{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ANGEL   K CANTER","gend":1,"add":"440 ARBOR PLACE                                             ","city":"BRISTOL                       ","state":"VA","zip":"24201-4666","dob":"1999-06-10","age":"","mstatus":"","insh":10161309,"cliId":"","pno":2766969051,"cno":2766969051,"email":"","ename":"","eno":"","pphy":"OBUEKWE, UZOMA N                                            ","ppno":"","pcpadd":"24530 Falcon Place Blvd Ste 201","pcpcity":"Abingdon                      ","pcpstate":"VA","pcpzip":242117665,"pcpcounty":"","pcpid":"P9307358","pcpname":"GRACE FAMILY MEDICINE CLINIC LLC","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"SOUTHWEST","aligned":"","ano":"","add2":"APARTMENT 302                                               ","add3":"","madd1":"440 ARBOR PLACE                                             ","madd2":"APARTMENT 302                                               ","madd3":"","mcity":"BRISTOL                       ","mstate":"VA","mzip":"24201-4666","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["O99.334","J09.X2","Z3A.30","Z72.0","R53.83","M79.10","R23.1","R00.0","I95.9","Z79.899","J10.1","J02.9","J11.1","O76","F17.210","Z3A.39","Z37.0","O80","O69.1XX0","O99.52","J45.909","Z39.1","Z34.82","Z34.83","Z23","F32.9","F41.9","Z87.891","Z30.9","R09.82","E78.5","E03.9","D64.9","R73.9","E07.9","J06.9","B34.9","R68.89","J34.89","R05","H43.393","Z03.818","O36.80X0","R10.9","R11.2","R51.9","Z20.822","R10.84","Z32.00","Z36.87","Z34.01","Z3A.10","Z34.91","Z36.3","Z3A.19","Z3A.20","R09.81","H92.01","J21.0","Z34.92","M54.9","Z3A.27","R10.2","R10.31"],"date":["2019-04-09","2019-02-06","2021-11-02","2019-02-06","2019-02-06","2019-02-06","2019-02-06","2021-10-28","2019-02-06","2019-02-06","2019-02-06","2020-03-18","2019-02-07","2019-04-09","2021-05-27","2019-04-09","2019-04-09","2019-04-09","2019-04-09","2019-04-09","2019-04-09","2019-04-09","2019-04-09","2019-04-09","2021-05-26","2021-10-28","2021-10-28","2021-10-28","2021-04-28","2019-06-18","2019-12-05","2019-12-05","2019-12-05","2019-12-05","2021-07-28","2019-12-16","2021-05-27","2020-03-18","2020-01-21","2021-08-27","2021-07-21","2021-01-19","2021-05-12","2021-05-27","2021-05-27","2021-05-27","2021-08-27","2021-05-27","2021-06-01","2021-06-01","2021-06-15","2021-06-15","2021-07-13","2021-08-11","2021-08-11","2021-08-27","2021-08-27","2021-08-27","2021-08-27","2021-09-22","2021-10-12","2021-10-12","2021-11-02","2021-11-19"],"priorHcc":["","",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":[["","60505015801","BUPROPION","75MG","60","Select","Select",""],["","69097087502","BUPROPN","150MG XL","30","Select","Select",""],["","45802043321","DEXTROMETHOR","30MG\/5ML","89","Select","Select",""],["","31722063231","OSELTAMIVIR","75MG","10","Select","Select",""],["","39328010610","PRENATAL","27-1MG","30","Select","Select",""],["","00781808926","AZITHROMYCIN","250MG","6","Select","Select",""],["","60505015801","BUPROPION ","TAB 75MG","60","Select","Select",""],["","47781030301","NITROFURANTN ","CAP 100MG","14","Select","Select",""],["","69097087502","BUPROPN ","TAB 150MG XL","30","Select","Select",""],["","45802043321","DEXTROMETHOR ","SUS 30MG\/5ML","89","Select","Select",""],["","31722063231","OSELTAMIVIR ","CAP 75MG","10","Select","Select",""],["","39328010610","PRENATAL ","TAB 27-1MG","30","Select","Select",""],["","00781808926","AZITHROMYCIN ","TAB 250MG","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":""}]}]}