{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BREANNA   R THOMPSON","gend":1,"add":"149 STELLA LOOP","city":"SPENCER","state":"VA","zip":"24165-3359","dob":"1998-09-02","age":"","mstatus":"","insh":4108235,"cliId":"","pno":2762244309,"cno":2762244309,"email":"","ename":"","eno":"","pphy":"FALBO III, FRANCIS J","ppno":2766946677,"pcpadd":"835 Woodland Dr, Ste 101","pcpcity":"Stuart","pcpstate":"VA","pcpzip":241711586,"pcpcounty":"","pcpid":"","pcpname":"PIONEER FAMILY MEDICAL","ano":"","add2":"                                                            ","add3":"","madd1":"149 STELLA LOOP","madd2":"                                                            ","madd3":"","mcity":"SPENCER","mstate":"VA","mzip":"24165-3359","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"ROANOKE\/ ALLEGHANY","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R00.0","I10","Z30.42","Z32.02","Z20.828","Z11.52","Z09","Z86.16","O24.013","E10.649","O99.333","Z3A.29","O26.892","B02.9","R21","E10.65","N30.00","Z11.59","R51.9","Z01.419","Z39.2","Z30.8","Z68.36","U07.1","R09.81","Z00.00","Z12.4","Z68.33","Z72.0","O24.313","E08.10","A41.9","R65.20","E11.10","O98.813","N10","O98.513","Z96.41","Z3A.35","Z79.4","Z23","E16.2","Z3A.28","O24.913","Z36.89","Z34.93","Z3A.32","E11.9","Z3A.34","O26.893","R10.9","R10.2","Z48.816","Z68.37","Z34.90","R11.2","R05","E10.9","R27.9","Z74.3","E16.1","Z3A.33","B02.0","O75.3","O60.14X0","E10.10","J80","O10.02","O23.03","O98.52","Z16.11","N20.2","O26.833","O32.1XX0","O76","Z11.1"],"date":["2020-07-20","2020-07-20","2021-05-18","2021-05-18","2021-01-21","2021-04-26","2021-02-09","2021-02-09","2020-07-20","2020-07-20","2020-06-02","2020-06-10","2020-06-10","2020-07-19","2020-07-14","2020-07-20","2020-07-20","2021-03-02","2021-03-29","2021-02-12","2020-08-18","2020-08-18","2020-08-18","2021-02-04","2021-02-04","2021-02-12","2021-02-12","2021-02-12","2021-02-12","2020-07-20","2020-07-20","2020-07-20","2020-07-19","2020-07-20","2020-07-20","2020-07-20","2020-07-20","2020-07-20","2020-07-20","2020-07-20","2020-10-19","2020-06-10","2020-06-10","2020-07-08","2020-06-30","2020-07-08","2020-06-30","2020-07-17","2020-07-17","2020-07-14","2020-07-14","2020-07-14","2020-07-28","2020-07-28","2020-07-28","2021-01-27","2021-01-27","2021-01-27","2020-06-02","2020-06-02","2020-06-02","2020-07-08","2020-07-17","2020-07-20","2020-07-20","2020-07-20","2020-07-20","2020-07-20","2020-07-20","2020-07-20","2020-07-20","2020-07-20","2020-07-20","2020-07-20","2020-07-20","2020-10-19"],"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":[["","68180012202","CEPHALEXIN ","CAP 500MG","14","Select","Select",""],["","00169750111","NOVOLOG ","INJ 100\/ML","40","Select","Select",""],["","70710122600","AMITRIPTYLIN ","TAB 25MG","30","Select","Select",""],["","68180030360","CEFUROXIME ","TAB 500MG","20","Select","Select",""],["","68462010530","ONDANSETRON ","TAB 4MG","20","Select","Select",""],["","00002614511","BAQSIMI ","POW 3MG\/DOSE","1","Select","Select",""],["","59762453701","MEDROXYPR ","INJ 150MG\/ML","1","Select","Select",""],["","63304069301","CLINDAMYCIN ","CAP 300MG","30","Select","Select",""],["","73070010011","INSULIN ","INJ 100\/ML","40","Select","Select",""],["","61442011301","ACYCLOVIR ","TAB 800MG","35","Select","Select",""],["","70461031903","FLUCLVX ","INJ 2019-20","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":[[["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":""}]}]}