{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JAMES   H MUNCY","gend":0,"add":"16010 BLACK HOLLOW  ROAD                                    ","city":"ABINGDON                      ","state":"VA","zip":"24210-9004","dob":"1982-09-15","age":"","mstatus":"","insh":10195785,"cliId":"","pno":2764928383,"cno":"","email":"","ename":"","eno":"","pphy":"HIGINBOTHOM, BRUCE C                                        ","ppno":"","pcpadd":"445 Porterfield Hwy Sw Ste A","pcpcity":"Abingdon                      ","pcpstate":"VA","pcpzip":242102583,"pcpcounty":"","pcpid":"P9058309","pcpname":"ABINGDON FAMILY HEALTHCARE","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"SOUTHWEST","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"16010 BLACK HOLLOW  ROAD                                    ","madd2":"                                                            ","madd3":"","mcity":"ABINGDON                      ","mstate":"VA","mzip":"24210-9004","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F39","F33.1","F41.1","F12.20","S91.114A","R69","W26.8XXA","Z23","M79.674","S91.311A","Z53.29","S91.119A","W25.XXXA","I10","Z72.0","R45.851","F31.9","F15.10","G47.10","F17.210","F31.30","F31.32","F31.81","F33.9","N52.9","Z20.828"],"date":["2020-06-17","2020-06-17","2020-06-17","2020-06-17","2020-06-11","2020-06-11","2020-06-11","2020-06-11","2020-06-11","2020-06-11","2020-06-11","2020-06-11","2020-06-11","2020-11-10","2020-06-11","2020-06-16","2020-06-15","2020-06-15","2020-06-15","2020-06-15","2020-06-16","2020-06-16","2020-07-08","2020-11-10","2020-11-10","2021-04-03"],"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":[["","65862052790","VENLAFAXINE","37.5 ER","90","Select","Select",""],["","68180051902","LISINOP\/HCTZ","20-12.5","90","Select","Select",""],["","00093314705","CEPHALEXIN","500MG","30","Select","Select",""],["","67877043203","ARIPIPRAZOLE","10MG","30","Select","Select",""],["","65862052790","VENLAFAXINE ","CAP 37.5 ER","90","Select","Select",""],["","68180051902","LISINOP\/HCTZ ","TAB 20-12.5","90","Select","Select",""],["","00093314705","CEPHALEXIN ","CAP 500MG","30","Select","Select",""],["","67877043203","ARIPIPRAZOLE ","TAB 10MG","30","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":""}]}]}