{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KATIE   E WILKENING","gend":1,"add":"8312 INDIAN TOWN ROAD","city":"KING GEORGE","state":"VA","zip":"22485-3610","dob":"2002-05-23","age":"","mstatus":"","insh":4186925,"cliId":"","pno":5406457316,"cno":5406457316,"email":"","ename":"","eno":"","pphy":"CALDWELL, KIMBERLY A","ppno":8042338534,"pcpadd":"4552 Empire Ct, ","pcpcity":"Fredericksburg","pcpstate":"VA","pcpzip":224081939,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"CENTRAL","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"8312 INDIAN TOWN ROAD","madd2":"                                                            ","madd3":"","mcity":"KING GEORGE","mstate":"VA","mzip":"22485-3610","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F41.9","Z63.8","F43.8","F32.89","Z62.820","Z01.818","G80.1","J30.2","M41.55","F33.0","F41.1","R26.9","G80.9","J32.9","G80.8","K02.62","K03.6","K05.10","F31.9","F43.0","H50.012","H52.13","H52.203","H53.9","Z79.899","Z00.121","M21.70","Z62.890","H50.312","H52.31","H52.223"],"date":["2021-01-04","2019-06-10","2021-05-25","2020-04-28","2020-10-06","2019-11-22","2019-11-22","2019-11-22","2019-11-22","2021-05-25","2019-01-24","2019-03-04","2019-11-26","2019-05-22","2020-06-10","2019-11-26","2019-11-26","2019-11-26","2019-11-26","2019-11-26","2021-05-04","2021-05-04","2021-05-04","2021-05-04","2021-05-04","2019-07-24","2019-08-27","2020-04-07","2019-12-11","2019-12-11","2019-12-11"],"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":[["","10702001250","HYDROXYZ ","TAB 50MG","30","Select","Select",""],["","69097083512","SERTRALINE ","TAB 100MG","45","Select","Select",""],["","43547034006","RISPERIDONE ","TAB 0.5MG","30","Select","Select",""],["","00832105410","BACLOFEN ","TAB 10MG","30","Select","Select",""],["","68180071160","CEFDINIR ","CAP 300MG","20","Select","Select",""],["","00378064110","PREDNISONE ","TAB 10MG","20","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":""}]}]}