{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"WENDY SMITH","gend":1,"add":"108 SHASTA LANE                                             ","city":"TAZEWELL                      ","state":"VA","zip":"24651-9287","dob":"1980-12-14","age":"","mstatus":"","insh":10219562,"cliId":"","pno":2769794425,"cno":2762455025,"email":"","ename":"","eno":"","pphy":"WALKER, TIMOTHY S                                           ","ppno":"","pcpadd":"202 8th St,Ste 101","pcpcity":"RADFORD                       ","pcpstate":"VA","pcpzip":241412426,"pcpcounty":"","pcpid":"P0144984","pcpname":"NEW RIVER VALLEY PEDIATRICS","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"SOUTHWEST","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"108 SHASTA LANE                                             ","madd2":"                                                            ","madd3":"","mcity":"TAZEWELL                      ","mstate":"VA","mzip":"24651-9287","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J06.9","R21","R52","R05","K21.9","J45.909","M54.5","J30.2","G40.909","J45.20","M54.9","J44.9","M25.532","Z98.84","Z90.49","F17.210","B34.9","B37.2","Z98.890","L08.9","Z23","R10.33","D53.1","S31.109A","W19.XXXA","R53.83","R51.9","Z91.14","G43.009"],"date":["2020-02-13","2020-09-21","2020-02-13","2021-09-13","2020-09-10","2020-09-10","2021-02-19","2021-09-13","2021-08-25","2020-05-14","2020-05-14","2020-05-14","2020-07-15","2020-10-05","2020-10-05","2020-07-15","2020-08-09","2020-09-15","2020-09-10","2020-09-21","2020-09-15","2020-10-15","2020-09-29","2020-09-29","2021-02-19","2021-03-11","2021-06-25","2021-06-25","2021-08-25"],"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":[["","11788000110","FOLIC","1MG","30","Select","Select",""],["","69452015120","VITAMIN","50000UNT","4","Select","Select",""],["","64380080707","IBUPROFEN","800MG","90","Select","Select",""],["","00173068220","VENTOLIN","","18","Select","Select",""],["","55111072030","LAMOTRIGINE","200MG ER","30","Select","Select",""],["","45802057178","FEXOFENADINE","180MG","30","Select","Select",""],["","68462039610","OMEPRAZOLE","20MG","30","Select","Select",""],["","66993001968","ALBUTEROL","HFA","18","Select","Select",""],["","47781049005","DOXYCYCL","100MG","14","Select","Select",""],["","60432027504","BROM\/PSE\/DM","","118","Select","Select",""],["","29300022019","MONTELUKAST","10MG","30","Select","Select",""],["","00168005430","NYSTATIN","100000","30","Select","Select",""],["","68382013814","TOPIRAMATE","25MG","120","Select","Select",""],["","69452017173","AZITHROMYCIN","250MG","6","Select","Select",""],["","00904759080","FEROSUL","325MG","30","Select","Select",""],["","70436015541","PROMETHAZINE","DM","120","Select","Select",""],["","65862042005","SMZ\/TMP","800-160","14","Select","Select",""],["","57237009960","CEFDINIR","300MG","14","Select","Select",""],["","59310057922","PROAIR","","8.5","Select","Select",""],["","69452014320","BENZONATATE","100MG","30","Select","Select",""],["","45802006435","TRIAMCINOLON","0.10%","15","Select","Select",""],["","87701041153","GNP","2500MCG","60","Select","Select",""],["","11788000110","FOLIC ","TAB 1MG","30","Select","Select",""],["","69452015120","VITAMIN ","CAP 50000UNT","4","Select","Select",""],["","64380080707","IBUPROFEN ","TAB 800MG","90","Select","Select",""],["","00173068220","VENTOLIN ","AER ","18","Select","Select",""],["","55111072030","LAMOTRIGINE ","TAB 200MG ER","30","Select","Select",""],["","45802057178","FEXOFENADINE ","TAB 180MG","30","Select","Select",""],["","68462039610","OMEPRAZOLE ","CAP 20MG","30","Select","Select",""],["","66993001968","ALBUTEROL ","AER HFA","18","Select","Select",""],["","47781049005","DOXYCYCL ","CAP 100MG","14","Select","Select",""],["","60432027504","BROM\/PSE\/DM ","SYP ","118","Select","Select",""],["","29300022019","MONTELUKAST ","TAB 10MG","30","Select","Select",""],["","00168005430","NYSTATIN ","CRE 100000","30","Select","Select",""],["","68382013814","TOPIRAMATE ","TAB 25MG","120","Select","Select",""],["","69452017173","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","00904759080","FEROSUL ","TAB 325MG","30","Select","Select",""],["","70436015541","PROMETHAZINE ","SOL DM","120","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","14","Select","Select",""],["","57237009960","CEFDINIR ","CAP 300MG","14","Select","Select",""],["","59310057922","PROAIR ","AER ","8.5","Select","Select",""],["","69452014320","BENZONATATE ","CAP 100MG","30","Select","Select",""],["","45802006435","TRIAMCINOLON ","CRE 0.001","15","Select","Select",""],["","87701041153","GNP ","SUB 2500MCG","60","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":""}]}]}