{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KIREENA JOHNSON","gend":1,"add":"2917   MOYER ROAD                                           ","city":"POWHATAN                      ","state":"VA","zip":"23139-7706","dob":"1989-01-04","age":"","mstatus":"","insh":10199063,"cliId":"","pno":3605311718,"cno":"\t8043320230","email":"","ename":"","eno":"","pphy":"CRESS, ALICIA NACPIL                                        ","ppno":"","pcpadd":"3452 Anderson Hwy Ste D                                     ","pcpcity":"Powhatan                      ","pcpstate":"VA","pcpzip":231395845,"pcpcounty":"","pcpid":"P0060117","pcpname":"POWHATAN MEDICAL ASSOCIATES","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"CENTRAL","aligned":"","ano":"","add2":"POWHATAN                      ","add3":"","madd1":"2917   MOYER ROAD                                           ","madd2":"","madd3":"","mcity":"POWHATAN                      ","mstate":"VA","mzip":"23139-7706","pcpfaxno":1831129840,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M62.838","F32.2","R20.0","Z86.69","Z68.25","N30.00","R20.2","G43.B1","Z20.828","J40","S61.225A","S61.205A","L91.8","N97.9","Z68.27","E28.2","G47.00","F41.9","Z31.41","Z30.09","Z68.28","N97.0"],"date":["2020-03-09","2020-03-09","2020-03-09","2020-03-09","2020-03-09","2020-05-19","2020-07-31","2020-07-31","2020-09-16","2020-09-16","2020-11-01","2020-11-01","2020-11-05","2021-05-20","2020-11-05","2020-11-05","2021-03-09","2021-03-09","2021-05-20","2021-01-11","2021-03-09","2021-05-20"],"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":[["","68645057054","CITALOPRAM","20MG","30","Select","Select",""],["","55111017915","TIZANIDINE","2MG","30","Select","Select",""],["","65162027250","SMZ\/TMP","800-160","6","Select","Select",""],["","50111056001","TRAZODONE","50MG","30","Select","Select",""],["","49035091530","OMEPRAZOLE","20MG","30","Select","Select",""],["","13668000701","ZOLPIDEM","5MG","30","Select","Select",""],["","65862052730","VENLAFAXINE","37.5 ER","30","Select","Select",""],["","68645057054","CITALOPRAM ","TAB 20MG","30","Select","Select",""],["","55111017915","TIZANIDINE ","TAB 2MG","30","Select","Select",""],["","65162027250","SMZ\/TMP ","TAB 800-160","6","Select","Select",""],["","50111056001","TRAZODONE ","TAB 50MG","30","Select","Select",""],["","49035091530","OMEPRAZOLE ","TAB 20MG","30","Select","Select",""],["","13668000701","ZOLPIDEM ","TAB 5MG","30","Select","Select",""],["","65862052730","VENLAFAXINE ","CAP 37.5 ER","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","",""],["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":""}]}]}