{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"EMMA CAUDILL","gend":1,"add":"13675 N SCENIC HIGHWAY","city":"ROCKY GAP ","state":"VA","zip":"24366-7001","dob":"2002-08-19","age":"","mstatus":"","insh":10177421,"cliId":"","pno":2769701226,"cno":2769705025,"email":"","ename":"","eno":"","pphy":"CREWS, MICHAEL O","ppno":"","pcpadd":"12301 Grapefield Rd, ","pcpcity":"Bastian ","pcpstate":"VA","pcpzip":243144547,"pcpcounty":"","pcpid":"","pcpname":"BLAND COUNTY MEDICAL CLINIC","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"SOUTHWEST","aligned":"","ano":"","add2":"","add3":"","madd1":"13675 N SCENIC HIGHWAY","madd2":"","madd3":"","mcity":"ROCKY GAP ","mstate":"VA","mzip":"24366-7001","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z01.419","N39.0","L70.0","Z79.899","J06.9","J02.0","T23.102A","B37.0","J01.90","B96.89","Z71.3","Z71.82","Z68.52","R09.81","L20.84","J02.9","R52","R50.9","Z11.52","S00.96XA","W57.XXXA","Z30.41","U07.1","Z20.822","R05","R35.0","R39.15"],"date":["2020-07-07","2021-10-12","2021-09-13","2021-09-13","2020-01-03","2019-11-22","2019-11-25","2019-12-16","2020-01-10","2020-01-10","2021-08-25","2021-08-25","2021-08-25","2020-01-31","2020-03-06","2021-03-12","2021-03-12","2021-03-12","2021-08-25","2021-08-03","2021-08-03","2021-08-06","2021-08-25","2021-08-25","2021-08-25","2021-10-12","2021-10-12"],"priorHcc":["",null,null,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":[["","67877021660","CEFUROXIME","500MG","20","Select","Select",""],["","61748030313","MYORISAN","30MG","60","Select","Select",""],["","00555901858","TRI-SPRINTEC","","28","Select","Select",""],["","67877025145","TRIAMCINOLON","0.10%","454","Select","Select",""],["","59762374401","CLINDAMYCIN","10MG\/ML","60","Select","Select",""],["","43598021055","SSD","1%","50","Select","Select",""],["","55111013781","ZENATANE","40MG","60","Select","Select",""],["","69238160706","TRI","","28","Select","Select",""],["","00574220145","TRETINOIN","0.10%","45","Select","Select",""],["","65862064163","AZITHROMYCIN","250MG","6","Select","Select",""],["","59746017509","PREDNISONE","20MG","9","Select","Select",""],["","60432060416","PROMETHAZINE","DM","120","Select","Select",""],["","68180071160","CEFDINIR","300MG","20","Select","Select",""],["","00054327099","FLUTICASONE","50MCG","16","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":""}]}]}