{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DIANA   G SAWYER","gend":1,"add":"448 JAYNE HILL CIRCLE                                       ","city":"GATE CITY                     ","state":"VA","zip":"24251-2440","dob":"1988-11-18","age":"","mstatus":"","insh":10169842,"cliId":"","pno":2765942794,"cno":2765942794,"email":"","ename":"","eno":"","pphy":"BLACK, PAUL CLIFFORD                                        ","ppno":"","pcpadd":"390 Kane St","pcpcity":"Gate City                     ","pcpstate":"VA","pcpzip":242512753,"pcpcounty":"","pcpid":"P9058844","pcpname":"MOUNTAIN REGION FAMILY MEDICINE","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"SOUTHWEST","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"448 JAYNE HILL CIRCLE                                       ","madd2":"                                                            ","madd3":"","mcity":"GATE CITY                     ","mstate":"VA","mzip":"24251-2440","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z11.1","O99.89","R10.9","R10.30","R10.811","R11.0","Z3A.01","N91.2","Z32.01","O34.219","F41.9","F32.9","Z34.90","Z23","Z36.9","Z34.82","Z00.00","Z36.3","O44.40","Z34.93","O36.63X0","O13.3","R05","O34.211","O75.9","O69.81X0","Z37.0","Z3A.39","O99.344","O13.4","Z30.2","Z79.899","Z87.891","Z37.9","Z3A.00","F41.8","O99.345","F53.0","Z39.2","R10.2","Z01.419","Z20.828"],"date":["2019-06-26","2019-07-11","2019-07-11","2019-07-11","2019-07-11","2019-07-11","2019-07-11","2019-07-17","2019-08-13","2020-03-12","2020-03-12","2020-03-12","2019-08-13","2020-01-03","2019-10-18","2019-10-18","2019-10-21","2019-12-06","2019-12-06","2020-02-14","2020-02-14","2020-03-09","2020-03-06","2020-03-12","2020-03-12","2020-03-12","2020-03-12","2020-03-12","2020-03-12","2020-03-12","2020-03-12","2020-03-12","2020-03-12","2020-03-12","2020-03-12","2020-03-12","2020-03-25","2020-03-25","2020-03-25","2021-04-14","2021-05-26","2021-08-06"],"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":[["","64380080807","IBUPROFEN","600MG","30","Select","Select",""],["","00406051205","OXYCOD\/APAP","5-325MG","18","Select","Select",""],["","00093005301","BUSPIRONE","5MG","60","Select","Select",""],["","16714081901","OSELTAMIVIR","75MG","10","Select","Select",""],["","50111078751","AZITHROMYCIN","250MG","6","Select","Select",""],["","64380080807","IBUPROFEN ","TAB 600MG","30","Select","Select",""],["","00406051205","OXYCOD\/APAP ","TAB 5-325MG","18","Select","Select",""],["","00093005301","BUSPIRONE ","TAB 5MG","60","Select","Select",""],["","16714081901","OSELTAMIVIR ","CAP 75MG","10","Select","Select",""],["","50111078751","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","",""],["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":""}]}]}