{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TARA   G KING","gend":1,"add":"28041   LEE HIGHWAY                                         ","city":"ABINGDON                      ","state":"VA","zip":"24211-7590","dob":"1997-08-26","age":"","mstatus":"","insh":10175562,"cliId":"","pno":2767801778,"cno":2767801778,"email":"","ename":"","eno":"","pphy":"BRESOWAR, KRISTIN O                                         ","ppno":"","pcpadd":"13168 MEADOWVIEW SQUARE","pcpcity":"MEADOWVIEW                    ","pcpstate":"VA","pcpzip":243610001,"pcpcounty":"","pcpid":"P0112784","pcpname":"MEADOWVIEW HEALTH CLINIC","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"SOUTHWEST","aligned":"","ano":"","add2":"APT 6                                                       ","add3":"","madd1":"28041   LEE HIGHWAY                                         ","madd2":"APT 6                                                       ","madd3":"","mcity":"ABINGDON                      ","mstate":"VA","mzip":"24211-7590","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z30.430","Z32.02","J01.00","F43.10","M79.641","M25.531","S63.501A","S69.91XA","W03.XXXA","S63.8X1A","W01.198A","H66.004","R09.81","L74.8","Z20.2","F32.9","Z30.432","Z01.419","Z11.3","Z11.8","Z32.01","O26.841","Z3A.11","Z34.81","Z11.4","Z36.89","Z36.82","Z3A.12","Z34.82","Z3A.14","O20.9","O46.91","R51.9","R22.40","Z87.59","O20.8","Z3A.15","O46.92","O23.42","Z3A.16","Z36.1","Z3A.19","O35.8XX0","Z36.3","Z3A.21","Z23","Z3A.23","Z3A.25"],"date":["2019-04-24","2019-04-24","2019-12-03","2019-12-30","2020-04-03","2020-04-03","2020-04-03","2020-04-03","2020-04-03","2020-04-03","2020-04-03","2020-06-10","2020-06-10","2020-06-10","2020-10-23","2020-10-23","2021-01-04","2021-07-07","2021-07-07","2021-07-07","2021-07-07","2021-07-19","2021-07-22","2021-07-22","2021-07-22","2021-07-22","2021-08-02","2021-08-02","2021-10-13","2021-08-14","2021-08-15","2021-08-14","2021-08-14","2021-08-14","2021-08-14","2021-08-15","2021-08-20","2021-08-15","2021-08-15","2021-08-27","2021-09-15","2021-09-15","2021-10-25","2021-09-27","2021-09-27","2021-10-13","2021-10-13","2021-10-25"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",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":[["","00781185220","AMOX\/K","875-125","20","Select","Select",""],["","00054327099","FLUTICASONE","50MCG","16","Select","Select",""],["","68180012202","CEPHALEXIN","500MG","14","Select","Select",""],["","16571066401","METRONIDAZOL","500MG","14","Select","Select",""],["","69452017272","AZITHROMYCIN","500MG","2","Select","Select",""],["","16714015901","ONDANSETRON ","TAB 4MG","30","Select","Select",""],["","00781185220","AMOX\/K ","TAB 875-125","20","Select","Select",""],["","00054327099","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","68180012202","CEPHALEXIN ","CAP 500MG","14","Select","Select",""],["","16571066401","METRONIDAZOL ","TAB 500MG","14","Select","Select",""],["","69452017272","AZITHROMYCIN ","TAB 500MG","2","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":""}]}]}