76.0","G24.9","Z72.0","R74.8","R45.6","R45.89","R68.89","R07.9","R06.89","Z95.0"],"date":["2020-05-06","2020-05-06","2020-05-06","2020-05-07","2020-05-07","2020-05-06","2020-05-06","2020-05-06","2020-05-06","2020-05-07","2021-01-27","2020-05-06","2020-10-21","2020-05-06","2020-05-06","2020-05-06","2020-08-17","2020-08-17","2020-08-17","2020-08-17","2020-08-17","2020-08-17","2021-01-29","2020-10-21","2020-10-21","2021-01-27","2020-08-19","2020-08-19","2021-04-22","2020-05-06","2021-01-27","2021-01-27","2020-05-07","2020-05-07","2020-05-07","2020-08-17","2020-08-17","2020-05-11","2020-10-21","2020-08-17","2020-08-17"],"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":[["","12496120803","SUBOXONE ","MIS 8-2MG","14","Select","Select",""],["","69547035302","NARCAN ","SPR ","2","Select","Select",""],["","68382003516","VENLAFAXINE ","CAP 75MG ER","30","Select","Select",""],["","16729020301","BUSPIRONE ","TAB 15MG","60","Select","Select",""],["","65162019050","NAPROXEN ","TAB 500MG","20","Select","Select",""],["","65862001305","SERTRALINE ","TAB 100MG","10","Select","Select",""],["","47335090588","QUETIAPINE ","TAB 200MG","10","Select","Select",""],["","53489011905","DOXYCYCL ","CAP 100MG","14","Select","Select",""],["","43547035411","LISINOPRIL ","TAB 20MG","21","Select","Select",""],["","42799080601","IVERMECTIN ","TAB 3MG","10","Select","Select",""],["","00832105410","BACLOFEN ","TAB 10MG","270","Select","Select",""],["","00228212750","CLONIDINE ","0.1MG","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":""}]}]}