{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DAVID   Z JUSTUS JR","gend":0,"add":"2871 BRUSHY FORK ROAD","city":"GRUNDY","state":"VA","zip":"24614-5330","dob":"1982-03-12","age":"","mstatus":"","insh":3180017,"cliId":"","pno":2765669034,"cno":2765669034,"email":"","ename":"","eno":"","pphy":"POWERS, WILLIAM T","ppno":2769352080,"pcpadd":"1532 SLATE CREEK RD, SUITE 101","pcpcity":"GRUNDY","pcpstate":"VA","pcpzip":246146975,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"SOUTHWEST","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"2871 BRUSHY FORK ROAD","madd2":"                                                            ","madd3":"","mcity":"GRUNDY","mstate":"VA","mzip":"24614-5330","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F11.20","Z79.899","M79.9","S92.011A","S92.061A","G89.18","R68.89","S92.061D","M81.0","M86.20","M79.671","L03.115","S92.001A","W17.81XA","F17.210","Y92.69","W18.30XA","Z87.891","Z79.891","L97.413","W23.0XXA","W11.XXXA","L02.611","Z98.890","T81.32XA","T81.42XA","Z72.0","M86.271","B19.10","A49.02","X58.XXXA","R06.02","S91.301D","R00.0","F15.10","T84.69XA","R53.83","S90.31XA","F17.200","X58.XXXD","M86.8X7","G89.4","M79.606","B19.20"],"date":["2020-01-24","2019-08-01","2019-05-21","2019-05-22","2019-07-16","2019-05-30","2019-11-18","2019-10-30","2019-09-27","2019-09-27","2020-02-17","2020-02-17","2019-05-14","2019-05-14","2020-02-17","2019-05-14","2019-05-14","2019-05-30","2019-07-19","2019-10-30","2019-09-20","2019-05-21","2019-07-19","2019-07-19","2019-07-19","2019-07-19","2019-07-19","2019-10-31","2019-10-31","2019-10-31","2019-05-22","2019-09-30","2019-11-18","2019-10-02","2020-01-24","2019-10-05","2019-07-16","2019-05-21","2019-10-05","2019-09-30","2019-10-05","2019-10-05","2019-10-05","2019-10-31"],"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":[["","12496120803","SUBOXONE ","MIS 8-2MG","56","Select","Select",""],["","68462012705","GABAPENTIN ","TAB 800MG","90","Select","Select",""],["","53746027205","SMZ\/TMP ","TAB 800-160","28","Select","Select",""],["","00406012410","HYDROCO\/APAP ","TAB 7.5-325","15","Select","Select",""],["","67877032005","IBUPROFEN ","TAB 600MG","30","Select","Select",""],["","47781022905","OXYCOD\/APAP ","TAB 7.5-325","12","Select","Select",""],["","87701040729","VITAMIN ","TAB 100MG","21","Select","Select",""],["","67877041920","LINEZOLID ","TAB 600MG","60","Select","Select",""],["","00093031401","KETOROLAC ","TAB 10MG","20","Select","Select",""],["","00781723864","BUPREN\/NALOX ","MIS 8-2MG","56","Select","Select",""],["","65862001705","AMOXICILLIN ","CAP 500MG","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","",""],["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":""}]}]}