{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ALISHA   L BURCHFIELD","gend":1,"add":"125   BUS SHOP ROAD                                         ","city":"JONESVILLE                    ","state":"VA","zip":"24263-7851","dob":"2003-02-02","age":"","mstatus":"","insh":10146500,"cliId":"","pno":2762103075,"cno":2768322132,"email":"","ename":"","eno":"","pphy":"VAUGHN, JEFFREY R                                           ","ppno":"","pcpadd":"105 W STONE DRIVE,Ste 3000","pcpcity":"KINGSPORT                     ","pcpstate":"TN","pcpzip":376603365,"pcpcounty":"","pcpid":"P9058721","pcpname":"HOLSTON MEDICAL GROUP PC","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"SOUTHWEST","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"125   BUS SHOP ROAD                                         ","madd2":"                                                            ","madd3":"","mcity":"JONESVILLE                    ","mstate":"VA","mzip":"24263-7851","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["D50.9","E61.1","R05","J01.90","Z30.011","Z30.017","F50.2","N92.0","J40","R50.9","R09.81","R11.10","H92.03","J02.9","N92.1","Z97.8","J30.9","D69.3","K21.9","R53.83","E53.8","Z97.5","R56.9","Z30.9","K58.9","F43.23","G40.309","G43.009","Z68.52","Z79.899","E55.9","Z30.42","R63.6","H43.393","D31.92","M25.562","Z00.129","Z11.3","G43.909","Z23","H52.13","H52.223","Z20.828","U07.1","K35.80","R10.31","J30.2","Z28.21","Z88.2","Z79.3","R10.813","R11.0","K59.00","Z90.49","Z11.1","M54.2","S19.9XXA","M54.6","S39.92XA","S16.1XXA","R51.9","V47.5XXA","Y92.410","S29.012A","N76.0","M79.604","M79.605","M79.661","M79.662","D51.0","Z00.00","Z03.818"],"date":["2020-08-26","2021-01-18","2021-01-18","2019-05-28","2019-02-26","2019-02-26","2019-02-26","2019-08-27","2019-03-11","2019-03-11","2019-03-11","2019-03-11","2019-03-11","2020-08-26","2019-08-27","2019-05-28","2020-02-11","2021-08-27","2020-08-26","2021-08-27","2019-05-28","2019-08-27","2020-12-15","2021-10-19","2019-08-27","2019-10-14","2019-10-10","2019-10-10","2019-10-10","2020-12-15","2020-08-26","2021-04-28","2020-05-19","2019-10-30","2020-11-02","2020-02-11","2020-08-26","2021-04-21","2020-08-26","2021-03-01","2020-11-02","2020-11-02","2020-11-24","2021-01-18","2020-12-16","2020-12-15","2020-12-15","2020-12-15","2020-12-16","2020-12-15","2020-12-15","2020-12-18","2020-12-18","2020-12-18","2021-01-18","2021-01-20","2021-01-20","2021-01-20","2021-01-20","2021-01-20","2021-01-20","2021-01-20","2021-01-20","2021-01-20","2021-04-21","2021-05-03","2021-05-03","2021-05-03","2021-05-03","2021-08-27","2021-08-27","2021-09-19"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","",null,"","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}},{"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":[["","70010075401","METHOCARBAM","500MG","20","Select","Select",""],["","00093094801","DICLOFEN","50MG","15","Select","Select",""],["","76204020030","ALBUTEROL","0.08%","90","Select","Select",""],["","00173069500","ADVAIR","100\/50","60","Select","Select",""],["","59762453701","MEDROXYPR","150MG\/ML","1","Select","Select",""],["","69097083312","SERTRALINE","25MG","30","Select","Select",""],["","55111029209","SUMATRIPTAN","50MG","9","Select","Select",""],["","68382014005","TOPIRAMATE","100MG","60","Select","Select",""],["","30768060693","VITAMIN","1000MCG","30","Select","Select",""],["","59310057922","PROAIR","","17","Select","Select",""],["","00536104105","CETIRIZINE","10MG","30","Select","Select",""],["","00591079501","DICYCLOMINE","20MG","60","Select","Select",""],["","29300022010","MONTELUKAST","10MG","30","Select","Select",""],["","68382070105","POT CHLORIDE","10MEQ ER","30","Select","Select",""],["","43386035701","HYDROCO\/APAP","7.5-325","15","Select","Select",""],["","45802086803","POLYETH","3350 NF","510","Select","Select",""],["","00536106210","STOOL","100MG","60","Select","Select",""],["","68462010530","ONDANSETRON","4MG","30","Select","Select",""],["","70010075401","METHOCARBAM ","TAB 500MG","20","Select","Select",""],["","00093094801","DICLOFEN ","TAB 50MG","15","Select","Select",""],["","76204020030","ALBUTEROL ","NEB 0.00083","90","Select","Select",""],["","00173069500","ADVAIR ","AER 100\/50","60","Select","Select",""],["","59762453701","MEDROXYPR ","INJ 150MG\/ML","1","Select","Select",""],["","69097083312","SERTRALINE ","TAB 25MG","30","Select","Select",""],["","55111029209","SUMATRIPTAN ","TAB 50MG","9","Select","Select",""],["","68382014005","TOPIRAMATE ","TAB 100MG","60","Select","Select",""],["","30768060693","VITAMIN ","TAB 1000MCG","30","Select","Select",""],["","59310057922","PROAIR ","AER ","17","Select","Select",""],["","00536104105","CETIRIZINE ","TAB 10MG","30","Select","Select",""],["","00591079501","DICYCLOMINE ","TAB 20MG","60","Select","Select",""],["","29300022010","MONTELUKAST ","TAB 10MG","30","Select","Select",""],["","68382070105","POT  CHLORIDE","CAP 10MEQ ER","30","Select","Select",""],["","43386035701","HYDROCO\/APAP ","TAB 7.5-325","15","Select","Select",""],["","45802086803","POLYETH ","POW 3350 NF","510","Select","Select",""],["","00536106210","STOOL ","CAP 100MG","60","Select","Select",""],["","68462010530","ONDANSETRON ","TAB 4MG","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":""}]}]}