{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JORDAN   E CURTIS-WILLIS","gend":1,"add":"1534 DOGWOOD ROAD                                           ","city":"POWHATAN                      ","state":"VA","zip":"23139-8025","dob":"1995-10-16","age":"","mstatus":"","insh":10220746,"cliId":"","pno":4344140035,"cno":8043041375,"email":"","ename":"","eno":"","pphy":"ROSE, ANDREW LEE                                            ","ppno":"","pcpadd":"11601 Iron Bridge Rd","pcpcity":"Chester                       ","pcpstate":"VA","pcpzip":238311467,"pcpcounty":"","pcpid":"P0109950","pcpname":"IRONBRIDGE FAMILY PRACTICE","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"CENTRAL","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"16406 Harrowgate Rd                                         ","madd2":"                                                            ","madd3":"","mcity":"Chester                       ","mstate":"VA","mzip":"23831-7313","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z36.3","Z3A.11","R68.89","R05","F17.210","R82.90","A49.3","B96.89","Z13.1","Z3A.27","Z36.85","O34.219","O42.113","Z3A.37","O42.92","D62","O69.81X0","O77.9","Z37.0","D64.9","O76","O86.12","Z20.828","O85","B99.9","O86.4","N71.9","Z98.891","Z12.4","Z39.2","Z30.430","O99.345","F53.0","F41.8","F90.2","F43.23","F98.8","Z51.81","J01.00","Z30.431","N92.1","J32.9","Z20.822","M79.10","B34.9","F41.1","F41.9","J30.2","F32.9","F31.10","F33.1","J06.9","Z68.22","J45.20","F32.1"],"date":["2020-01-03","2020-01-03","2020-01-24","2020-01-24","2021-02-08","2020-04-30","2020-04-30","2020-04-21","2020-02-20","2020-02-20","2020-04-21","2020-05-03","2020-05-03","2020-05-05","2020-05-03","2020-05-03","2020-05-03","2020-05-03","2020-05-03","2020-05-03","2020-05-05","2020-05-05","2021-08-31","2020-05-05","2020-05-05","2020-05-08","2020-05-08","2020-05-08","2020-06-16","2020-06-16","2020-06-16","2020-11-11","2020-11-11","2020-07-13","2020-10-14","2020-10-14","2021-09-28","2020-11-16","2021-02-09","2021-01-11","2021-01-11","2021-03-23","2021-02-08","2021-02-08","2021-02-09","2021-07-19","2021-03-23","2021-03-23","2021-03-23","2021-06-05","2021-07-19","2021-09-10","2021-09-10","2021-09-28","2021-09-28"],"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":[["","64380080707","IBUPROFEN","800MG","30","Select","Select",""],["","00406055201","OXYCODONE","5MG","20","Select","Select",""],["","65862018730","ONDANSETRON","4MG","30","Select","Select",""],["","59417010410","VYVANSE","40MG","30","Select","Select",""],["","68382003516","VENLAFAXINE","75MG ER","30","Select","Select",""],["","69097083412","SERTRALINE","50MG","45","Select","Select",""],["","68180071160","CEFDINIR","300MG","20","Select","Select",""],["","65862050320","AMOX\/K","875-125","20","Select","Select",""],["","68180016013","AZITHROMYCIN","250MG","6","Select","Select",""],["","50111064701","FLUOXETINE","10MG","7","Select","Select",""],["","00093312301","DICLOXACILL","250MG","40","Select","Select",""],["","69238126601","OSELTAMIVIR","75MG","10","Select","Select",""],["","00555088602","ESTRADIOL","1MG","10","Select","Select",""],["","00093770198","LEVOCETIRIZI","5MG","30","Select","Select",""],["","00054327099","FLUTICASONE","50MCG","16","Select","Select",""],["","00603533815","PREDNISONE","10MG","21","Select","Select",""],["","67877054360","CEFDINIR ","CAP 300MG","20","Select","Select",""],["","64380080707","IBUPROFEN ","TAB 800MG","30","Select","Select",""],["","00406055201","OXYCODONE ","TAB 5MG","20","Select","Select",""],["","65862018730","ONDANSETRON ","TAB 4MG","30","Select","Select",""],["","59417010410","VYVANSE ","CAP 40MG","30","Select","Select",""],["","68382003516","VENLAFAXINE ","CAP 75MG ER","30","Select","Select",""],["","69097083412","SERTRALINE ","TAB 50MG","45","Select","Select",""],["","65862050320","AMOX\/K ","TAB 875-125","20","Select","Select",""],["","68180016013","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","50111064701","FLUOXETINE ","CAP 10MG","7","Select","Select",""],["","00093312301","DICLOXACILL ","CAP 250MG","40","Select","Select",""],["","69238126601","OSELTAMIVIR ","CAP 75MG","10","Select","Select",""],["","00555088602","ESTRADIOL ","TAB 1MG","10","Select","Select",""],["","00093770198","LEVOCETIRIZI ","TAB 5MG","30","Select","Select",""],["","00054327099","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","00603533815","PREDNISONE ","PAK 10MG","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":""}]}]}