{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ELIZABETH   J HALL","gend":1,"add":"11727 ESSEX ROAD","city":"COEBURN","state":"VA","zip":"24230-6725","dob":"1997-12-19","age":"","mstatus":"","insh":10227564,"cliId":"","pno":2763455915,"cno":2763455915,"email":"","ename":"","eno":"","pphy":"NIDA, MAURICE E","ppno":2764660584,"pcpadd":"410 Stagecoach Rd, ","pcpcity":"Bristol","pcpstate":"VA","pcpzip":242018359,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"SOUTHWEST","aligned":"","ano":"","add2":"LOT 10","add3":"","madd1":"11727 ESSEX ROAD","madd2":"LOT 10","madd3":"","mcity":"COEBURN","mstate":"VA","mzip":"24230-6725","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F31.62","F41.8","G43.909","M54.5","F31.9","F43.10","N92.6","J32.0","J30.1","H10.45","J45.20","F41.9","K21.9","F32.9","J18.1","R05","R09.81","J34.89","Z20.828","F17.210","Z79.899","R06.02","Z01.419","M79.641","S69.91XA","M25.531","S63.501A","R26.89","R30.0","M79.10","W18.30XA","Y92.009","F20.9","Z88.1","Z91.041","F17.200","H53.9","J18.9","Z11.59","Z72.0","N92.1","E28.2","Q38.6","L73.1","Z97.5","R68.89"],"date":["2020-09-29","2020-12-16","2020-12-16","2020-12-16","2021-05-06","2021-05-06","2020-03-03","2020-05-08","2020-05-08","2020-05-08","2020-05-08","2020-08-04","2020-11-10","2020-08-04","2020-11-10","2021-01-22","2020-11-10","2020-11-10","2021-01-22","2020-11-10","2020-11-10","2020-11-10","2021-04-26","2020-07-25","2020-07-25","2020-07-25","2020-07-25","2020-07-25","2020-07-07","2020-07-25","2020-07-25","2020-07-25","2020-07-25","2020-07-25","2020-07-25","2020-07-25","2020-09-09","2020-11-10","2020-11-10","2020-11-10","2021-04-26","2021-04-26","2021-04-26","2021-04-26","2021-04-26","2020-03-03"],"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":[["","00378668910","PANTOPRAZOLE ","TAB 40MG","60","Select","Select",""],["","69097083412","SERTRALINE ","TAB 50MG","30","Select","Select",""],["","13668021730","ARIPIPRAZOLE ","TAB 5MG","30","Select","Select",""],["","55111029236","SUMATRIPTAN ","TAB 50MG","6","Select","Select",""],["","00904572872","ALLERGY ","TAB 10MG","30","Select","Select",""],["","69097012403","TOPIRAMATE ","TAB 100MG","30","Select","Select",""],["","61442010301","DICLOFENAC ","TAB 75MG DR","60","Select","Select",""],["","68180016013","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","16729011917","MONTELUKAST ","TAB 10MG","30","Select","Select",""],["","63868015130","LORATADINE ","TAB 10MG","30","Select","Select",""],["","29300011101","LAMOTRIGINE ","TAB 25MG","85","Select","Select",""],["","68645056354","IBUPROFEN ","TAB 800MG","20","Select","Select",""],["","16729044315","BUPROPN ","TAB 150MG XL","30","Select","Select",""],["","29300013905","DIVALPROEX ","TAB 250MG DR","30","Select","Select",""],["","45802008801","ALBUTEROL ","AER HFA","8.5","Select","Select",""],["","33342006707","OLANZAPINE ","TAB 2.5MG","30","Select","Select",""],["","29300012410","MELOXICAM ","7.5MG","30","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","",""],["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":""}]}]}