{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"APRIL   L BROWN","gend":1,"add":"1852   OLIVER CREEK  ROAD                                   ","city":"TROY                          ","state":"VA","zip":"22974-4031","dob":"1977-04-10","age":"","mstatus":"","insh":10221917,"cliId":"","pno":4349535878,"cno":4349535878,"email":"","ename":"","eno":"","pphy":"HAWKINS, ANDREW RICHARD                                     ","ppno":"","pcpadd":"29 Jefferson Ct","pcpcity":"Zion Crossroads               ","pcpstate":"VA","pcpzip":229429602,"pcpcounty":"","pcpid":"P9307508","pcpname":"SPRING CREEK FAMILY MEDICINE","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"1852   OLIVER CREEK  ROAD                                   ","madd2":"                                                            ","madd3":"","mcity":"TROY                          ","mstate":"VA","mzip":"22974-4031","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K59.09","Z12.31","F41.1","K21.9","N89.8","M26.622","M25.50","R30.0","Z23","M94.0","R68.84","G89.29","S03.01XA","R10.9","D25.9","D25.1","Z12.4","D25.2","Z20.822","Z11.52","N92.0","Z01.818","R93.41","B34.9","N80.0","R10.84","G89.18","Z09","R82.90","N76.0","K21.00","Z48.89","B96.89","M79.18","M79.641","M79.642","M05.741","R76.8","M05.742"],"date":["2020-05-18","2021-07-22","2021-01-28","2020-06-25","2021-07-26","2020-10-15","2020-09-23","2021-07-08","2020-10-15","2020-11-05","2021-01-28","2021-01-28","2021-01-28","2021-02-17","2021-07-08","2021-05-26","2021-03-25","2021-04-16","2021-09-09","2021-09-09","2021-05-04","2021-05-04","2021-05-04","2021-05-21","2021-05-26","2021-05-26","2021-05-27","2021-07-08","2021-07-08","2021-07-08","2021-07-08","2021-07-26","2021-07-08","2021-09-14","2021-10-29","2021-10-29","2021-11-15","2021-11-15","2021-11-15"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",null,null,null]}},{"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":[["","68645057054","CITALOPRAM","20MG","30","Select","Select",""],["","49035030601","EQ","","119","Select","Select",""],["","50111033402","METRONIDAZOL","500MG","14","Select","Select",""],["","31722071390","PANTOPRAZOLE","40MG","30","Select","Select",""],["","10702000709","CYCLOBENZAPR","10MG","30","Select","Select",""],["","68645056259","IBUPROFEN","600MG","30","Select","Select",""],["","70010075401","METHOCARBAM","500MG","60","Select","Select",""],["","55111014512","FLUCONAZOLE","150MG","2","Select","Select",""],["","68382005005","MELOXICAM","7.5MG","30","Select","Select",""],["","50580050150","TYLENOL","325MG","36","Select","Select",""],["","69784018010","POLYETH","3350 NF","10","Select","Select",""],["","65162083366","DICLOFENAC","1%","100","Select","Select",""],["","42858000101","OXYCODONE","5MG","10","Select","Select",""],["","68645057054","CITALOPRAM ","TAB 20MG","30","Select","Select",""],["","49035030601","EQ ","POW ","119","Select","Select",""],["","50111033402","METRONIDAZOL ","TAB 500MG","14","Select","Select",""],["","31722071390","PANTOPRAZOLE ","TAB 40MG","30","Select","Select",""],["","10702000709","CYCLOBENZAPR ","TAB 10MG","30","Select","Select",""],["","68645056259","IBUPROFEN ","TAB 600MG","30","Select","Select",""],["","70010075401","METHOCARBAM ","TAB 500MG","60","Select","Select",""],["","55111014512","FLUCONAZOLE ","TAB 150MG","2","Select","Select",""],["","59746017310","PREDNISONE ","TAB 10MG","30","Select","Select",""],["","68382005005","MELOXICAM ","TAB 7.5MG","30","Select","Select",""],["","50580050150","TYLENOL ","TAB 325MG","36","Select","Select",""],["","69784018010","POLYETH ","POW 3350 NF","10","Select","Select",""],["","42806040021","METHYLPRED ","TAB 4MG","21","Select","Select",""],["","65162083366","DICLOFENAC ","GEL 0.01","100","Select","Select",""],["","42858000101","OXYCODONE ","TAB 5MG","10","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":""}]}]}