{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JESSICA   L SMITH","gend":1,"add":"39   JORDAN  ROAD                                           ","city":"BUENA VISTA                   ","state":"VA","zip":"24416-4423","dob":"1987-04-14","age":"","mstatus":"","insh":10234801,"cliId":"","pno":5405697443,"cno":7155400386,"email":"","ename":"","eno":"","pphy":"HAMILTON, THOMAS F                                          ","ppno":"","pcpadd":"2252 Magnolia Ave","pcpcity":"Buena Vista                   ","pcpstate":"VA","pcpzip":244163122,"pcpcounty":"","pcpid":"P0117978","pcpname":"BUENA VISTA MEDICAL ASSOCIATES","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"APT 1                                                       ","add3":"","madd1":"39   JORDAN  ROAD                                           ","madd2":"APT 1                                                       ","madd3":"","mcity":"BUENA VISTA                   ","mstate":"VA","mzip":"24416-4423","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I45.89","R07.9","R20.0","R11.10","R20.2","E87.6","G44.209","R10.9","Z20.2","Z20.822","R43.2","F33.2","M32.9","N30.00","M25.562","S80.212A","Y09","M54.2","V87.8XXA","Y08.89XA","M54.5","M54.6","M79.641","R51.9","S00.83XA","S20.222A","S30.0XXA","S00.03XA","S60.221A","M79.89","T07.XXXA","T14.90XA","V89.9XXA","Y93.9","Y92.9","S80.812A","S00.11XA","F17.210","R10.2","R09.81","R35.0","J02.9","R52","A69.20","A64","R11.2","R53.83","M79.10","R10.84","R21","A54.9","Z32.02","K21.9","Z87.440","Z87.442","Z79.899","R53.81","R10.32","R63.4","N13.30","N12","N10","B96.20","N20.0","F19.10","R94.5","G40.909","Z86.19","Z62.810","Z91.5","R79.89","F19.11","R07.81","Y04.0XXA","Y92.009","Y93.89","S00.12XA","S10.93XA","S50.11XA","S80.12XA","S80.11XA","T71.9XXA","Z04.3","G44.309","W19.XXXA","M25.552","M25.572","R68.84","S09.90XA","R55","W13.2XXA","W22.8XXA","Y92.89","S01.01XA","S70.212A","S90.512A","Z23","S70.312A","R05.9","R30.0","N89.8","Z03.818","F17.200","M54.50","Z30.09","Z12.4"],"date":["2020-12-01","2020-12-01","2020-12-01","2020-12-01","2020-12-01","2021-07-13","2020-12-01","2021-08-18","2021-07-13","2021-01-12","2021-01-12","2021-02-01","2021-02-01","2021-02-01","2021-02-14","2021-02-14","2021-08-18","2021-08-18","2021-02-14","2021-02-14","2021-02-14","2021-02-14","2021-02-14","2021-09-16","2021-08-18","2021-02-14","2021-02-14","2021-09-16","2021-08-18","2021-02-14","2021-02-14","2021-02-14","2021-02-14","2021-02-14","2021-02-14","2021-02-14","2021-02-14","2021-09-16","2021-11-08","2021-05-07","2021-05-07","2021-11-08","2021-05-07","2021-05-18","2021-05-18","2021-09-16","2021-05-18","2021-08-18","2021-05-18","2021-05-18","2021-05-18","2021-05-18","2021-05-18","2021-08-18","2021-08-18","2021-05-18","2021-05-18","2021-06-02","2021-06-02","2021-07-12","2021-07-12","2021-07-13","2021-07-13","2021-07-13","2021-07-13","2021-07-13","2021-07-13","2021-07-13","2021-07-13","2021-07-13","2021-07-13","2021-07-13","2021-08-18","2021-08-18","2021-08-18","2021-09-16","2021-08-18","2021-08-18","2021-08-18","2021-08-18","2021-08-18","2021-08-18","2021-08-18","2021-09-16","2021-09-16","2021-09-16","2021-09-16","2021-09-16","2021-09-16","2021-09-16","2021-09-16","2021-09-16","2021-09-16","2021-09-16","2021-09-16","2021-09-16","2021-09-16","2021-09-16","2021-10-17","2021-10-17","2021-11-08","2021-11-08","2021-11-08","2021-11-08","2021-11-08","2021-11-08"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",null,"","",null,"","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",null,null,null,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":[["","75826011510","PHENAZOPYRID","200MG","6","Select","Select",""],["","65862007701","CIPROFLOXACN","500MG","20","Select","Select",""],["","65862039010","ONDANSETRON","4MG