{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"STEPHANIE GUARD","gend":1,"add":"903   HEATHER GLENN DRIVE                                   ","city":"RADFORD                       ","state":"VA","zip":"24141-3439","dob":"1988-11-04","age":"","mstatus":"","insh":10247225,"cliId":"","pno":5405536514,"cno":5405536514,"email":"","ename":"","eno":"","pphy":"KNISELY, THOMAS F                                           ","ppno":"","pcpadd":"1314 Peters Creek Rd Nw","pcpcity":"Roanoke                       ","pcpstate":"VA","pcpzip":240172500,"pcpcounty":"","pcpid":"P9443291","pcpname":"RADFORD STUDENT HEALTH CENTER","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"APARTMENT G                                                 ","add3":"","madd1":"903   HEATHER GLENN DRIVE                                   ","madd2":"APARTMENT G                                                 ","madd3":"","mcity":"RADFORD                       ","mstate":"VA","mzip":"24141-3439","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["O36.63X0","O98.52","O99.344","O99.214","O70.1","O69.81X0","O69.82X0","E66.9","Z37.0","B00.9","Z3A.39","F41.9","Z87.891","O80","Z3A.00","H10.89","N89.8","R09.82","R05","R06.00","F33.1","Z30.430","F32.81","F82","Z30.431","N94.3","Z97.5","F41.1","J02.9","R42","R07.81"],"date":["2020-06-15","2020-06-15","2020-06-15","2020-06-15","2020-06-15","2020-06-15","2020-06-15","2020-06-15","2020-06-15","2020-06-15","2020-06-15","2020-06-15","2020-11-27","2020-06-15","2020-06-15","2020-10-27","2020-11-10","2020-11-27","2020-12-01","2020-12-01","2021-09-15","2021-01-26","2021-02-03","2021-02-16","2021-02-25","2021-02-25","2021-02-25","2021-09-02","2021-10-15","2021-10-15","2021-10-15"],"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":[["","43547028211","ESCITALOPRAM","20MG","90","Select","Select",""],["","50111078710","AZITHROMYCIN","250MG","6","Select","Select",""],["","59746017509","PREDNISONE","20MG","10","Select","Select",""],["","42806071401","BENZONATATE","100MG","30","Select","Select",""],["","00555032302","HYDROXYZ","25MG","30","Select","Select",""],["","16714069211","FLUCONAZOLE","150MG","1","Select","Select",""],["","50111033402","METRONIDAZOL","500MG","14","Select","Select",""],["","80777027398","MODERNA","COVID-19","0.5","Select","Select",""],["","43547028211","ESCITALOPRAM ","TAB 20MG","90","Select","Select",""],["","50111078710","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","59746017509","PREDNISONE ","TAB 20MG","10","Select","Select",""],["","42806071401","BENZONATATE ","CAP 100MG","30","Select","Select",""],["","00555032302","HYDROXYZ ","CAP 25MG","30","Select","Select",""],["","16714069211","FLUCONAZOLE ","TAB 150MG","1","Select","Select",""],["","50111033402","METRONIDAZOL ","TAB 500MG","14","Select","Select",""],["","80777027398","MODERNA ","INJ COVID-19","0.5","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":""}]}]}