{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"WENDY KIDD","gend":1,"add":"184 HOLLY GROVE ESTATE","city":"BUMPASS ","state":"VA","zip":"23024-0000","dob":"1982-07-17","age":"","mstatus":"","insh":1352282,"cliId":"","pno":8046248290,"cno":8046248290,"email":"","ename":"","eno":"","pphy":"BOWLES JR, JAMES H","ppno":"","pcpadd":"2884 Sandy Hook Rd, ","pcpcity":"Sandy Hook","pcpstate":"VA","pcpzip":231532226,"pcpcounty":"","pcpid":"","pcpname":"BOWLES AND BOWLES MD INC","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"","add3":"","madd1":"184 HOLLY GROVE ESTATE","madd2":"","madd3":"","mcity":"BUMPASS ","mstate":"VA","mzip":"23024-0000","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J20.9","J01.90","R05","R51","R09.81","F17.200","R50.9","K59.00","R19.4","F32.81","F41.0","F41.1","N20.0","R11.0","Z72.0","R10.9","G47.33","N20.1","K59.09","G43.909","F41.8","F30.8","R68.89","R00.2","Z68.1","E55.9","E53.8","R06.02","K59.04","Z01.419","Z11.51","Z80.3","N76.0","Z12.4","Z32.02","Z98.890","Z30.42","R06.00","N39.0","Z87.442","F43.21","R53.83","R30.0","R10.32","R18.8","G43.109","R20.2","M54.40","Z30.9","R06.83","M62.830","M54.5","K57.30"],"date":["2019-01-23","2019-01-23","2019-01-23","2019-12-26","2019-01-23","2020-05-07","2019-01-23","2019-04-03","2020-05-08","2019-04-22","2019-04-22","2020-04-23","2021-07-21","2019-08-15","2021-03-17","2021-07-21","2021-06-09","2019-09-04","2019-09-16","2019-12-26","2020-04-16","2020-04-23","2020-04-29","2020-04-29","2020-04-29","2020-10-01","2020-05-06","2020-05-07","2020-05-08","2020-07-02","2020-07-02","2020-07-02","2021-05-28","2020-07-02","2020-07-09","2020-10-01","2021-05-28","2020-10-01","2020-11-05","2020-10-01","2020-10-01","2021-03-17","2020-10-20","2020-11-05","2021-02-24","2021-03-17","2021-03-17","2021-03-17","2021-05-28","2021-06-09","2021-07-21","2021-07-21","2021-07-21"],"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":[["","50111033402","METRONIDAZOL","500MG","14","Select","Select",""],["","59762453701","MEDROXYPR","150MG\/ML","1","Select","Select",""],["","65862042005","SMZ\/TMP","800-160","14","Select","Select",""],["","42806054701","VITAMIN","1.25MG","12","Select","Select",""],["","11788000110","FOLIC","1MG","90","Select","Select",""],["","43386009019","GAVILYTE-G","","4,000.00","Select","Select",""],["","00406012305","HYDROCO\/APAP","5-325MG","15","Select","Select",""],["","00527058601","DICYCLOMINE","10MG","40","Select","Select",""],["","57237005960","CEFUROXIME","500MG","14","Select","Select",""],["","64380076921","PEG-3350\/KCL","\/SODIUM","4,000.00","Select","Select",""],["","16714008210","HYDROXYZ","25MG","30","Select","Select",""],["","00093019901","VENLAFAXINE","25MG","60","Select","Select",""],["","64980030650","DENTA","PLUS 2PK","102","Select","Select",""],["","64380080807","IBUPROFEN","600MG","21","Select","Select",""],["","65862001705","AMOXICILLIN","500MG","21","Select","Select",""],["","69543038810","KETOROLAC","10MG","20","Select","Select",""],["","10702000709","CYCLOBENZAPR","10MG","20","Select","Select",""],["","68180044501","QUETIAPINE","25MG","30","Select","Select",""],["","16729013616","CLONAZEPAM","0.5MG","10","Select","Select",""],["","70710113803","FLUCONAZOLE","100MG","7","Select","Select",""],["","51672128202","TRIAMCINOLON","0.10%","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","",""],["No","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":""}]}]}