{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BERTHA   A JENNELLE","gend":1,"add":"409 PEARL STREET","city":"PEARISBURG","state":"VA","zip":"24134-1014","dob":"1969-04-21","age":"","mstatus":"","insh":10144675,"cliId":"","pno":5409227307,"cno":5409227307,"email":"","ename":"","eno":"","pphy":"GRUBE, RICHARD","ppno":2762288686,"pcpadd":"1375 W Ridge Rd, ","pcpcity":"Wytheville","pcpstate":"VA","pcpzip":243825011,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"409 PEARL STREET","madd2":"                                                            ","madd3":"","mcity":"PEARISBURG","mstate":"VA","mzip":"24134-1014","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M25.561","G89.29","K76.0","Z11.59","D50.9","R60.9","I50.9","D64.9","E66.01","R73.9","J06.9","H66.002"],"date":["2020-01-15","2020-01-15","2020-08-18","2020-08-18","2021-04-28","2020-06-05","2020-06-05","2020-07-07","2021-04-28","2021-04-28","2019-01-31","2019-01-31"],"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":[["","57237001830","DULOXETINE ","CAP 30MG","60","Select","Select",""],["","69543025216","VIRTUSSIN ","SOL 100-10\/5","120","Select","Select",""],["","62175047032","PAROXETIN ","TAB 12.5MG","30","Select","Select",""],["","13668009490","PRAMIPEXOLE ","TAB 1MG","30","Select","Select",""],["","16714074703","OMEPRAZOLE ","CAP 20MG","30","Select","Select",""],["","00781261305","AMOXICILLIN ","CAP 500MG","20","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":""}]}]}