{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DOUGLIS   S GAMBOA","gend":1,"add":"211   BOONE STREET                                          ","city":"WEBER CITY                    ","state":"VA","zip":"24290-8000","dob":"1982-08-01","age":"","mstatus":"","insh":10161407,"cliId":"","pno":8065441557,"cno":"","email":"","ename":"","eno":"","pphy":"ARNETTE, BRYAN THOMAS                                       ","ppno":"","pcpadd":"1754 US Highway 23 N","pcpcity":"Weber City                    ","pcpstate":"VA","pcpzip":242907071,"pcpcounty":"","pcpid":"P9058735","pcpname":"HOLSTON MEDICAL GROUP PC","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"SOUTHWEST","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"211   BOONE STREET                                          ","madd2":"                                                            ","madd3":"","mcity":"WEBER CITY                    ","mstate":"VA","mzip":"24290-8000","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z12.4","Z33.1","Z23","Z36.89","Z3A.28","J06.9","H66.90","O47.1","Z3A.37","Z79.899","Z39.1","Z34.82","Z34.83","O80","Z37.0","Z3A.38","Z3A.39","P59.9","R68.89","F41.1","F33.1","R63.5","K59.09","R35.1","G44.89","O90.89","R51","Z00.00","N81.10","R79.89","N81.2","N81.11","N81.6","R35.0","F42.2","F33.9","Z91.411","N13.5","I44.7","E66.9","Z68.36","F41.8","E04.1","R76.8","G47.00","F43.22","R05","J02.9","J02.0","R10.31","Z20.822"],"date":["2019-02-11","2019-04-01","2020-11-17","2019-02-11","2019-02-11","2019-03-19","2019-03-19","2019-04-11","2019-04-11","2020-06-30","2019-04-18","2019-04-18","2019-04-24","2019-04-24","2019-04-24","2019-04-24","2019-04-24","2019-04-27","2019-06-18","2020-09-22","2020-05-26","2020-05-22","2020-05-08","2020-05-08","2020-05-13","2020-05-13","2020-05-13","2020-05-08","2020-05-11","2020-08-20","2020-06-30","2020-06-30","2020-06-30","2020-08-20","2020-12-09","2020-12-09","2020-09-22","2020-06-30","2020-06-30","2020-06-30","2020-06-30","2020-06-30","2020-08-20","2020-08-20","2020-08-20","2020-08-20","2021-07-01","2021-07-01","2021-07-01","2021-08-20","2021-07-01"],"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":[["","42858010201","OXYCOD\/APAP","5-325MG","12","Select","Select",""],["","59267100003","PFIZER","COVID-19","0.3","Select","Select",""],["","16729031801","OXYBUTYNIN","10MG ER","30","Select","Select",""],["","16714079904","CETIRIZINE","10MG","30","Select","Select",""],["","00185067405","HYDROXYZ","25MG","120","Select","Select",""],["","60505016601","FLUVOXAMINE","100MG","60","Select","Select",""],["","00054327099","FLUTICASONE","50MCG","16","Select","Select",""],["","13107003134","MIRTAZAPINE","15MG","30","Select","Select",""],["","43547034106","RISPERIDONE","1MG","60","Select","Select",""],["","16714081901","OSELTAMIVIR","75MG","10","Select","Select",""],["","24208031510","POLYMYXIN","TRIMETHP","10","Select","Select",""],["","16714040101","CEFUROXIME","500MG","14","Select","Select",""],["","68462019005","NAPROXEN","500MG","20","Select","Select",""],["","42858010201","OXYCOD\/APAP ","TAB 5-325MG","12","Select","Select",""],["","59267100003","PFIZER ","INJ COVID-19","0.3","Select","Select",""],["","16729031801","OXYBUTYNIN ","TAB 10MG ER","30","Select","Select",""],["","16714079904","CETIRIZINE ","TAB 10MG","30","Select","Select",""],["","00185067405","HYDROXYZ ","CAP 25MG","120","Select","Select",""],["","60505016601","FLUVOXAMINE ","TAB 100MG","60","Select","Select",""],["","00054327099","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","13107003134","MIRTAZAPINE ","TAB 15MG","30","Select","Select",""],["","43547034106","RISPERIDONE ","TAB 1MG","60","Select","Select",""],["","16714081901","OSELTAMIVIR ","CAP 75MG","10","Select","Select",""],["","24208031510","POLYMYXIN ","SOL TRIMETHP","10","Select","Select",""],["","16714040101","CEFUROXIME ","TAB 500MG","14","Select","Select",""],["","68462019005","NAPROXEN ","TAB 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":""}]}]}