{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SAMUEL   A STANLEY","gend":0,"add":"PO BOX 3943                                                 ","city":"WISE                          ","state":"VA","zip":"24293-3943","dob":"1994-10-29","age":"","mstatus":"","insh":10147315,"cliId":"","pno":2763656825,"cno":2763656825,"email":"","ename":"","eno":"","pphy":"WALID SAADO                                                 ","ppno":"","pcpadd":"5476 Dickenson Hwy,Ste 320","pcpcity":"Clintwood                     ","pcpstate":"VA","pcpzip":242287182,"pcpcounty":"","pcpid":"P9058975","pcpname":"POUND COMPREHENSIVE CLINIC","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"SOUTHWEST","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"PO BOX 3943                                                 ","madd2":"                                                            ","madd3":"","mcity":"WISE                          ","mstate":"VA","mzip":"24293-3943","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F11.20","F11.10","F17.200","J45.901","J40","L02.91","J30.9","U07.1","S81.012A","F19.20"],"date":["2021-11-17","2021-11-17","2021-11-17","2020-09-23","2021-02-10","2021-11-29","2021-06-02","2021-05-05","2021-07-14","2021-08-25"],"priorHcc":[null,null,null,"","",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":[["","12496120803","SUBOXONE","8-2MG","11","Select","Select",""],["","66993001968","ALBUTEROL","HFA","18","Select","Select",""],["","00186037020","SYMBICORT","160-4.5","10.2","Select","Select",""],["","00781808926","AZITHROMYCIN","250MG","6","Select","Select",""],["","00069047103","CHANTIX","0.5& 1MG","53","Select","Select",""],["","00054018913","BUPREN\/NALOX","8-2MG","42","Select","Select",""],["","31722055190","LEVOCETIRIZI","5MG","30","Select","Select",""],["","68180050201","MELOXICAM","15MG","30","Select","Select",""],["","69238110002","DOXYCYCL","100MG","20","Select","Select",""],["","12496120803","SUBOXONE ","MIS 8-2MG","11","Select","Select",""],["","66993001968","ALBUTEROL ","AER HFA","18","Select","Select",""],["","00186037020","SYMBICORT ","AER 160-4.5","10.2","Select","Select",""],["","00781808926","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","00069047103","CHANTIX ","PAK 0.5& 1MG","53","Select","Select",""],["","00054018913","BUPREN\/NALOX ","SUB 8-2MG","42","Select","Select",""],["","31722055190","LEVOCETIRIZI ","TAB 5MG","30","Select","Select",""],["","68180050201","MELOXICAM ","TAB 15MG","30","Select","Select",""],["","69238110002","DOXYCYCL ","CAP 100MG","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","",""],["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":""}]}]}