{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BARBARA   H CARTER","gend":1,"add":"149   ARCHIE DRIVE                                          ","city":"MADISON HEIGHTS               ","state":"VA","zip":"24572-4135","dob":"1989-02-18","age":"","mstatus":"","insh":10204269,"cliId":"","pno":4348510883,"cno":4348510883,"email":"","ename":"","eno":"","pphy":"KADREE, MARGARET A                                          ","ppno":"","pcpadd":"320 Federal St","pcpcity":"Lynchburg                     ","pcpstate":"VA","pcpzip":245042306,"pcpcounty":"","pcpid":"P9476162","pcpname":"JOHNSON HEALTH CENTER INTEGRATED SERVICES","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"149   ARCHIE DRIVE                                          ","madd2":"                                                            ","madd3":"","mcity":"MADISON HEIGHTS               ","mstate":"VA","mzip":"24572-4135","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F41.9","O36.80X0","R11.2","J06.9","Z34.82","Z36.3","O09.291","O09.292","Z3A.21","O99.112","D68.59","R03.0","Z23","Z34.83","Z36.89","Z36.5","Z39.1","O13.3","Z3A.32","Z3A.33","Z3A.34","Z3A.35","O99.113","D68.2","O99.820","Z88.1","Z88.5","Z88.0","O36.8130","D68.61","Z3A.36","O13.4","O99.12","O99.824","Z3A.37","Z37.0","Z79.01","O69.1XX0","O80","Z30.2","R30.0","Z39.2","J02.9","Z13.6","M25.561","G89.29","M67.51","M22.2X1","U07.1"],"date":["2019-10-02","2019-10-10","2020-03-06","2020-03-06","2020-06-29","2020-04-21","2020-04-24","2020-04-24","2020-04-24","2020-04-24","2020-04-24","2020-06-18","2020-06-18","2020-08-10","2020-06-18","2020-06-18","2020-06-29","2020-08-12","2020-07-14","2020-07-20","2020-07-28","2020-08-03","2020-08-10","2020-08-10","2020-08-10","2020-08-10","2020-08-10","2020-08-03","2020-08-03","2020-08-12","2020-08-10","2020-08-12","2020-08-12","2020-08-12","2020-08-12","2020-08-12","2020-08-12","2020-08-12","2020-08-12","2020-08-13","2020-09-02","2020-09-24","2020-09-29","2020-10-30","2021-01-19","2021-01-19","2020-12-18","2021-01-19","2021-09-21"],"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":[["","65862042005","SMZ\/TMP","800-160","14","Select","Select",""],["","65162052111","PROMETHAZINE","25MG","20","Select","Select",""],["","13668013601","ESCITALOPRAM","10MG","90","Select","Select",""],["","00955100410","ENOXAPARIN","40\/0.4ML","12","Select","Select",""],["","00574402235","BACITRACIN","OP","3.5","Select","Select",""],["","50428043715","MAGNESIUM","500MG","90","Select","Select",""],["","67877057305","BENZONATATE","100MG","15","Select","Select",""],["","53489011905","DOXYCYCL","100MG","20","Select","Select",""],["","50742026001","NIFEDIPINE","30MG ER","30","Select","Select",""],["","16571020106","DICLOFENAC","75MG DR","60","Select","Select",""],["","65862039010","ONDANSETRON","4MG ODT","10","Select","Select",""],["","59779091934","TUSSIN","10-100\/5","474","Select","Select",""],["","68180012202","CEPHALEXIN","500MG","21","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","14","Select","Select",""],["","65162052111","PROMETHAZINE ","TAB 25MG","20","Select","Select",""],["","13668013601","ESCITALOPRAM ","TAB 10MG","90","Select","Select",""],["","00955100410","ENOXAPARIN ","INJ 40\/0.4ML","12","Select","Select",""],["","00574402235","BACITRACIN ","OIN OP","3.5","Select","Select",""],["","50428043715","MAGNESIUM ","TAB 500MG","90","Select","Select",""],["","67877057305","BENZONATATE ","CAP 100MG","15","Select","Select",""],["","53489011905","DOXYCYCL ","CAP 100MG","20","Select","Select",""],["","50742026001","NIFEDIPINE ","TAB 30MG ER","30","Select","Select",""],["","16571020106","DICLOFENAC ","TAB 75MG DR","60","Select","Select",""],["","65862039010","ONDANSETRON ","TAB 4MG ODT","10","Select","Select",""],["","59779091934","TUSSIN ","LIQ 10-100\/5","474","Select","Select",""],["","68180012202","CEPHALEXIN ","CAP 500MG","21","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":""}]}]}