{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KAREY   L CRAFT-FRALIN","gend":1,"add":"179 SPOTTSWOOD AVENUE N","city":"BUCHANAN","state":"VA","zip":"24066-5385","dob":"1976-06-24","age":"","mstatus":"","insh":10199852,"cliId":"","pno":5402931902,"cno":5402931902,"email":"","ename":"","eno":"","pphy":"GLENNEY, ROBERT","ppno":5402541239,"pcpadd":"18080 Main St, ","pcpcity":"Buchanan","pcpstate":"VA","pcpzip":240665482,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"179 SPOTTSWOOD AVENUE N","madd2":"                                                            ","madd3":"","mcity":"BUCHANAN","mstate":"VA","mzip":"24066-5385","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R41.82","R00.0","I51.7","R94.31","F23","F15.19","I10","F32.9","N39.0","K21.9","Z87.891","Z00.8","F15.20","F17.210"],"date":["2019-09-15","2019-09-15","2019-09-15","2019-09-15","2019-09-15","2019-09-15","2020-05-13","2020-05-13","2020-05-13","2020-05-13","2020-05-13","2019-09-15","2019-09-15","2019-09-15"],"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":[["","68180072003","AMLODIPINE ","TAB 5MG","30","Select","Select",""],["","68180051703","LISINOPRIL ","TAB 40MG","30","Select","Select",""],["","13668013710","ESCITALOPRAM ","TAB 20MG","30","Select","Select",""],["","55111064505","OMEPRAZOLE ","CAP 40MG","30","Select","Select",""],["","58657045101","PHENAZOPYRID ","TAB 200MG","10","Select","Select",""],["","13811071910","NITROFURANTN ","CAP 100MG","14","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":""}]}]}