{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SAMANTHA   M JANNEY","gend":1,"add":"155 STRAWFIELD CIRCLE","city":"ROCKY MOUNT","state":"VA","zip":"24151-3341","dob":"1989-06-27","age":"","mstatus":"","insh":4261868,"cliId":"","pno":5408141352,"cno":5408141352,"email":"","ename":"","eno":"","pphy":"BLASKIS, WILLIAM JOSEPH","ppno":5403895093,"pcpadd":"150 Spartan Dr, ","pcpcity":"Salem","pcpstate":"VA","pcpzip":241533208,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":5403526168,"add2":"                                                            ","add3":"","madd1":"155 STRAWFIELD CIRCLE","madd2":"                                                            ","madd3":"","mcity":"ROCKY MOUNT","mstate":"VA","mzip":"24151-3341","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J96.01","R68.89","F11.20","R51","R53.83","R53.81","D64.9","R94.5","N89.8","N92.6","E28.2","Z32.02","Z31.69","N91.2","J02.9","S09.90XA","Z11.3","R10.84","N93.9","Z32.01","F33.41","F43.10","B37.3","G47.31","K08.89","G47.33","J01.90","I10","J30.9","F33.1","Z87.51","N97.9","R05","R06.02","J20.8","B97.89","R25.2","K02.9","R60.9","Z20.5","Z87.42"],"date":["2019-02-01","2021-02-23","2021-05-16","2020-02-03","2021-01-12","2021-01-12","2020-02-03","2020-02-03","2020-08-31","2020-08-31","2020-10-08","2021-01-20","2020-12-08","2020-10-08","2019-01-21","2019-01-21","2019-01-28","2019-04-12","2020-12-08","2021-04-27","2019-01-24","2019-01-24","2019-01-28","2019-02-12","2021-04-06","2019-04-02","2019-02-08","2020-10-12","2019-02-08","2019-08-14","2019-09-20","2021-01-20","2019-07-25","2019-07-25","2019-07-25","2019-07-25","2019-04-12","2020-08-10","2020-10-12","2021-01-12","2021-03-15"],"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":[["","65162010250","GABAPENTIN ","CAP 300MG","45","Select","Select",""],["","00093762056","LETROZOLE ","TAB 2.5MG","10","Select","Select",""],["","00555077902","MEDROXYPR ","TAB 10MG","10","Select","Select",""],["","68645058259","METFORMIN ","TAB 500MG","60","Select","Select",""],["","69238158306","NORLYDA ","TAB 0.35MG","28","Select","Select",""],["","57237000511","FLUCONAZOLE ","TAB 150MG","1","Select","Select",""],["","64380080807","IBUPROFEN ","TAB 600MG","60","Select","Select",""],["","65862001305","SERTRALINE ","TAB 100MG","60","Select","Select",""],["","00093117410","PENICILLN ","TAB 500MG","30","Select","Select",""],["","58160089852","FLUARIX ","INJ 2018-19","0.5","Select","Select",""],["","00000000000",""," ","60","Select","Select",""],["","66685100200","AMOX\/K ","TAB 500-125","14","Select","Select",""],["","00378064110","PREDNISONE ","TAB 10MG","20","Select","Select",""],["","65862092585","INCASSIA ","TAB 0.35MG","28","Select","Select",""],["","00093406801","PRAZOSIN ","CAP 2MG","60","Select","Select",""],["","57237007710","ONDANSETRON ","TAB 4MG ODT","15","Select","Select",""],["","16714048202","LORATADINE ","TAB 10MG","30","Select","Select",""],["","16571020150","DICLOFENAC ","75MG DR","20","Select","Select",""],["","00116200116","CHLORHEX ","0.12%","473","Select","Select",""],["","16714029904","AMOXICILLIN ","500MG","20","Select","Select",""],["","63304069301","CLINDAMYCIN ","300MG","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","",""],["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":""}]}]}