{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MICHELLE   C LEE","gend":1,"add":"9505 EASTERN VIEW TRAIL                                     ","city":"FREDERICKSBURG                ","state":"VA","zip":"22408-1733","dob":"1987-07-22","age":"","mstatus":"","insh":10194701,"cliId":"","pno":5712281382,"cno":5712281382,"email":"","ename":"","eno":"","pphy":"GUIRGUIS, EKRAM G                                           ","ppno":"","pcpadd":"4370 Starkey Rd","pcpcity":"Roanoke                       ","pcpstate":"VA","pcpzip":240180603,"pcpcounty":"","pcpid":"P9443221","pcpname":"MARY WASHINGTON HEALTHCARE PHYSICIANS","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"CENTRAL","aligned":"","ano":"","add2":"APARTMENT 106                                               ","add3":"","madd1":"10908 Antelope Trl                                          ","madd2":"                                                            ","madd3":"","mcity":"Fredericksburg                ","mstate":"VA","mzip":"22407-6375","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["O23.40","O21.9","O23.42","O26.892","O99.332","Z87.891","Z3A.16","O71.9","O35.9XX9","O35.5XX1","O99.342","O35.8XX1","F41.9","F39","F60.3","O40.3XX1","O36.63X0","O99.343","O34.211","Z37.0","D50.9","O99.02","Z3A.39","F32.9","O99.344","Z88.2","O77.0","O35.8XX0","O34.219","Z3A.40","P83.88","R21","Z20.828","Z23","N91.1","O36.80X0","O20.0","O46.91","Z3A.10","O20.9","Z3A.08","O03.9","N93.9","R10.2","R10.9","O02.1"],"date":["2019-08-28","2019-08-28","2019-08-28","2019-08-28","2019-08-28","2019-08-28","2019-08-28","2019-08-28","2019-09-05","2020-01-30","2019-12-20","2020-02-05","2021-11-12","2021-11-12","2021-11-12","2020-02-05","2020-02-05","2020-02-05","2020-02-07","2020-02-07","2020-02-06","2020-02-06","2020-02-07","2020-02-07","2020-02-07","2020-02-06","2020-02-07","2020-02-07","2020-02-07","2020-02-07","2020-02-10","2020-02-10","2021-01-29","2021-08-21","2021-09-10","2021-09-10","2021-10-01","2021-10-01","2021-10-02","2021-10-02","2021-10-01","2021-10-02","2021-10-02","2021-10-02","2021-10-02","2021-10-04"],"priorHcc":["","","","","","","","","","","","",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":[["","00228202950","ALPRAZOLAM","0.5MG","60","Select","Select",""],["","42858010201","OXYCOD\/APAP","5-325MG","20","Select","Select",""],["","00172392570","DIAZEPAM","2MG","30","Select","Select",""],["","69097081312","GABAPENTIN","100MG","90","Select","Select",""],["","13668001105","CITALOPRAM","40MG","30","Select","Select",""],["","51991054690","MULTIGEN","FOLIC","60","Select","Select",""],["","00591354360","BUPROPION","150MG SR","60","Select","Select",""],["","43547030403","ARIPIPRAZOLE","10MG","30","Select","Select",""],["","50111045001","TRAZODONE","150MG","30","Select","Select",""],["","00228202950","ALPRAZOLAM ","TAB 0.5MG","60","Select","Select",""],["","42858010201","OXYCOD\/APAP ","TAB 5-325MG","20","Select","Select",""],["","43547030403","ARIPIPRAZOLE ","TAB 10MG","30","Select","Select",""],["","00172392570","DIAZEPAM ","TAB 2MG","30","Select","Select",""],["","69097081312","GABAPENTIN ","CAP 100MG","90","Select","Select",""],["","13668001105","CITALOPRAM ","TAB 40MG","30","Select","Select",""],["","51991054690","MULTIGEN ","TAB FOLIC","60","Select","Select",""],["","50111045001","TRAZODONE ","TAB 150MG","30","Select","Select",""],["","00591354360","BUPROPION ","TAB 150MG SR","60","Select","Select",""],["","00093031401","KETOROLAC ","TAB 10MG","15","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":""}]}]}