ODT","10","Select","Select",""],["","00093031401","KETOROLAC","10MG","15","Select","Select",""],["","47781030301","NITROFURANTN","100MG","14","Select","Select",""],["","12496120803","SUBOXONE","8-2MG","14","Select","Select",""],["","65862042005","SMZ\/TMP","800-160","20","Select","Select",""],["","67877057505","BENZONATATE","200MG","30","Select","Select",""],["","68180016013","AZITHROMYCIN","250MG","6","Select","Select",""],["","43547030303","ARIPIPRAZOLE","5MG","14","Select","Select",""],["","70710113908","FLUCONAZOLE","150MG","1","Select","Select",""],["","13668000705","ZOLPIDEM","5MG","5","Select","Select",""],["","50111033401","METRONIDAZOL","500MG","21","Select","Select",""],["","47781035703","BUPREN\/NALOX","8-2MG","14","Select","Select",""],["","65162052110","PROMETHAZINE","25MG","12","Select","Select",""],["","68180071160","CEFDINIR","300MG","10","Select","Select",""],["","42858010201","OXYCOD\/APAP","5-325MG","10","Select","Select",""],["","66993001968","ALBUTEROL","HFA","18","Select","Select",""],["","31722063231","OSELTAMIVIR","75MG","10","Select","Select",""],["","00781286810","OMEPRAZOLE","20MG","30","Select","Select",""],["","69238110002","DOXYCYCL","100MG","42","Select","Select",""],["","68180012202","CEPHALEXIN","500MG","28","Select","Select",""],["","63304069301","CLINDAMYCIN","300MG","14","Select","Select",""],["","13668013501","ESCITALOPRAM","5MG","12","Select","Select",""],["","69547035302","NARCAN","","2","Select","Select",""],["","59651017301","DOXEPIN","10MG","30","Select","Select",""],["","68180071160","CEFDINIR ","CAP 300MG","10","Select","Select",""],["","75826011510","PHENAZOPYRID ","TAB 200MG","6","Select","Select",""],["","65862007701","CIPROFLOXACN ","TAB 500MG","20","Select","Select",""],["","65862039010","ONDANSETRON ","TAB 4MG ODT","10","Select","Select",""],["","00093031401","KETOROLAC ","TAB 10MG","15","Select","Select",""],["","47781030301","NITROFURANTN ","CAP 100MG","14","Select","Select",""],["","12496120803","SUBOXONE ","MIS 8-2MG","14","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","20","Select","Select",""],["","67877057505","BENZONATATE ","CAP 200MG","30","Select","Select",""],["","68180016013","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","43547030303","ARIPIPRAZOLE ","TAB 5MG","14","Select","Select",""],["","70710113908","FLUCONAZOLE ","TAB 150MG","1","Select","Select",""],["","13668000705","ZOLPIDEM ","TAB 5MG","5","Select","Select",""],["","50111033401","METRONIDAZOL ","TAB 500MG","21","Select","Select",""],["","47781035703","BUPREN\/NALOX ","MIS 8-2MG","14","Select","Select",""],["","65162052110","PROMETHAZINE ","TAB 25MG","12","Select","Select",""],["","42858010201","OXYCOD\/APAP ","TAB 5-325MG","10","Select","Select",""],["","66993001968","ALBUTEROL ","AER HFA","18","Select","Select",""],["","31722063231","OSELTAMIVIR ","CAP 75MG","10","Select","Select",""],["","00781286810","OMEPRAZOLE ","CAP 20MG","30","Select","Select",""],["","69238110002","DOXYCYCL ","CAP 100MG","42","Select","Select",""],["","68180012202","CEPHALEXIN ","CAP 500MG","28","Select","Select",""],["","63304069301","CLINDAMYCIN ","CAP 300MG","14","Select","Select",""],["","13668013501","ESCITALOPRAM ","TAB 5MG","12","Select","Select",""],["","69547035302","NARCAN ","SPR ","2","Select","Select",""],["","59651017301","DOXEPIN ","CAP 10MG","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":""}]}]}