{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KEYOSHA   L MILLER","gend":1,"add":"1301   PARK AVENUE                                          ","city":"LYNCHBURG                     ","state":"VA","zip":"24501-1885","dob":"1991-06-25","age":"","mstatus":"","insh":10191154,"cliId":"","pno":4343632928,"cno":4343632928,"email":"","ename":"","eno":"","pphy":"CLARK, HAL C                                                ","ppno":"","pcpadd":"21556 Timberlake Rd # D,Ste 320","pcpcity":"Lynchburg                     ","pcpstate":"VA","pcpzip":245027234,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"APT 115                                                     ","add3":"","madd1":"1301   PARK AVENUE                                          ","madd2":"APT 115                                                     ","madd3":"","mcity":"LYNCHBURG                     ","mstate":"VA","mzip":"24501-1885","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K04.7","Z32.02","R03.0","L03.211","Z01.419","N76.0","Z30.46","Z30.09","Z30.42","J18.0","Z30.8","Z72.0","B37.3","N92.6","R05","J02.9","J45.20","F33.2","F41.1","R45.851","G47.00","J30.2","F10.10","Z71.3","Z71.82","Z23","R68.83","R06.02","R53.1","R19.7","M79.10","F17.210","Z20.822","J40","K20.80","R07.89","R10.9","K76.9","R07.9"],"date":["2019-11-08","2019-10-31","2019-10-31","2019-11-08","2019-11-14","2019-11-14","2019-11-29","2019-11-29","2021-11-09","2020-01-21","2020-06-12","2021-04-09","2020-06-12","2021-11-09","2021-09-17","2021-09-17","2021-04-02","2021-05-06","2021-05-06","2021-04-02","2021-04-09","2021-04-09","2021-04-09","2021-05-06","2021-05-06","2021-05-06","2021-05-31","2021-05-31","2021-05-31","2021-05-31","2021-05-31","2021-05-31","2021-05-31","2021-09-17","2021-11-18","2021-11-18","2021-11-18","2021-11-18","2021-11-18"],"priorHcc":["","","","","","","","",null,"","","","",null,"","","","","","","","","","","","","","","","","","","","",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":[["","67457088799","MEDROXYPR","150MG\/ML","1","Select","Select",""],["","67405060301","FLUCONAZOLE","150MG","2","Select","Select",""],["","66993001968","ALBUTEROL","HFA","18","Select","Select",""],["","00536589688","NICOTINE","21MG\/24H","28","Select","Select",""],["","67877057505","BENZONATATE","200MG","30","Select","Select",""],["","00054001925","PREDNISONE","50MG","5","Select","Select",""],["","68180016013","AZITHROMYCIN","250MG","6","Select","Select",""],["","23155050105","HYDROXYZ","25MG","60","Select","Select",""],["","43547028111","ESCITALOPRAM","10MG","30","Select","Select",""],["","57237003105","AMOXICILLIN","500MG","20","Select","Select",""],["","60432060816","PROMETHAZINE","6.25\/5ML","240","Select","Select",""],["","45802091987","CETIRIZINE","10MG","30","Select","Select",""],["","17478071710","KETOTIF","0.025%OP","5","Select","Select",""],["","67457088799","MEDROXYPR ","INJ 150MG\/ML","1","Select","Select",""],["","67405060301","FLUCONAZOLE ","TAB 150MG","2","Select","Select",""],["","66993001968","ALBUTEROL ","AER HFA","18","Select","Select",""],["","00536589688","NICOTINE ","DIS 21MG\/24H","28","Select","Select",""],["","67877057505","BENZONATATE ","CAP 200MG","30","Select","Select",""],["","00054001925","PREDNISONE ","TAB 50MG","5","Select","Select",""],["","68180016013","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","23155050105","HYDROXYZ ","TAB 25MG","60","Select","Select",""],["","43547028111","ESCITALOPRAM ","TAB 10MG","30","Select","Select",""],["","57237003105","AMOXICILLIN ","CAP 500MG","20","Select","Select",""],["","60432060816","PROMETHAZINE ","SYP 6.25\/5ML","240","Select","Select",""],["","45802091987","CETIRIZINE ","TAB 10MG","30","Select","Select",""],["","17478071710","KETOTIF ","DRO 0.025%OP","5","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":""}]}]}