{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LEWIS   E JONES","gend":0,"add":"157W QUEEN STREET ","city":"STRASBURG ","state":"VA","zip":"22657-2227","dob":"1968-05-22","age":"","mstatus":"","insh":10218474,"cliId":"","pno":5406839152,"cno":5406839152,"email":"","ename":"","eno":"","pphy":"AGYEIWAAH, MAVIS A","ppno":5405351029,"pcpadd":"5060 Valley View Blvd NW, ","pcpcity":"Roanoke ","pcpstate":"VA","pcpzip":240122038,"pcpcounty":"","pcpid":"","pcpname":"VALLEY HEALTH WINCHESTER FAMILY PRACTICE","ano":"","add2":"","add3":"","madd1":"157W QUEEN STREET ","madd2":"","madd3":"","mcity":"STRASBURG ","mstate":"VA","mzip":"22657-2227","pcpfaxno":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"NORTHERN\/ WINCHESTER","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E78.5","I10","R06.09","I50.22","I42.8","E11.9","I11.0","J44.9","Z82.49","Z87.891","Z79.899","Z91.018","E11.42","E78.2","E11.69","I50.9","E66.01","F17.200","M79.671","M15.9","G89.29","M79.672","Z12.5","Z12.11","Z72.0","Z23","Z53.20","M25.511","K04.7","K08.89","D72.829","E55.9","Z00.01","M79.662","L72.3","E66.9","Z28.21","E66.3","E11.65","R06.00"],"date":["2021-09-01","2021-09-01","2020-09-30","2021-09-01","2021-09-01","2021-09-01","2021-05-28","2021-09-01","2020-04-30","2020-04-30","2020-04-30","2020-04-30","2020-03-03","2020-03-03","2020-09-23","2021-04-06","2021-04-06","2021-04-06","2020-05-21","2020-05-21","2020-10-21","2020-05-21","2020-09-22","2021-04-06","2020-09-23","2021-01-06","2020-09-23","2020-10-21","2021-01-03","2021-01-03","2021-01-06","2021-01-06","2021-01-06","2021-01-06","2021-01-06","2021-01-06","2021-04-06","2021-04-06","2021-05-28","2021-09-01"],"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":[["","68462026430","ROSUVASTATIN","40MG","90","Select","Select",""],["","00093317431","ALBUTEROL","E","17","Select","Select",""],["","69097052444","DICLOFENAC","1%","200","Select","Select",""],["","53746051105","SPIRONOLACT","25MG","90","Select","Select",""],["","00054430125","FUROSEMIDE","80MG","90","Select","Select",""],["","60505014202","GLIPIZIDE","10MG","180","Select","Select",""],["","00378363405","CARVEDILOL","25MG","270","Select","Select",""],["","50458014030","INVOKANA","100MG","30","Select","Select",""],["","00078069620","ENTRESTO","97-103MG","60","Select","Select",""],["","65862017601","PENICILLN","500MG","40","Select","Select",""],["","75834002001","VITAMIN","50000UNT","6","Select","Select",""],["","00310620530","FARXIGA","5MG","30","Select","Select",""],["","45802065078","LORATADINE","10MG","30","Select","Select",""],["","00193737701","CONTOUR","NEXT","1","Select","Select",""],["","00193658621","MICROLET","LANCETS","100","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":[[["Yes","Select","","","","","Select","",""],["Yes","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":""}]}]}