{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BONNIE ROLES","gend":1,"add":"25 WOODPARK LANE                                            ","city":"WOODSTOCK                     ","state":"VA","zip":"22664-1823","dob":"1966-07-14","age":"","mstatus":"","insh":10151515,"cliId":"","pno":5403255691,"cno":5403336030,"email":"","ename":"","eno":"","pphy":"CLAUDIA H METHVIN MD PLLC","ppno":"","pcpadd":"227 S Main St","pcpcity":"Woodstock                     ","pcpstate":"VA","pcpzip":226641451,"pcpcounty":"","pcpid":"P9058520","pcpname":"CLAUDIA H METHVIN MD PLLC","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"NORTHERN\/ WINCHESTER","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"25 WOODPARK LANE                                            ","madd2":"                                                            ","madd3":"","mcity":"WOODSTOCK                     ","mstate":"VA","mzip":"22664-1823","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M17.0","E55.9","E78.00","I10","R73.01","R68.89","Z01.419","K76.0","K76.9","R76.8","M25.561","M25.562","R51.9","H53.8","Z87.828","Z82.49","M27.40"],"date":["2020-12-15","2021-08-11","2021-08-11","2021-08-11","2021-08-11","2020-12-10","2020-12-10","2020-12-10","2020-12-10","2020-12-10","2020-12-15","2020-12-15","2021-08-12","2021-07-13","2021-07-13","2021-08-12","2021-08-12"],"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":[["","00093081101","NORTRIPTYLIN","25MG","30","Select","Select",""],["","16571020106","DICLOFENAC","75MG DR","60","Select","Select",""],["","51991081701","PROPRANOLOL","60MG ER","30","Select","Select",""],["","60505294509","EZETIMIBE","10MG","90","Select","Select",""],["","68180098003","LISINOPRIL","10MG","30","Select","Select",""],["","59267100001","PFIZER","COVID-19","0.3","Select","Select",""],["","69097015907","MELOXICAM","15MG","30","Select","Select",""],["","68180098103","LISINOPRIL ","TAB 20MG","90","Select","Select",""],["","00093081101","NORTRIPTYLIN ","CAP 25MG","30","Select","Select",""],["","16571020106","DICLOFENAC ","TAB 75MG DR","60","Select","Select",""],["","51991081701","PROPRANOLOL ","CAP 60MG ER","30","Select","Select",""],["","60505294509","EZETIMIBE ","TAB 10MG","90","Select","Select",""],["","59267100001","PFIZER ","INJ COVID-19","0.3","Select","Select",""],["","69097015907","MELOXICAM ","TAB 15MG","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":""}]}]}