{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TIFFINY COLE","gend":1,"add":"1446 FAYETTE STREET","city":"MARTINSVILLE","state":"VA","zip":"24112-3350","dob":"1978-05-28","age":"","mstatus":"","insh":4268911,"cliId":"","pno":9807346223,"cno":9807346223,"email":"","ename":"","eno":"","pphy":"AARON, CAREN T","ppno":2766660452,"pcpadd":"319 Hospital Dr Ste 101, ","pcpcity":"Martinsville","pcpstate":"VA","pcpzip":241121928,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"APT 88","add3":"","madd1":"1446 FAYETTE STREET","madd2":"APT 88","madd3":"","mcity":"MARTINSVILLE","mstate":"VA","mzip":"24112-3350","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J09.X2","R13.10","K29.70","F31.9","R63.4","R25.1","E01.0","E07.9","F17.200","E05.90","R06.02","R06.9","R07.89","R07.9","R42","I48.91","I48.92","E83.42","J06.9","R09.89","T18.128A","F41.9","I10","F41.0","F17.210","F14.10","F12.10","Z90.49","E04.9","H04.123","H52.10","K29.00","B96.81","B37.81","Z20.822","J02.9","J09.X9","R05","T17.298A","I48.3","T18.198A","K29.50","E03.9","Z79.899","R00.2","F19.90","R11.2","R19.7","Z87.898","E05.01","R53.81","R68.83","M79.10","R53.83"],"date":["2019-02-05","2020-06-12","2020-06-12","2020-09-02","2019-03-08","2019-03-08","2019-03-08","2019-03-08","2019-05-15","2020-07-28","2019-05-05","2019-05-05","2019-05-06","2019-05-06","2019-05-05","2019-05-06","2019-05-08","2019-05-08","2020-02-11","2020-06-12","2020-06-09","2021-01-26","2021-01-26","2020-06-09","2020-06-09","2019-05-06","2019-05-06","2020-06-12","2019-05-06","2019-06-27","2019-06-27","2020-06-12","2020-06-12","2020-06-12","2021-01-26","2021-01-26","2019-02-05","2020-02-11","2020-06-11","2019-05-06","2020-06-09","2020-06-12","2020-06-12","2020-06-12","2021-01-25","2019-05-15","2020-02-11","2020-02-11","2020-02-11","2021-01-25","2021-01-25","2021-01-25","2021-01-25","2021-01-25"],"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":[["","23155007101","METHIMAZOLE ","TAB 10MG","60","Select","Select",""],["","00093078710","ATENOLOL ","TAB 25MG","30","Select","Select",""],["","63824005634","MUCINEX ","TAB 30-600ER","14","Select","Select",""],["","00591544305","PREDNISONE ","TAB 20MG","10","Select","Select",""],["","68382050010","OMEPRAZOLE ","CAP 40MG","30","Select","Select",""],["","00536100836","ASPIRIN ","CHW 81MG","30","Select","Select",""],["","60432053760","NYSTATIN ","SUS 100000","60","Select","Select",""],["","00228202996","ALPRAZOLAM ","TAB 0.5MG","10","Select","Select",""],["","00115165901","PROPRANOLOL ","TAB 10MG","180","Select","Select",""],["","00093506105","HYDROXYZ ","TAB 25MG","60","Select","Select",""],["","69238126601","OSELTAMIVIR ","CAP 75MG","10","Select","Select",""],["","00536589688","NICOTINE ","DIS 21MG\/24H","14","Select","Select",""],["","00781261305","AMOXICILLIN ","CAP 500MG","56","Select","Select",""],["","00527193206","CLARITHROMYC ","TAB 500MG","28","Select","Select",""],["","57237000511","FLUCONAZOLE ","150MG","2","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":""}]}]}