{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MEGAN   S KEEN","gend":1,"add":"240   HOWERTONS BOTTOM ROAD                                 ","city":"DANVILLE                      ","state":"VA","zip":"24540-9998","dob":"1994-12-13","age":"","mstatus":"","insh":10144598,"cliId":"","pno":2762528033,"cno":2762528033,"email":"","ename":"","eno":"","pphy":"RUSZKOWSKI, RONALD J                                        ","ppno":"","pcpadd":"320 Hospital Dr","pcpcity":"Martinsville                  ","pcpstate":"VA","pcpzip":241121900,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"LOT 22                                                      ","add3":"","madd1":"240   HOWERTONS BOTTOM ROAD                                 ","madd2":"LOT 22                                                      ","madd3":"","mcity":"DANVILLE                      ","mstate":"VA","mzip":"24540-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["O23.42","O23.592","B96.89","Z3A.17","Z88.8","Z3A.16","R10.2","O26.92","O09.899","Z3A.00","O09.32","Z3A.20","M62.830","M54.9","Z33.1","O09.33","O99.343","Z3A.34","Z32.01","O99.810","Z34.83","R10.12","O23.593","Z3A.36","N76.0","Z3A.38","O26.893","G25.9","O47.1","R25.9","F41.9","O80","O99.02","Z37.0","D64.9","O90.81","Z39.1","D72.829","K59.00","Z39.2","F41.8","Z30.011","R51","R52","N89.8","Z01.419","Z23","Z30.41","R87.810","Z20.828","S91.201A","W23.0XXA","S91.211A","S99.921A","W17.89XA","N64.4","U07.1","M79.10","R05","Z12.4","N64.52","E66.3","L81.8"],"date":["2019-07-23","2019-07-23","2019-07-23","2019-07-23","2021-08-19","2019-07-23","2019-07-23","2019-07-23","2019-07-29","2019-07-29","2019-08-16","2019-08-16","2019-09-02","2019-09-02","2019-09-02","2019-12-23","2019-12-20","2019-11-21","2019-11-25","2019-11-27","2019-12-25","2019-12-03","2019-12-12","2019-12-12","2020-02-27","2019-12-25","2019-12-20","2019-12-20","2019-12-20","2019-12-20","2020-02-11","2019-12-25","2019-12-25","2019-12-27","2019-12-27","2019-12-27","2019-12-27","2019-12-27","2019-12-27","2020-02-10","2020-07-01","2020-02-10","2020-02-11","2020-02-11","2021-10-13","2021-10-13","2020-07-01","2021-10-13","2020-07-01","2021-08-19","2020-10-21","2020-10-21","2020-10-21","2020-10-21","2020-10-21","2021-04-16","2021-08-19","2021-08-19","2021-08-19","2021-10-13","2021-10-13","2021-10-13","2021-10-13"],"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":[["","00555902658","JUNEL","Jan-20","28","Select","Select",""],["","69097083412","SERTRALINE","50MG","30","Select","Select",""],["","68682045570","METRONIDAZOL","0.75%VAG","70","Select","Select",""],["","50111078810","AZITHROMYCIN","500MG","2","Select","Select",""],["","00378064205","PREDNISONE","20MG","15","Select","Select",""],["","65862039010","ONDANSETRON","4MG ODT","12","Select","Select",""],["","69097014260","ALBUTEROL","HFA","6.7","Select","Select",""],["","68180086573","BLISOVI","Jan-20","28","Select","Select",""],["","51293081101","PHENAZOPYRID","200MG","6","Select","Select",""],["","00555902658","JUNEL ","TAB 43831","28","Select","Select",""],["","69097083412","SERTRALINE ","TAB 50MG","30","Select","Select",""],["","68682045570","METRONIDAZOL ","GEL 0.75%VAG","70","Select","Select",""],["","50111078810","AZITHROMYCIN ","TAB 500MG","2","Select","Select",""],["","00378064205","PREDNISONE ","TAB 20MG","15","Select","Select",""],["","65862039010","ONDANSETRON ","TAB 4MG ODT","12","Select","Select",""],["","69097014260","ALBUTEROL ","AER HFA","6.7","Select","Select",""],["","68180086573","BLISOVI ","TAB 43831","28","Select","Select",""],["","51293081101","PHENAZOPYRID ","TAB 200MG","6","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":""}]}]}