{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"EMMALEE   R ADKINS","gend":1,"add":"709A   RIVERSIDE DRIVE                                      ","city":"LYNCHBURG                     ","state":"VA","zip":"24503-1326","dob":"1998-01-29","age":"","mstatus":"","insh":10232444,"cliId":"","pno":4349418540,"cno":4349418540,"email":"","ename":"","eno":"","pphy":"TRAN, GEORGE M                                              ","ppno":"","pcpadd":"412 Namozine St","pcpcity":"Burkeville                    ","pcpstate":"VA","pcpzip":239223184,"pcpcounty":"","pcpid":"P9058482","pcpname":"CENTRA SOUTHSIDE PROFESSIONAL LLC","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"APARTMENT 28                                                ","add3":"","madd1":"709A   RIVERSIDE DRIVE                                      ","madd2":"APARTMENT 28                                                ","madd3":"","mcity":"LYNCHBURG                     ","mstate":"VA","mzip":"24503-1326","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F33.1","R63.5","Z13.220","Z13.21","Z00.01","Z71.3","Z71.89","R60.9","R10.2","G47.10","N94.89","N70.11","G89.29","F41.9","F32.9","E55.9","E78.5","Z11.59","N83.291","N83.292","E66.01","Z68.41","E78.00","K21.9","Z20.828","F90.9","R07.89","H91.93","F41.8","H90.3","R20.8","R41.0","G43.709","G47.11","N30.00","R30.0","R19.7","Z91.018","R10.11","R10.84","T78.1XXA","R13.10","Z71.9"],"date":["2021-11-11","2020-05-19","2020-05-19","2020-05-19","2021-03-12","2020-07-16","2020-05-19","2020-05-19","2020-07-07","2021-07-21","2020-06-15","2020-07-07","2020-07-07","2020-07-07","2020-07-07","2020-07-07","2020-07-07","2020-07-07","2020-07-13","2020-07-13","2020-08-13","2021-03-12","2020-08-13","2020-08-13","2020-09-04","2021-01-15","2021-02-11","2021-03-12","2021-03-12","2021-05-28","2021-05-28","2021-05-28","2021-05-28","2021-05-28","2021-06-18","2021-06-18","2021-10-05","2021-10-18","2021-10-05","2021-10-18","2021-10-18","2021-11-17","2021-10-01"],"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":[["","69315012710","FOLIC","1000MCG","90","Select","Select",""],["","50428016183","CVS","2000UNIT","90","Select","Select",""],["","10702001801","OXYCODONE","5MG","5","Select","Select",""],["","59779010112","PAIN","500MG","60","Select","Select",""],["","37000074084","METAMUCIL","58.6%ORG","425","Select","Select",""],["","47781030301","NITROFURANTN","100MG","14","Select","Select",""],["","75826011510","PHENAZOPYRID","200MG","6","Select","Select",""],["","42806016005","HYDROXYZ","25MG","40","Select","Select",""],["","69452015120","VITAMIN","50000UNT","12","Select","Select",""],["","67877032105","IBUPROFEN","800MG","90","Select","Select",""],["","69097084507","CYCLOBENZAPR","5MG","90","Select","Select",""],["","69315012710","FOLIC ","TAB 1000MCG","90","Select","Select",""],["","50428016183","CVS ","CAP 2000UNIT","90","Select","Select",""],["","10702001801","OXYCODONE ","TAB 5MG","5","Select","Select",""],["","59779010112","PAIN ","TAB 500MG","60","Select","Select",""],["","37000074084","METAMUCIL ","POW 58.6%ORG","425","Select","Select",""],["","47781030301","NITROFURANTN ","CAP 100MG","14","Select","Select",""],["","75826011510","PHENAZOPYRID ","TAB 200MG","6","Select","Select",""],["","42806016005","HYDROXYZ ","TAB 25MG","40","Select","Select",""],["","69452015120","VITAMIN ","CAP 50000UNT","12","Select","Select",""],["","67877032105","IBUPROFEN ","TAB 800MG","90","Select","Select",""],["","69097084507","CYCLOBENZAPR ","TAB 5MG","90","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":""}]}]}