{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JESSICA HUNNELL","gend":1,"add":"18141 CLEVELAND ROAD                                        ","city":"ABINGDON                      ","state":"VA","zip":"24211-5659","dob":"1989-12-10","age":"","mstatus":"","insh":10254471,"cliId":"","pno":2762746259,"cno":2762746259,"email":"","ename":"","eno":"","pphy":"WILSON, RACHEL C                                            ","ppno":"","pcpadd":"410 Stagecoach Rd,Ste D","pcpcity":"Bristol                       ","pcpstate":"VA","pcpzip":242018359,"pcpcounty":"","pcpid":"P9059217","pcpname":"WELLMONT MEDICAL ASSOCIATES INC","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"SOUTHWEST","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"18141 CLEVELAND ROAD                                        ","madd2":"                                                            ","madd3":"","mcity":"ABINGDON                      ","mstate":"VA","mzip":"24211-5659","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z32.01","Z87.59","K57.32","M54.5","R10.9","Z88.5","Z79.899","M06.9","E11.9","Z79.84","K21.9","E28.2","Z90.49","M54.9","K44.9","R39.9","Z87.19","N39.0","R31.9","R10.32","R69","R73.9","N97.0","K57.30","K64.9","M25.562","Z86.79","S76.312A","K57.92","R11.0","B37.9","T36.95XA","M54.2","O41.8X10","Z3A.08","Z39.1","Z34.82","Z34.83","J02.9","Z34.92","J01.80","R09.81","U07.1","O99.213","E66.9","Z3A.32","O26.893","R12","Z3A.35","Z3A.38","O34.211","O99.354","Z37.0","O36.63X0","O99.214","E66.01","O99.284","Z3A.39","Z86.16","Z79.82","Z23","O34.219","P92.9","R63.4"],"date":["2020-07-02","2020-07-02","2021-03-10","2020-07-12","2020-07-12","2020-07-12","2020-08-28","2021-11-19","2020-08-16","2020-08-16","2020-07-12","2021-11-19","2020-07-12","2020-07-12","2020-07-12","2021-03-08","2020-07-31","2021-03-08","2021-03-08","2021-01-29","2020-08-16","2020-08-28","2021-02-11","2020-09-09","2020-09-09","2021-01-12","2021-01-11","2021-01-12","2021-03-02","2021-01-29","2021-02-04","2021-02-04","2021-02-04","2021-04-21","2021-04-21","2021-07-20","2021-07-20","2021-11-17","2021-08-04","2021-08-04","2021-08-13","2021-08-13","2021-08-13","2021-10-01","2021-10-01","2021-10-01","2021-10-28","2021-10-28","2021-10-28","2021-11-17","2021-11-19","2021-11-19","2021-11-19","2021-11-19","2021-11-19","2021-11-19","2021-11-19","2021-11-19","2021-11-19","2021-11-19","2021-11-19","2021-11-19","2021-11-24","2021-11-24"],"priorHcc":["","","","","","","",null,"","","",null,"","","","","","","","","","","","","","","","","","","","","","","","","",null,"","","","","","","","","","","",null,null,null,null,null,null,null,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":[["","59746017210","PREDNISONE","5MG","20","Select","Select",""],["","68382004001","PROMETHAZINE","12.5MG","20","Select","Select",""],["","68382009605","HYDROXYCHLOR","200MG","60","Select","Select",""],["","00781261305","AMOXICILLIN","500MG","30","Select","Select",""],["","23155010210","METFORMIN","500MG","60","Select","Select",""],["","13811071910","NITROFURANTN","100MG","14","Select","Select",""],["","51293081101","PHENAZOPYRID","200MG","9","Select","Select",""],["","66685100100","AMOX\/K","875-125","30","Select","Select",""],["","57237007710","ONDANSETRON","4MG ODT","8","Select","Select",""],["","60505079204","ENOXAPARIN","40\/0.4ML","12","Select","Select",""],["","62175013643","OMEPRAZOLE","40MG","30","Select","Select",""],["","00406012305","HYDROCO\/APAP","5-325MG","8","Select","Select",""],["","70710113908","FLUCONAZOLE","150MG","2","Select","Select",""],["","52817033200","CYCLOBENZAPR","10MG","21","Select","Select",""],["","42806040021","METHYLPRED","4MG","21","Select","Select",""],["","67877054360","CEFDINIR","300MG","10","Select","Select",""],["","16103035011","PHARBETOL","500MG","30","Select","Select",""],["","49483060350","IBUPROFEN","600MG","30","Select","Select",""],["","43386006019","GAVILYTE-C","","4,000.00","Select","Select",""],["","16729003410","LETROZOLE","2.5MG","15","Select","Select",""],["","59746017210","PREDNISONE ","TAB 5MG","20","Select","Select",""],["","68382004001","PROMETHAZINE ","TAB 12.5MG","20","Select","Select",""],["","68382009605","HYDROXYCHLOR ","TAB 200MG","60","Select","Select",""],["","00781261305","AMOXICILLIN ","CAP 500MG","30","Select","Select",""],["","23155010210","METFORMIN ","TAB 500MG","60","Select","Select",""],["","13811071910","NITROFURANTN ","CAP 100MG","14","Select","Select",""],["","51293081101","PHENAZOPYRID ","TAB 200MG","9","Select","Select",""],["","66685100100","AMOX\/K ","TAB 875-125","30","Select","Select",""],["","57237007710","ONDANSETRON ","TAB 4MG ODT","8","Select","Select",""],["","60505079204","ENOXAPARIN ","INJ 40\/0.4ML","12","Select","Select",""],["","62175013643","OMEPRAZOLE ","CAP 40MG","30","Select","Select",""],["","00406012305","HYDROCO\/APAP ","TAB 5-325MG","8","Select","Select",""],["","70710113908","FLUCONAZOLE ","TAB 150MG","2","Select","Select",""],["","52817033200","CYCLOBENZAPR ","TAB 10MG","21","Select","Select",""],["","42806040021","METHYLPRED ","TAB 4MG","21","Select","Select",""],["","67877054360","CEFDINIR ","CAP 300MG","10","Select","Select",""],["","31722057310","ESOMEPRA ","CAP 40MG DR","30","Select","Select",""],["","16103035011","PHARBETOL ","TAB 500MG","30","Select","Select",""],["","49483060350","IBUPROFEN ","TAB 600MG","30","Select","Select",""],["","00378668977","PANTOPRAZOLE ","TAB 40MG","30","Select","Select",""],["","43386006019","GAVILYTE-C ","SOL ","4,000.00","Select","Select",""],["","16729003410","LETROZOLE ","TAB 2.5MG","15","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":[[["Yes","Select","","","","","Select","",""],["Yes","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":""}]}]}