{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ALESHA   M SHARP","gend":1,"add":"1510   SLEEPY HOLLOW ROAD                                   ","city":"CHRISTIANSBRG                 ","state":"VA","zip":"24073-7610","dob":"1989-03-20","age":"","mstatus":"","insh":10229930,"cliId":"","pno":5405058549,"cno":5405058549,"email":"","ename":"","eno":"","pphy":"BOONE, JOHN A                                               ","ppno":"","pcpadd":"1611 Wenonah Ave","pcpcity":"Pearisburg                    ","pcpstate":"VA","pcpzip":241341839,"pcpcounty":"","pcpid":"P0117715","pcpname":"CARILION FAMILY MEDICINE GILES COUNTY","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"1510   SLEEPY HOLLOW ROAD                                   ","madd2":"                                                            ","madd3":"","mcity":"CHRISTIANSBRG                 ","mstate":"VA","mzip":"24073-7610","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z11.3","R11.10","Z77.21","J45.909","F17.200","Z20.828"],"date":["2020-05-04","2020-08-24","2020-08-24","2020-08-24","2020-08-24","2020-12-02"],"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":[["","59310057922","PROAIR","","8.5","Select","Select",""],["","68682045570","METRONIDAZOL","0.75%VAG","70","Select","Select",""],["","00093317431","ALBUTEROL","E","8.5","Select","Select",""],["","72647033104","METHYLPRED","4MG","21","Select","Select",""],["","62332042671","BENZONATATE","100MG","42","Select","Select",""],["","57237003105","AMOXICILLIN","500MG","20","Select","Select",""],["","55111064505","OMEPRAZOLE","40MG","30","Select","Select",""],["","55111068405","IBU","800MG","30","Select","Select",""],["","43547039950","CYCLOBENZAPR","5MG","42","Select","Select",""],["","43547028211","ESCITALOPRAM","20MG","90","Select","Select",""],["","00093083205","CLONAZEPAM","0.5MG","30","Select","Select",""],["","00054327099","FLUTICASONE","50MCG","16","Select","Select",""],["","00310737020","BUDES\/FORMOT","160-4.5","10","Select","Select",""],["","51224002218","AZITHROMYCIN","250MG","6","Select","Select",""],["","59310057922","PROAIR ","AER ","8.5","Select","Select",""],["","68682045570","METRONIDAZOL ","GEL 0.75%VAG","70","Select","Select",""],["","00093317431","ALBUTEROL ","FAT E","8.5","Select","Select",""],["","72647033104","METHYLPRED ","TAB 4MG","21","Select","Select",""],["","62332042671","BENZONATATE ","CAP 100MG","42","Select","Select",""],["","57237003105","AMOXICILLIN ","CAP 500MG","20","Select","Select",""],["","55111064505","OMEPRAZOLE ","CAP 40MG","30","Select","Select",""],["","55111068405","IBU ","TAB 800MG","30","Select","Select",""],["","43547039950","CYCLOBENZAPR ","TAB 5MG","42","Select","Select",""],["","43547028211","ESCITALOPRAM ","TAB 20MG","90","Select","Select",""],["","00093083205","CLONAZEPAM ","TAB 0.5MG","30","Select","Select",""],["","00054327099","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","00310737020","BUDES\/FORMOT ","AER 160-4.5","10","Select","Select",""],["","51224002218","AZITHROMYCIN ","TAB 250MG","6","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":""}]}]}