{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"AARON HUNT","gend":0,"add":"P O BOX 393                                                 ","city":"VANSANT                       ","state":"VA","zip":"24656-0393","dob":"1981-09-11","age":"","mstatus":"","insh":10230293,"cliId":"","pno":2768651041,"cno":2768651041,"email":"","ename":"","eno":"","pphy":"OWENS, DIA P                                                ","ppno":"","pcpadd":"185 Redwood Ave","pcpcity":"Pennington Gap                ","pcpstate":"VA","pcpzip":242772599,"pcpcounty":"","pcpid":"P0060039","pcpname":"THOMPSON FAMILY HEALTH CENTER","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"SOUTHWEST","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"P O BOX 393                                                 ","madd2":"                                                            ","madd3":"","mcity":"VANSANT                       ","mstate":"VA","mzip":"24656-0393","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M47.12","M75.52","K21.9","M54.5","M25.561","M25.511","M62.838","Z79.899","M54.2","M25.562","M25.512","M13.811","E78.2","Z13.29","K30","F31.81","F43.12","I10","K64.5","K62.89","K59.09"],"date":["2021-01-19","2020-06-30","2020-11-20","2020-03-16","2020-03-16","2020-03-18","2020-03-18","2020-05-28","2020-03-18","2020-03-16","2020-03-18","2020-12-18","2020-05-28","2020-05-28","2021-01-19","2020-07-07","2020-07-07","2020-12-18","2020-11-19","2020-11-20","2021-01-19"],"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":[["","50111043301","TRAZODONE","50MG","30","Select","Select",""],["","00093506201","HYDROXYZ","50MG","90","Select","Select",""],["","13668000901","CITALOPRAM","10MG","30","Select","Select",""],["","16714062401","LAMOTRIGINE","50MG ER","30","Select","Select",""],["","31722071390","PANTOPRAZOLE","40MG","30","Select","Select",""],["","55111018010","TIZANIDINE","4MG","60","Select","Select",""],["","68001041103","GABAPENTIN","600MG","90","Select","Select",""],["","00781261305","AMOXICILLIN","500MG","22","Select","Select",""],["","67877032105","IBUPROFEN","800MG","20","Select","Select",""],["","00406012301","HYDROCO\/APAP","5-325MG","12","Select","Select",""],["","29300012510","MELOXICAM","15MG","30","Select","Select",""],["","68001033408","LISINOPRIL","10MG","90","Select","Select",""],["","46122057072","ANTI-GAS","180MG","60","Select","Select",""],["","00904645760","DOK","100MG","60","Select","Select",""],["","00043300520","GAS-X","PREVENT","60","Select","Select",""],["","50111043301","TRAZODONE ","TAB 50MG","30","Select","Select",""],["","00093506201","HYDROXYZ ","TAB 50MG","90","Select","Select",""],["","13668000901","CITALOPRAM ","TAB 10MG","30","Select","Select",""],["","16714062401","LAMOTRIGINE ","TAB 50MG ER","30","Select","Select",""],["","31722071390","PANTOPRAZOLE ","TAB 40MG","30","Select","Select",""],["","55111018010","TIZANIDINE ","TAB 4MG","60","Select","Select",""],["","68001041103","GABAPENTIN ","TAB 600MG","90","Select","Select",""],["","00781261305","AMOXICILLIN ","CAP 500MG","22","Select","Select",""],["","67877032105","IBUPROFEN ","TAB 800MG","20","Select","Select",""],["","00406012301","HYDROCO\/APAP ","TAB 5-325MG","12","Select","Select",""],["","29300012510","MELOXICAM ","TAB 15MG","30","Select","Select",""],["","68001033408","LISINOPRIL ","TAB 10MG","90","Select","Select",""],["","46122057072","ANTI-GAS ","CAP 180MG","60","Select","Select",""],["","00904645760","DOK ","CAP 100MG","60","Select","Select",""],["","00043300520","GAS-X ","CAP PREVENT","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","",""],["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":""}]}]}