{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JESSICA GEARHART","gend":1,"add":"5222 LEWIS ROAD","city":"ROANOKE","state":"VA","zip":"24014-6716","dob":"1981-07-25","age":"","mstatus":"","insh":4169423,"cliId":"","pno":5409155801,"cno":5409155801,"email":"","ename":"","eno":"","pphy":"COUTURE, STEPHEN A","ppno":5402832570,"pcpadd":"5304 INDIAN GRAVE ROAD, ","pcpcity":"ROANOKE","pcpstate":"VA","pcpzip":240189100,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"5222 LEWIS ROAD","madd2":"                                                            ","madd3":"","mcity":"ROANOKE","mstate":"VA","mzip":"24014-6716","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J20.9","R06.2","R09.81","H92.01","F17.200","J45.21","N30.01","S93.402A","S09.90XA","W10.9XXA","S00.93XA","R40.2362","R40.2142","R40.2252","F31.9","N76.0","N89.8","N32.81","B96.89","F31.32","N92.1","J40","J45.20","F41.1"],"date":["2019-05-20","2019-05-20","2019-05-20","2019-05-20","2020-02-13","2019-09-09","2020-02-14","2020-02-13","2020-02-13","2020-02-13","2020-02-13","2020-02-13","2020-02-13","2020-02-13","2020-02-13","2020-01-22","2020-01-22","2020-01-22","2020-01-22","2020-07-22","2019-05-15","2019-05-15","2019-05-15","2020-07-22"],"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":[["","00093321205","CLONAZEPAM ","TAB 1MG","90","Select","Select",""],["","13668001105","CITALOPRAM ","TAB 40MG","30","Select","Select",""],["","65862023060","LAMOTRIGINE ","TAB 200MG","30","Select","Select",""],["","68682045570","METRONIDAZOL ","GEL 0.75%VAG","70","Select","Select",""],["","65162019050","NAPROXEN ","TAB 500MG","20","Select","Select",""],["","75826011510","PHENAZOPYRID ","TAB 200MG","6","Select","Select",""],["","47781030301","NITROFURANTN ","CAP 100MG","20","Select","Select",""],["","00169406013","VICTOZA ","INJ 18MG\/3ML","18","Select","Select",""],["","65862007701","CIPROFLOXACN ","TAB 500MG","14","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","20","Select","Select",""],["","00093317431","ALBUTEROL ","FAT E HFA INH","8.5","Select","Select",""],["","59779035926","TUSSIN "," ","118","Select","Select",""],["","00378064010","PREDNISONE ","TAB 5MG","60","Select","Select",""],["","63402030230","LATUDA ","TAB 20MG","30","Select","Select",""],["","00054418425","DEXAMETHASON ","TAB 4MG","8","Select","Select",""],["","00555077902","MEDROXYPR ","TAB 10MG","42","Select","Select",""],["","24208063562","NEO\/POLY\/HC ","SUS 1% OTIC","10","Select","Select",""],["","68462030529","NORETHINDRON ","TAB 0.35MG","28","Select","Select",""],["","53489011905","DOXYCYCL ","CAP 100MG","20","Select","Select",""],["","68180016013","AZITHROMYCIN ","250MG","6","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":""}]}]}