{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CARROL   A CLEVELAND","gend":0,"add":"11497 ALUM SPRINGS ROAD","city":"RIXEYVILLE","state":"VA","zip":"22737-3004","dob":"1958-03-20","age":"","mstatus":"","insh":10184687,"cliId":"","pno":5407175064,"cno":"               ","email":"","ename":"","eno":"","pphy":"SCHMITZ, NANCY A","ppno":5406723010,"pcpadd":"13198 James Madison Hwy, ","pcpcity":"Orange","pcpstate":"VA","pcpzip":229602808,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"NORTHERN\/ WINCHESTER","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"11497 ALUM SPRINGS ROAD","madd2":"                                                            ","madd3":"","mcity":"RIXEYVILLE","mstate":"VA","mzip":"22737-3004","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["A09","R10.9","D64.9","I10","E78.5","K21.9","D69.59","E83.42","R16.0","F10.230","F10.20","F17.200","Z91.81","Z86.010","Z80.9","K76.0","K80.20","I71.4","K62.5","F10.129","R07.89","W17.89XA","S20.211A","G56.00","Z01.818","S92.311A","M79.671","W19.XXXA","R60.0","S93.321A","K64.9","Z98.890","H40.9","Z83.3","Z84.1","F17.210","K92.2","F10.10","G89.11","R07.82","R45.851","R07.81","F41.9","D50.8","E78.2","K64.8","K62.1","K63.5","K52.9","D50.9","S92.314A","W01.0XXA","Y92.9","R60.9","Z79.899","S92.311D","F17.218","Z91.19","D12.0","D12.3","D12.8","D12.7","R53.81","Z11.59","T24.201A","R07.9","S99.921A","S93.321D","Y90.9","R11.0","K76.9","K70.10","W13.2XXA","W18.39XA","M79.672","R20.2","D69.6","D50.0","R77.8","Z71.2","F10.229","F10.220","Y90.8","J98.11","M79.661","M79.89"],"date":["2019-09-21","2019-09-21","2020-08-20","2020-07-28","2020-08-20","2020-09-18","2019-09-21","2019-09-21","2019-09-21","2019-09-21","2019-09-21","2020-07-28","2019-09-21","2020-09-18","2020-08-20","2019-09-21","2019-09-21","2019-09-21","2020-09-18","2020-03-27","2020-03-27","2020-03-27","2020-03-27","2020-03-27","2020-05-05","2020-05-08","2021-03-09","2020-05-01","2020-06-29","2020-05-04","2020-08-20","2020-08-20","2020-08-20","2020-09-18","2020-08-20","2020-09-18","2020-07-28","2020-07-28","2020-03-27","2020-03-27","2020-03-27","2020-03-27","2020-05-08","2020-04-27","2020-04-27","2020-09-18","2020-09-18","2020-09-18","2019-09-21","2020-09-18","2020-05-01","2020-05-01","2020-05-01","2020-05-01","2020-09-18","2020-08-03","2020-08-03","2020-08-03","2020-09-18","2020-09-18","2020-09-18","2020-09-18","2020-09-18","2020-09-18","2020-01-04","2020-03-10","2020-05-01","2020-06-29","2020-07-28","2020-07-28","2019-09-21","2019-09-21","2020-03-27","2020-05-08","2021-03-09","2021-03-09","2019-09-21","2020-02-27","2020-02-27","2020-02-27","2020-03-10","2020-03-10","2020-03-10","2020-03-10","2020-05-01","2020-05-01"],"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":[["","42858000101","OXYCODONE ","TAB 5MG","7","Select","Select",""],["","50742061510","METOPROL ","TAB 25MG ER","30","Select","Select",""],["","72205000390","ROSUVASTATIN ","TAB 10MG","30","Select","Select",""],["","43547028010","ESCITALOPRAM ","TAB 5MG","30","Select","Select",""],["","00185061505","HYDROXYZ ","CAP 50MG","30","Select","Select",""],["","00555015902","CHLORDIAZEP ","CAP 25MG","54","Select","Select",""],["","43386009019","GAVILYTE-G ","SOL ","4,000.00","Select","Select",""],["","68682010301","DICLOFENAC ","TAB 100MG ER","21","Select","Select",""],["","43598021055","SSD ","CRE 0.01","50","Select","Select",""],["","68180012202","CEPHALEXIN ","CAP 500MG","40","Select","Select",""],["","68462018022","MUPIROCIN ","OIN 0.02","22","Select","Select",""],["","52651000010","WITCH ","PAD CLEANSNG","60","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","",""],["Yes","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":""}]}]}