{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JASMINE   M LETENDRE","gend":1,"add":"260 SATURN DRIVE                                            ","city":"DRYDEN                        ","state":"VA","zip":"24243-8557","dob":"1995-11-12","age":"","mstatus":"","insh":10192821,"cliId":"","pno":2762750131,"cno":2762750131,"email":"","ename":"","eno":"","pphy":"ALMATARI, ABDULLATIEF                                       ","ppno":"","pcpadd":"127 Health Care Dr","pcpcity":"Pennington Gap                ","pcpstate":"VA","pcpzip":242772853,"pcpcounty":"","pcpid":"P0060078","pcpname":"PENNINGTON FAMILY HEALTH CENTER","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"SOUTHWEST","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"260 SATURN DRIVE                                            ","madd2":"                                                            ","madd3":"","mcity":"DRYDEN                        ","mstate":"VA","mzip":"24243-8557","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F11.20","R68.89","F17.210","F12.11","F15.11","H44.003","H05.013","T78.3XXA","H57.89","T78.40XA","X58.XXXA","F17.200","Q75.3","Z79.899","L23.9","R06.02","R07.9","F10.11","F13.11","F12.10","N63.0","N64.53","Z97.5","Z30.46","Z30.09","Z30.013","Z01.812","Z30.42","H11.431","H10.022","H15.121","R07.89","R05"],"date":["2021-11-08","2021-02-16","2021-11-08","2021-02-03","2021-11-08","2020-07-03","2020-07-03","2020-07-06","2020-07-03","2020-07-03","2020-07-03","2020-07-03","2020-07-03","2020-07-03","2020-07-06","2020-07-06","2020-07-06","2021-11-08","2021-11-08","2021-11-08","2020-10-29","2020-10-29","2020-10-29","2020-11-19","2020-11-19","2020-11-19","2021-02-04","2021-07-07","2021-03-29","2021-04-01","2021-04-01","2021-08-24","2021-08-24"],"priorHcc":[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":[["","12496120803","SUBOXONE","8-2MG","56","Select","Select",""],["","65862057490","MONTELUKAST","10MG","10","Select","Select",""],["","65862085901","FAMOTIDINE","20MG","14","Select","Select",""],["","00093506105","HYDROXYZ","25MG","21","Select","Select",""],["","61314063705","PREDNISOLONE","1% OP","5","Select","Select",""],["","64980051505","OFLOXACIN","0.3% OP","5","Select","Select",""],["","68001043897","LORATADINE","10MG","28","Select","Select",""],["","42806008801","ESTRADIOL","1MG","30","Select","Select",""],["","49483060350","IBUPROFEN","600MG","48","Select","Select",""],["","00069046903","CHANTIX","1MG","28","Select","Select",""],["","69547035302","NARCAN","","2","Select","Select",""],["","50111033402","METRONIDAZOL","500MG","14","Select","Select",""],["","43547026810","ROPINIROLE","0.25MG","30","Select","Select",""],["","00781808926","AZITHROMYCIN","250MG","6","Select","Select",""],["","43598021050","SSD","1%","50","Select","Select",""],["","00054001925","PREDNISONE","50MG","6","Select","Select",""],["","00536110788","NICOTINE ","DIS 14MG\/24H","30","Select","Select",""],["","68001041408","DULOXETINE ","CAP 30MG","30","Select","Select",""],["","12496120803","SUBOXONE ","MIS 8-2MG","56","Select","Select",""],["","65862057490","MONTELUKAST ","TAB 10MG","10","Select","Select",""],["","65862085901","FAMOTIDINE ","TAB 20MG","14","Select","Select",""],["","00093506105","HYDROXYZ ","TAB 25MG","21","Select","Select",""],["","61314063705","PREDNISOLONE ","SUS 1% OP","5","Select","Select",""],["","64980051505","OFLOXACIN ","DRO 0.3% OP","5","Select","Select",""],["","68001043897","LORATADINE ","TAB 10MG","28","Select","Select",""],["","42806008801","ESTRADIOL ","TAB 1MG","30","Select","Select",""],["","49483060350","IBUPROFEN ","TAB 600MG","48","Select","Select",""],["","00069046903","CHANTIX ","PAK 1MG","28","Select","Select",""],["","69547035302","NARCAN ","SPR ","2","Select","Select",""],["","50111033402","METRONIDAZOL ","TAB 500MG","14","Select","Select",""],["","43547026810","ROPINIROLE ","TAB 0.25MG","30","Select","Select",""],["","00781808926","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","43598021050","SSD ","CRE 0.01","50","Select","Select",""],["","00054001925","PREDNISONE ","TAB 50MG","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","",""],["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":""}]}]}